The Causes of Discharge against Medical Advice from the Emergency Department of a Teaching Hospital of Tehran in 2012

Discharge against medical advice (DAMA) occurs when a patient leaves the hospital against the physician’s advice. The aim of this study was to investigate the causes of discharge against medical advice.
In this cross-sectional study, all patients who were discharged against medical advice from the Emergency Department of Shohada-e-Tajrish teaching hospital in the second half of 2012, were included. Data were collected by a researcher-made checklist that its validity and reliability had been confirmed. Data were analyzed by using Chi square and independent two-sample t-test.
The results show that among all the units of Emergency Department, the units of general surgery (14.4%), internal medicine (11.9%), and neurosurgery (11.9%) had the highest rate of discharge against medical advice, respectively. The main causes of discharge against medical advice were partial recovery according to patients’ opinion, the distance from home to hospital, and patients’ exhaustion from the hospital environment. However, there was no statistically significant relationship between discharge against medical advice and the type of Emergency Department unit, work shifts, or income.
Due to the high rate of discharge against medical advice in teaching hospitals of Iran, it is essential to pay more attention to this important issue as the main issue emphasized on in clinical governance in teaching hospitals of Iran, and also prioritize providing high quality services in order to increase patients’ satisfaction and decrease the rate of discharge against medical advice.