The pandemic’s effect on discharge against medical advice from the emergency department

Mehmet Cihat DEMİR; İlter AĞAÇKIRAN; Yasemin ÖZDAMAR; Mustafa BOĞAN

doi:10.28982/josam.907496

Journal of Surgery and Medicine

Research Article

Year 2021, Volume 5, Issue 5, 433 - 438, 01.05.2021

Mehmet Cihat DEMİR İlter AĞAÇKIRAN Yasemin ÖZDAMAR Mustafa BOĞAN

https://doi.org/10.28982/josam.907496

Abstract

References

1. Ding R, Jung JJ, Kirsch TD, Levy F, McCarthy ML. Uncompleted emergency department care: patients who leave against medical advice. Acad Emerg Med. 2007;14(10):870-6. doi: 10.1197/j.aem.2007.06.027.
2. Hwang SW, Li J, Gupta R, Chien V, Martin RE. What happens to patients who leave hospital against medical advice? CMAJ. 2003;168(4):417-20.
3. Beauchamp TL, Childress JF. Principles of biomedical ethics. 5th ed. Oxford University Press, New York, USA; 2001.
4. Link K, Brody C, Chan J. Leaving a medical service against advice. Va Med. 1983;110(2):100-2.
5. Aliyu Z. Discharge against medical advice: sociodemographic, clinical and financial perspectives. Int J Clin Pract. 2002;56(5):325-7.
6. Holden P, Vogtsberger KN, Mohl PC, Fuller DS. Patients who leave the hospital against medical advice: the role of the psychiatric consultant. Psychosomatics. 1989;30(4):396-404. doi: 10.1016/S0033-3182(89)72245-3.
7. Baptist AP, Warrier I, Arora R, Ager J, Massanari RM. Hospitalized patients with asthma who leave against medical advice: characteristics, reasons, and outcomes. J Allergy Clin Immunol. 2007;119(4):924-9. doi: 10.1016/j.jaci.2006.11.695.
8. Jeremiah J, O’Sullivan P, Stein MD. Who leaves against medical advice? J Gen Intern Med. 1995;10(7):403-5. doi: 10.1007/BF02599843.
9. Boğan M, Karadağ M, Boğan F. Examination of emergency medicine physicians’ and residents’ Twitter activities during the first days of the COVID-19 outbreak. Int J Travel Med Glob Health. 2020;8(2):46-50. doi: 10.34172/IJTMGH.2020.08.
10. Republic of Turkey Presidential Official Gazette. Ministry of Health notification: Yataklı sağlık tesislerinde acil servis hizmetlerinin uygulama usul ve esasları hakkında tebliğde değişiklik yapılmasına dair tebliğ. (in Turkish). Feb 20, 2018, numbered 30338. Accessed: December 20, 2020: https://www.resmigazete.gov.tr/eskiler/2018/02/20180220-4.htm.
11. Henson VL, Vickery DS. Patient self discharge from the emergency department: who is at risk? Emerg Med J. 2005;22(7):499-501. doi: 10.1136/emj.2003.005447.
12. Ibrahim SA, Kwoh CK, Krishnan E. Factors associated with patients who leave acute-care hospitals against medical advice. Am J Public Health. 2007;97(12):2204-8. doi: 10.2105/AJPH.2006.100164.
13. Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The Fear of COVID-19 Scale: Development and Initial Validation. Int J Ment Health Addict. 2020;1-9. doi: 10.1007/s11469-020-00270-8.
14. Bavel JJV, Baicker K, Boggio PS, Capraro V, Cichocka A, Cikara M, et al. Using social and behavioural science to support COVID-19 pandemic response. Nat Hum Behav. 2020;4(5):460-71. doi: 10.1038/s41562-020-0884-z.
15. Albitar O, Ballouze R, Ooi JP, Sheikh Ghadzi SM. Risk factors for mortality among COVID-19 patients. Diabetes Res Clin Pract. 2020;166:108293. doi: 10.1016/j.diabres.2020.108293.
16. Bertsimas D, Lukin G, Mingardi L, Nohadani O, Orfanoudaki A, Stellato B, et al. COVID-19 mortality risk assessment: An international multi-center study. PLoS One. 2020;15(12):e0243262. doi: 10.1371/journal.pone.0243262.
17. Wynants L, Van Calster B, Collins GS, Riley RD, Heinze G, Schuit E, et al. Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal. BMJ. 2020;369:m1328. doi: 10.1136/bmj.m1328.
18. Zengin S, Avcı S, Yılmaz S. Clinical and basic cardiovascular features of patients with COVID-19 admitted to a tertiary care center in Turkey. J Surg Med. 2020;4(5):367-70. doi: 10.28982/josam.727935.
19. Spooner KK, Salemi JL, Salihu HM, Zoorob RJ. Discharge Against Medical Advice in the United States, 2002-2011. Mayo Clin Proc. 2017;92(4):525-35. doi: 10.1016/j.mayocp.2016.12.022.
20. Noohi K, Komsari S, Nakhaee N, Yazdi Feyzabadi V. Reasons for Discharge against Medical Advice: A Case Study of Emergency Departments in Iran. Int J Health Policy Manag. 2013;1(2):137-42. doi: 10.15171/ijhpm.2013.25.
21. Eze B, Agu K, Nwosu J. Discharge against medical advice at a tertiary center in southeastern Nigeria: sociodemographic and clinical dimensions. Patient Intelligence. 2010;2:27-31. doi: 10.2147/PI.S11337.
22. Jerrard DA, Chasm RM. Patients leaving against medical advice (AMA) from the emergency department-disease prevalence and willingness to return. J Emerg Med. 2011;41(4):412-7. doi: 10.1016/j.jemermed.2009.10.022.
23. Sayed ME, Jabbour E, Maatouk A, Bachir R, Dagher GA. Discharge Against Medical Advice From the Emergency Department: Results From a Tertiary Care Hospital in Beirut, Lebanon. Medicine (Baltimore). 2016;95(6):e2788. doi: 10.1097/MD.0000000000002788.
24. Nasir AA, Babalola OM. Clinical spectrum of discharges against medical advice in a developing country. Indian J Surg. 2008;70(2):68-72. doi: 10.1007/s12262-008-0018-8.
25. Pathy R, Mills KE, Gazeley S, Ridgley A, Kiran T. Health is a spiritual thing: perspectives of health care professionals and female Somali and Bangladeshi women on the health impacts of fasting during Ramadan. Ethn Health. 2011;16(1):43-56. doi: 10.1080/13557858.2010.523780.
26. Christian MD. Triage. Crit Care Clin. 2019;35(4):575-89. doi: 10.1016/j.ccc.2019.06.009.
27. van der Linden MC, Meester BE, van der Linden N. Emergency department crowding affects triage processes. Int Emerg Nurs. 2016;29:27-31. doi: 10.1016/j.ienj.2016.02.003.
28. Ilhan B, Kunt MM, Damarsoy FF, Demir MC, Aksu NM. NEDOCS: is it really useful for detecting emergency department overcrowding today?. Medicine (Baltimore). 2020;99(28):e20478. doi: 10.1097/MD.0000000000020478.
29. Shirani F, Jalili M, Asl-E-Soleimani H. Discharge against medical advice from emergency department: results from a tertiary care hospital in Tehran, Iran. Eur J Emerg Med. 2010;17(6):318-21. doi: 10.1097/MEJ.0b013e3283334ef1.

The pandemic’s effect on discharge against medical advice from the emergency department

Year 2021, Volume 5, Issue 5, 433 - 438, 01.05.2021

Mehmet Cihat DEMİR İlter AĞAÇKIRAN Yasemin ÖZDAMAR Mustafa BOĞAN

https://doi.org/10.28982/josam.907496

Abstract

Background/Aim: Reasons for discharge against medical advice (DAMA) may vary according to countries' conditions and environmental or individual factors. Patients who choose to leave the hospital against the doctors’ recommendations are at risk of inadequate treatment and increased rehospitalization risk. The COVID-19 disease has come to the fore with a pandemic and the atmosphere of fear and panic it creates. We aimed to investigate the effect of fear of the pandemic on DAMA. Methods: This study was conducted in the emergency department (ED) of a tertiary hospital in Turkey. The characteristics of all patients who were discharged against medical advice and their reasons over six months at the beginning of the pandemic were examined prospectively. Results: A total of 263 patients left the ED on various excuses against medical advice between February 6-August 31, 2020 (DAMA rate: 2.4‰). The most common complaint of patients discharged against medical advice was abdominal pain (27%). The top 3 most common causes of DAMA were the fear of being infected by COVID-19 (36.5%), the thought of being neglected (12.2%), and the month of Ramadan (11.4%). Conclusion: The pandemic is an important reason for DAMA. Patients leave the hospital against medical advice with an avoidance-avoidance conflict during the COVID-19 pandemic. Defining dirty and clean areas within the emergency services with sharp boundaries and informing patients may prevent DAMA due to the fear of being infected with COVID-19. Physicians do not ignore the risk of progression to worse clinical outcomes in patients who discontinue treatment due to the pandemic.

Keywords

COVID-19, Discharge against medical advice, Emergency department, Pandemic

References

1. Ding R, Jung JJ, Kirsch TD, Levy F, McCarthy ML. Uncompleted emergency department care: patients who leave against medical advice. Acad Emerg Med. 2007;14(10):870-6. doi: 10.1197/j.aem.2007.06.027.
2. Hwang SW, Li J, Gupta R, Chien V, Martin RE. What happens to patients who leave hospital against medical advice? CMAJ. 2003;168(4):417-20.
3. Beauchamp TL, Childress JF. Principles of biomedical ethics. 5th ed. Oxford University Press, New York, USA; 2001.
4. Link K, Brody C, Chan J. Leaving a medical service against advice. Va Med. 1983;110(2):100-2.
5. Aliyu Z. Discharge against medical advice: sociodemographic, clinical and financial perspectives. Int J Clin Pract. 2002;56(5):325-7.
6. Holden P, Vogtsberger KN, Mohl PC, Fuller DS. Patients who leave the hospital against medical advice: the role of the psychiatric consultant. Psychosomatics. 1989;30(4):396-404. doi: 10.1016/S0033-3182(89)72245-3.
7. Baptist AP, Warrier I, Arora R, Ager J, Massanari RM. Hospitalized patients with asthma who leave against medical advice: characteristics, reasons, and outcomes. J Allergy Clin Immunol. 2007;119(4):924-9. doi: 10.1016/j.jaci.2006.11.695.
8. Jeremiah J, O’Sullivan P, Stein MD. Who leaves against medical advice? J Gen Intern Med. 1995;10(7):403-5. doi: 10.1007/BF02599843.
9. Boğan M, Karadağ M, Boğan F. Examination of emergency medicine physicians’ and residents’ Twitter activities during the first days of the COVID-19 outbreak. Int J Travel Med Glob Health. 2020;8(2):46-50. doi: 10.34172/IJTMGH.2020.08.
10. Republic of Turkey Presidential Official Gazette. Ministry of Health notification: Yataklı sağlık tesislerinde acil servis hizmetlerinin uygulama usul ve esasları hakkında tebliğde değişiklik yapılmasına dair tebliğ. (in Turkish). Feb 20, 2018, numbered 30338. Accessed: December 20, 2020: https://www.resmigazete.gov.tr/eskiler/2018/02/20180220-4.htm.
11. Henson VL, Vickery DS. Patient self discharge from the emergency department: who is at risk? Emerg Med J. 2005;22(7):499-501. doi: 10.1136/emj.2003.005447.
12. Ibrahim SA, Kwoh CK, Krishnan E. Factors associated with patients who leave acute-care hospitals against medical advice. Am J Public Health. 2007;97(12):2204-8. doi: 10.2105/AJPH.2006.100164.
13. Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The Fear of COVID-19 Scale: Development and Initial Validation. Int J Ment Health Addict. 2020;1-9. doi: 10.1007/s11469-020-00270-8.
14. Bavel JJV, Baicker K, Boggio PS, Capraro V, Cichocka A, Cikara M, et al. Using social and behavioural science to support COVID-19 pandemic response. Nat Hum Behav. 2020;4(5):460-71. doi: 10.1038/s41562-020-0884-z.
15. Albitar O, Ballouze R, Ooi JP, Sheikh Ghadzi SM. Risk factors for mortality among COVID-19 patients. Diabetes Res Clin Pract. 2020;166:108293. doi: 10.1016/j.diabres.2020.108293.
16. Bertsimas D, Lukin G, Mingardi L, Nohadani O, Orfanoudaki A, Stellato B, et al. COVID-19 mortality risk assessment: An international multi-center study. PLoS One. 2020;15(12):e0243262. doi: 10.1371/journal.pone.0243262.
17. Wynants L, Van Calster B, Collins GS, Riley RD, Heinze G, Schuit E, et al. Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal. BMJ. 2020;369:m1328. doi: 10.1136/bmj.m1328.
18. Zengin S, Avcı S, Yılmaz S. Clinical and basic cardiovascular features of patients with COVID-19 admitted to a tertiary care center in Turkey. J Surg Med. 2020;4(5):367-70. doi: 10.28982/josam.727935.
19. Spooner KK, Salemi JL, Salihu HM, Zoorob RJ. Discharge Against Medical Advice in the United States, 2002-2011. Mayo Clin Proc. 2017;92(4):525-35. doi: 10.1016/j.mayocp.2016.12.022.
20. Noohi K, Komsari S, Nakhaee N, Yazdi Feyzabadi V. Reasons for Discharge against Medical Advice: A Case Study of Emergency Departments in Iran. Int J Health Policy Manag. 2013;1(2):137-42. doi: 10.15171/ijhpm.2013.25.
21. Eze B, Agu K, Nwosu J. Discharge against medical advice at a tertiary center in southeastern Nigeria: sociodemographic and clinical dimensions. Patient Intelligence. 2010;2:27-31. doi: 10.2147/PI.S11337.
22. Jerrard DA, Chasm RM. Patients leaving against medical advice (AMA) from the emergency department-disease prevalence and willingness to return. J Emerg Med. 2011;41(4):412-7. doi: 10.1016/j.jemermed.2009.10.022.
23. Sayed ME, Jabbour E, Maatouk A, Bachir R, Dagher GA. Discharge Against Medical Advice From the Emergency Department: Results From a Tertiary Care Hospital in Beirut, Lebanon. Medicine (Baltimore). 2016;95(6):e2788. doi: 10.1097/MD.0000000000002788.
24. Nasir AA, Babalola OM. Clinical spectrum of discharges against medical advice in a developing country. Indian J Surg. 2008;70(2):68-72. doi: 10.1007/s12262-008-0018-8.
25. Pathy R, Mills KE, Gazeley S, Ridgley A, Kiran T. Health is a spiritual thing: perspectives of health care professionals and female Somali and Bangladeshi women on the health impacts of fasting during Ramadan. Ethn Health. 2011;16(1):43-56. doi: 10.1080/13557858.2010.523780.
26. Christian MD. Triage. Crit Care Clin. 2019;35(4):575-89. doi: 10.1016/j.ccc.2019.06.009.
27. van der Linden MC, Meester BE, van der Linden N. Emergency department crowding affects triage processes. Int Emerg Nurs. 2016;29:27-31. doi: 10.1016/j.ienj.2016.02.003.
28. Ilhan B, Kunt MM, Damarsoy FF, Demir MC, Aksu NM. NEDOCS: is it really useful for detecting emergency department overcrowding today?. Medicine (Baltimore). 2020;99(28):e20478. doi: 10.1097/MD.0000000000020478.
29. Shirani F, Jalili M, Asl-E-Soleimani H. Discharge against medical advice from emergency department: results from a tertiary care hospital in Tehran, Iran. Eur J Emerg Med. 2010;17(6):318-21. doi: 10.1097/MEJ.0b013e3283334ef1.

Details

Primary Language	English
Subjects	Emergency Medicine
Journal Section	Research article
Authors	Mehmet Cihat DEMİR (Primary Author) DUZCE UNIVERSITY, FACULTY OF MEDICINE 0000-0002-0106-3383 Türkiye İlter AĞAÇKIRAN Hitit University Erol Olçok Training and Research Hospital 0000-0003-4859-2220 Türkiye Yasemin ÖZDAMAR Manisa Şehir Hastanesi 0000-0002-6529-5028 Türkiye Mustafa BOĞAN DUZCE UNIVERSITY, FACULTY OF MEDICINE 0000-0002-3238-1827 Türkiye
Publication Date	May 1, 2021
Published in Issue	Year 2021, Volume 5, Issue 5

Cite

Bibtex	@research article { josam907496, journal = {Journal of Surgery and Medicine}, issn = {}, eissn = {2602-2079}, address = {jsurgmed@gmail.com}, publisher = {Fatih BAŞAK}, year = {2021}, volume = {5}, pages = {433 - 438}, doi = {10.28982/josam.907496}, title = {The pandemic’s effect on discharge against medical advice from the emergency department}, key = {cite}, author = {Demir, Mehmet Cihat and Ağaçkıran, İlter and Özdamar, Yasemin and Boğan, Mustafa} }
APA	Demir, M. C. , Ağaçkıran, İ. , Özdamar, Y. & Boğan, M. (2021). The pandemic’s effect on discharge against medical advice from the emergency department . Journal of Surgery and Medicine , 5 (5) , 433-438 . DOI: 10.28982/josam.907496
MLA	Demir, M. C. , Ağaçkıran, İ. , Özdamar, Y. , Boğan, M. "The pandemic’s effect on discharge against medical advice from the emergency department" . Journal of Surgery and Medicine 5 (2021 ): 433-438 <https://jsurgmed.com/en/pub/issue/62363/907496>
Chicago	Demir, M. C. , Ağaçkıran, İ. , Özdamar, Y. , Boğan, M. "The pandemic’s effect on discharge against medical advice from the emergency department". Journal of Surgery and Medicine 5 (2021 ): 433-438
RIS	TY - JOUR T1 - The pandemic’s effect on discharge against medical advice from the emergency department AU - Mehmet Cihat Demir , İlter Ağaçkıran , Yasemin Özdamar , Mustafa Boğan Y1 - 2021 PY - 2021 N1 - doi: 10.28982/josam.907496 DO - 10.28982/josam.907496 T2 - Journal of Surgery and Medicine JF - Journal JO - JOR SP - 433 EP - 438 VL - 5 IS - 5 SN - -2602-2079 M3 - doi: 10.28982/josam.907496 UR - https://doi.org/10.28982/josam.907496 Y2 - 2021 ER -
EndNote	%0 Journal of Surgery and Medicine The pandemic’s effect on discharge against medical advice from the emergency department %A Mehmet Cihat Demir , İlter Ağaçkıran , Yasemin Özdamar , Mustafa Boğan %T The pandemic’s effect on discharge against medical advice from the emergency department %D 2021 %J Journal of Surgery and Medicine %P -2602-2079 %V 5 %N 5 %R doi: 10.28982/josam.907496 %U 10.28982/josam.907496
ISNAD	Demir, Mehmet Cihat , Ağaçkıran, İlter , Özdamar, Yasemin , Boğan, Mustafa . "The pandemic’s effect on discharge against medical advice from the emergency department". Journal of Surgery and Medicine 5 / 5 (May 2021): 433-438 . https://doi.org/10.28982/josam.907496
AMA	Demir M. C. , Ağaçkıran İ. , Özdamar Y. , Boğan M. The pandemic’s effect on discharge against medical advice from the emergency department. J Surg Med. 2021; 5(5): 433-438.
Vancouver	Demir M. C. , Ağaçkıran İ. , Özdamar Y. , Boğan M. The pandemic’s effect on discharge against medical advice from the emergency department. Journal of Surgery and Medicine. 2021; 5(5): 433-438.
IEEE	M. C. Demir , İ. Ağaçkıran , Y. Özdamar and M. Boğan , "The pandemic’s effect on discharge against medical advice from the emergency department", Journal of Surgery and Medicine, vol. 5, no. 5, pp. 433-438, May. 2021, doi:10.28982/josam.907496

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