Study on the Reasons of Discharge with the Personal Consent of Patients Admitted to the Emergency Ward of Kowsar Hospital of Semnan, Iran

Study on the Reasons of Discharge with the Personal Consent of Patients Admitted to the Emergency Ward of Kowsar Hospital of Semnan, Iran
Mehdi Yarahmadi, Mehri Ayati, Mohammad Taghi Ghorbanian
Journal of Guilan University of Medical Sciences, 20 January 2024
Abstract
Background
Discharge against Medical Advice (DAMA) indicates the dissatisfaction of patients with the care services of the health system. Additionally, it threatens the patient’s life and causes negative financial outcomes for hospitals.
Objective
This study aimed to identify the causes of self-discharge decisions in the emergency department at Kowsar Hospital, Semnan, Iran.
Methods
This was a descriptive-analytical study conducted between August 2021 to March 2022. The data were collected by a researcher-made questionnaire containing demographic characteristics and reasons for self-discharge, including three main concepts: personal, staff-related factors, and environmental factors with sub-concepts. Data were analyzed using SPSS.
Results
Of 140 patients with a mean age of 33.52 ± 16.17 years, 58.6% were men and 41.4% were women. Moreover, 63.6% of patients were married, 42.1% had a diploma education, and 11.4% had a history of taking neuropsychiatric drugs. Also, 42.9% of patients were covered by social security insurance. The highest rate of self-discharge was in the evening (42.1%) and night (37.9%) shifts. The most important reasons for self-discharge decision were problems related to insurance (30%), COVID-19 infection (26.4%), poor communication (17.1%), dissatisfaction with care (15.7 %), disrespectful behavior of staff (12.9%), and inappropriate emergency ward facilities (12.1%).
Conclusion
Make appropriate decisions to improve the quality of medical services and increase cooperation in health insurance, separating the departments of infectious diseases away from other departments, holding briefing sessions for physicians and medical staff, increasing awareness of patients about possible complications of self-discharge, and expanding the amenities of emergency ward can reduce the rate of self-discharge decision.

Editor’s note: The Guilan University of Medical Sciences is located in Rasht, Iran.