Discharge of children from hospital against medical advice

Abstract

Background

Discharge against medical advice (DAMA) from hospital may have negative effects on the well-being of the patients. In pediatric patients the decision for DAMA is made by the parent(s). The present study aimed to evaluate the prevalence of DAMA and examine the reasons for DAMA provided by the parents.

Methods

A cross-sectional descriptive study on DAMA was conducted from March 2005 to February 2007 in the pediatric ward of Taleghani hospital in Tehran, Iran.

Results

The prevalence of DAMA was 5.3%, comprising 97 of 1842 children discharged. The age of the 97 children ranged from 1 day to 8 years, with a mean hospitalization duration of 4±3.3 days. Seventy-seven (79.4%) of the 97 children were <12 months. Thirty-four (35.1%) children were discharged within 48 hours of admission. The most commonly diagnosed diseases in these children were neonatal jaundice (37.1%), sepsis (21.6%), and gastroenteritis (16.4%). The reasons for DAMA were as follows: parent’s assumption of improvement (32.9%), dissatisfactory treatment and care (29.9%), inconvenience for child hospitalization (18.5%), and financial constraints (15.5%).

Conclusions

The prevalence of DAMA in the present study was within the range of other DAMA studies in children. The majority of DAMA cases could have been prevented by more satisfactory facilities and effective communication between medical staff and the parents.