Volume 3, Issue 4 ( Autumn 2017 -- 2017)                   JCCNC 2017, 3(4): 277-282 | Back to browse issues page

XML Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Heydari M, Khosravizadeh O, Kalhor R, Sharifi M, Ahmadzadeh Ghasab A. Discharge Against Medical Advice in Teaching Hospitals: A Telephone Survey. JCCNC. 2017; 3 (4) :277-282
URL: http://jccnc.iums.ac.ir/article-1-150-en.html
1- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
2- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
3- PhD Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. , azade.ah67@gmail.com
Abstract:   (112 Views)
Background: Discharge with personal consent is considered as one of the main problems in hospitalization condition since many patients leave the hospital prematurely against the doctor’s advice. Thus, the aim of this study was to identify the factors affecting the discharge with personal satisfaction in selected teaching hospitals of Tehran University of Medical Sciences.
Methods: The present study was a descriptive and cross-sectional analysis that was carried out on patients discharged with personal satisfaction from selected training hospitals of the Tehran University of Medical Sciences in 2016. The sample size was 153 patients who were randomly selected from Sina, Shariati and specialized women hospitals. The data were collected through using a self-made checklist and telephone interview. The SPSS V. 18 software and statistical tests such as Chi-square and t-test were used for data analysis.
Results: The most common causes of patient’s discharge with personal satisfaction was personal issues related to the sick and the highest among these causes was patient recovery. The least common causes of discharge with personal satisfaction was related to the hospital. There was no significant link of gender, age, place and insurance type with personal discharge, but there was a significant link between the discharges of the hospital with own agreement and type of the hospital (P < 0.05).
Conclusion: Hospital staff education, motivating the staff to participate actively in obtaining consent from patients and informing the patients about the stage of their treatment and recovery should be considered as priority management activities.
Full-Text [PDF 563 kb]   (34 Downloads) |   |   Full-Text (HTML)  (24 Views)  
Type of Study: Research | Subject: General
Received: 2017/05/10 | Accepted: 2017/09/27 | Published: 2017/11/1

1. Alfandre, D., 2014. Reconsidering against medical advice discharges. Journal of General Internal Medicine, 29(5), p. 706. doi: 10.1007/s11606-014-2804-2. [DOI:10.1007/s11606-014-2804-2]
2. Bastani, P., 2012. The causes of discharge against medical advice in teaching & madical Shohadaye Tajrish center. Paper presented at The First Congress on Clinical Governance and Continuous Quality Improvement. 2012 May 16; Tabriz, Iran.
3. Greenwald, J. L., Denham, C. R. & Jack, B. W., 2007. The hospital discharge. Journal of Patient Safety, 3(2), pp. 97–106. doi: 10.1097/01.jps.0000236916.94696.12. [DOI:10.1097/01.jps.0000236916.94696.12]
4. Hadadi, A. et al., 2016. Discharge against medical advice from a Tehran emergency department. International Journal of Health Care Quality Assurance, 29(1), pp. 24–32. doi: 10.1108/ijhcqa-03-2015-0030. [DOI:10.1108/IJHCQA-03-2015-0030]
5. Hwang, S. W., et al., 2003. What happens to patients who leave hospital against medical advice. Canadian Medical Association Journal, 168(4), pp. 417-20. PMCID: PMC143546 [PMID] [PMCID]
6. Ismail, A. K., Mohamad, A. & Che'Man, Z., 2016. Factors associated with discharge against medical advice from emergency department, Universiti Kebangsaan Malaysia Medical Centre. Medicine & Health, 11(1), pp. 29-37. [DOI:10.17845/MH.2016.1101.05]
7. Jackson, J. L., Chamberlin, J. & Kroenke, K., 2001. Predictors of patient satisfaction. Social Science & Medicine, 52(4), pp. 609–20. doi: 10.1016/s0277-9536(00)00164-7. [DOI:10.1016/S0277-9536(00)00164-7]
8. Jeong, J. et al., 2016. The association between acute alcohol consumption and discharge against medical advice of injured patients in the ED. The American Journal of Emergency Medicine, 34(3), pp. 464–8. doi: 10.1016/j.ajem.2015.11.065. [DOI:10.1016/j.ajem.2015.11.065]
9. Jeremiah, J., O'Sullivan, P. & Stein, M. D., 1995. Who leaves against medical advice. Journal of General Internal Medicine, 10(7), pp. 403–5. doi: 10.1007/bf02599843. [DOI:10.1007/BF02599843]
10. Kalburgi, S., Cady, R. & McClymont, S., 2016. Development of a clinical algorithm for threatened discharge against medical advice. Pediatrics, 137(3), p. 330A. doi: 10.1542/peds.137.supplement_3.330a. [DOI:10.1542/peds.137.Supplement_3.330A]
11. Kavosi, Z., et al., 2012. Factors affecting discharge against medical advice in a teaching hospital in Shiraz, Iran. Infornatic Health Management, 9, pp. 448-56.
12. Macrohon, B. C., 2012. Pediatrician's perspectives on Discharge Against Medical Advice (DAMA) among pediatric patients: A qualitative study. BMC Pediatrics, 12(1). doi: 10.1186/1471-2431-12-75. [DOI:10.1186/1471-2431-12-75]
13. Malekzadeh, R., et al., 2016. Causes of discharge against medical advice in hospitals affiliated with Mazandaran university of medical sciences, 2014. Journal of Mazandaran University of Medical Sciences, 26(140), pp. 95-102.
14. Martenstein, I., Plinkert, A. S. & Wienke, A., 2016. Cave in case of premature discharge against medical advice. HNO, 64(3), pp. 184–5. doi: 10.1007/s00106-015-0116-4. [DOI:10.1007/s00106-015-0116-4]
15. Naderi, S. et al., 2014. Patients in a private hospital in India leave the emergency department against medical advice for financial reasons. International Journal of Emergency Medicine, 7(1), p. 13. doi: 10.1186/1865-1380-7-13. [DOI:10.1186/1865-1380-7-13]
16. Nikpour A., 2010. [Servey of Satisfaction after discharge from affiliated hospitals to Tehran University of Medical Sciences (Persian)] [MSc. thesis]. Tehran: Tehran University of Medical Sciences.
17. Rezaeiimofrad, M., 2010. Patients' reasons for discharge against medical advice in university hospitals of Kashan university of medical sciences in 2008. Hakim Research Journal, 13(1), pp. 33-9.
18. Saravi, B. et al., 2013. Discharge against medical advice in the pediatric wards in Boo-Ali Sina Hospital, Sari, Iran 2010. Acta Informatica Medica, 21(4), p. 253. doi: 10.5455/aim.2013.21.253-256. [DOI:10.5455/aim.2013.21.253-256]
19. Southern, W. N., Nahvi, S. & Arnsten, J. H., 2012. Increased risk of mortality and readmission among patients discharged against medical advice. The American Journal of Medicine, 125(6), pp. 594-602. doi: 10.1016/j.amjmed.2011.12.017. [DOI:10.1016/j.amjmed.2011.12.017]
20. Vahdat, S., Hesam, S. & Mehrabian, F., 2010. Effective factors on patient discharge with own agreement in selected Therapeutic Training Centers of Ghazvin Shahid Rajaei. The Faculty of Nursing and Midwifery, Guilan Province, 20(2), pp. 47-52.

Add your comments about this article : Your username or Email:
Write the security code in the box

Send email to the article author

Designed & Developed by : Yektaweb