Clinical Audit of Self-Discharge against Medical Advice in Dr. Soulati Hospital in Urmia, Iran

Discharge against medical advice (DAMA) may expose patients to an increased risk of adverse medical outcomes. We conducted an intervention based on the factors associated with discharge against medical advice for reducing DAMA.

This was a pretest-posttest intervention conducted in Dr. Soulati Hospital in Urmia، Iran، in 2011-2012. We analyzed the data extracted from the clinical governance office forms about self-discharge. After determining causes of discharge against medical advice (DAMA) according to data in 2011، we designed an intervention in clinical governance team to reduce the rate of self-discharges. Interventions like effective relationship among physician and patient، financial support in DAMA cases، and assessing patients’ decision-making capacity were designed. Four months after implementing، we analyzed self-discharges prevalence rate and result was compared with the previous year. Data were analyzed using the Excel software and information presented by descriptive statistics.

The rate of DAMA in the study hospital was found to be 4. 6% which decreased to 2. 8 percent of all the discharged patients 4 months after the intervention. Among patients who discharged against medical advice in this study، family or financial obstacle، patient’s healthy feeling، dissatisfaction with their care، dislike of the hospital environment، prolonged hospitalization، and patient judgment of improvement were the most important factor for their decision.

Discharge against medical advice comes from many factors and information about the reasons for DAMA is necessary for identifying implementable strategies to reduce the likelihood and adverse health consequences of DAMA. Enhancement of doctor-patient communication، improvement of hospital environment and social workers could reduce the DAMA rate. The need for a clearly documented system or guidelines for assessing and managing such patients is highlighted.