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Incidence of Discharge Against Medical Advice in Queensland Hospital Emergency Departments Among Indigenous Patients from 2016 to 2021

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Abstract

Background

The incidence of discharge against medical advice (DAMA) in emergency departments (EDs) among Indigenous people is a growing concern in Australia. This study aimed to determine the incidence of ED DAMA in public hospitals in Queensland (QLD) from 2016 to 2021 and investigate the disparities in ED DAMA between Indigenous and non-Indigenous patients. The study also assessed the impact of the COVID-19 pandemic on the incidence of ED DAMA.

Methods

A descriptive epidemiological study was conducted using aggregated data from QLD public hospital EDs. The data was retrieved from Clinical Excellence QLD, Healthcare Improvement Unit, in the QLD Health Open Data Portal for the period 1 January 2016 to 31 December 2021. Incidence rates and unadjusted odds ratios were calculated and compared using the chi-square test to identify differences between Indigenous and non-Indigenous patients.

Results

The annual incidence of DAMA in EDs was 7.7% among Indigenous patients, compared to 4.8% among non-Indigenous patients, with the highest rate (8.9%) reported in 2021 among Indigenous patients. The incidence of ED DAMA was higher for Indigenous patients in major cities (20.0%) than in very remote areas (7.4%). Patients in triage categories 4 (10.0%) and 3 (7.3%) accounted for the vast majority of ED DAMA events among Indigenous patients. The acute group A hospitals had the highest incidence of ED DAMA (10.9% for Indigenous patients and 6.5% for non-Indigenous patients). The COVID-19 pandemic had no impact on the incidence of ED DAMA.

Conclusion

Indigenous patients experience a disparity in ED DAMA incidence. Addressing this issue requires collaborative efforts from healthcare providers, policymakers, and community organizations.

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Data availability

The datasets generated and analysed during the current study are available from the study supervisor Dr. Hou (x.hou@uq.edu.au) on reasonable request.

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Author information

Authors and Affiliations

  1. Department of Family and Community Medicine and Behavioral Sciences, College of Medicine, University of Sharjah, Sharjah, UAE

    Ibrahim Mahmoud

  2. Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Australia

    Saira Sanjida, Paul Schwenn, Roxanne Bainbridge & Xiang-Yu Hou

  3. Department of Computer Science, College of Computing and Informatics, University of Sharjah, Sharjah, UAE

    Ibrahim Abaker Hashem

  4. Faculty of Medicine, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia

    Harry Collin & Kevin Chu

  5. Emergency and Trauma Centre, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

    Kevin Chu

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Contributions

All authors contributed to the study’s conception and design. Ibrahim Mahmoud, Saira Sanjida, Paul Schwenn, and Ibrahim Abaker Hashem performed material preparation, data collection, and analysis. Ibrahim Mahmoud wrote the first draft of the manuscript and all authors commented on previous versions of the manuscript. The study was supervised by Xiang-Yu Hou. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ibrahim Mahmoud.

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Ethical Approval

The University of Queensland Human Research Ethics Committee approved an ethics exemption application for this study (HREC No: 2022/HE001308). Consent to participate is not applicable.

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Not applicable.

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The authors declare no competing interests.

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Mahmoud, I., Sanjida, S., Schwenn, P. et al. Incidence of Discharge Against Medical Advice in Queensland Hospital Emergency Departments Among Indigenous Patients from 2016 to 2021. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01786-0

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