Spectrum of Discharge and Leave Against Medical Advice (DAMA and LAMA) at Pediatric Emergency of a Public Sector Tertiary Care Hospital, Pakistan.

Abstract

Objective: To assess the frequency and reasons for Discharge against medical advice (DAMA) in the pediatric emergency of a public sector tertiary care hospital.

Study Design: Retrospective observational study.

Place and duration of study: Dr. RKMP Civil Hospital Karachi, January to December 2019.

Material and methods: We reviewed the medical records of all patients visiting the pediatric emergency during the year 2019 and gathered data regarding disposition outcome whether they got DAMA or not. If yes, then the reason behind that as told by attendants was noted. Descriptive statistics were applied using SPSS 22.

Results: A total of 2651 patients (2.7%) fell under the category of DAMA, out of which 82.5% provided a reason for leaving. Male gender and infant age group was predominant. Most common category of reasons of DAMA was personal and social reasons (39.26%), followed by reasons related to disease and management (37.71%) and reasons related to hospital facilities (20.52%). Financial constraint was the least common reason. Among individual reasons another child / sick person at home was the most commonly cited reason in 17.64%. Other common reasons were refusing intravenous medicines or fluids (11.52%), traveler or inconvenience to hospitalization (10.79%), not satisfied with hospital facilities (10.74%) and non-availability of ventilator or intensive care facilities due to full occupancy in (9.78%).

Conclusion: This study demonstrates that DAMA is commonly encountered in pediatric emergency which can be prevented by improving communication gaps and hospital resources.

KEYWORDS: Health care quality indicator, DAMA, LAMA, pediatric emergency, system improvement.