Discharge Against Medical Advice (DAMA) Among Inpatients with Cardiac Problems in CCH
Authors: Alshammari Mohammed Sayel Hammad , Mates Rechel , Alshammari Tahani Madyn Hakem , Alshammari Najah Sayal Hammad 
Published: October 2022

Background: The instance of a patient already in hospital wishing to leave against clinician’s advice is referred to as self-discharge or discharge against medical advice. DAMA is a relatively common problem in health care systems. Because lengths of stay (LOS) are commonly several days, these patients often remain acutely ill at the time of self-discharge, and they may remain exposed to the risk of inappropriately treated medical problem, resulting in the need for readmission. It is not surprising that DAMA poses a major problem for many clinicians who treat inpatients, particularly those with cardiac problems because incomplete therapy in conditions such as ischemic heart disease may exert a negative impact on health outcome. Additionally, consequent care will be probably associated with more challenges and higher overall costs over time. Avoiding DAMA is, thus, likely to be beneficial for both patients and health systems. Methods: Study Design -Non-experimental, cross-sectional research design which will identify the reasons influencing DAMA among inpatients with cardiac problems is CCH. The study will describe the reasons by using a quantitative method. Setting of the study - The research will be conducted in Cardiac Center Hail, Ha’il Region, Kingdom of Saudi Arabia, and will focus on inpatient departments. Sample - In order to get accurate result of study, all discharged patients will be asked to participate in this study optionally. Data collection procedures - After getting approval from ethical committee in CCH and Hail Health Cluster, the questionnaires will be kept in nursing station, and explanation of a purpose of study will be demonstrated to all participants. Then, a collection box of questionnaires will be provided in the nursing office. Thereafter, data will be stored within one week from distribution to be ready for analysis. Data analysis - The ‘Patient Satisfaction Survey - DAMA form’ was designed on the basis of the reasons cited by patients in the past for self-discharge and the potential reasons are provided in this form. Demographic information was comprised of such biological characteristics as age, gender, and nationality. Finally, the prospectively collected data were analysed. The data are presented as n = % for the quantitative variables and are summarized by absolute frequencies and percentages for the categorical variables. Results: For approximately 45-day period, there were 102 discharges, of which 19 (18.63%) were cases of DAMA. Analysis was conducted in 17 patients after the exclusion of 2 patients due to missing data. Modes of admission were the emergency department, hospital transfer, and routine or elective admissions. The most prevalent reason cited by the study was feeling well (88.24%), followed by the desire to be transferred to other hospital (5.88%) and financial problems (5.88%). The baseline characteristics of the DAMA cases, for male and female separately, are depicted in Table 1. The range age of study population is above 18 to over 60 years with a male to female ratio of 16:1. Nearly one third of the study patients were in the age group of 51-60 years. The most common age group was 51-60 years in the men and over 60 years in the women. Conclusion: The most frequent self-reported reasons for DAMA in inpatient cardiac patients included feeling well, desire to be transferred to another hospital and financial problems respectively. We believe that explaining the importance of proper medical treatment and benefits versus risks of medication compliance may lessen impulsive decision of DAMA. Providing strategies for decreasing the rate of DAMA by analysing the current circumstances and developing effective interventions may benefit both patients (improving their health) and health care systems (decreasing unnecessary readmissions). There will be a continuous monitoring of the patient satisfaction survey both in regular and monthly basis by the Nursing Service Department. Proper coordination with social health workers, medical and nursing staff will be done. Multidisciplinary collaboration through regular committee meetings shall be implemented.