Discharge against Medical Advice: an Interventional Study

Document Type : Research Paper


Tabriz Health Services Management Research Center, Department of Health Services Management, School of Management and Medical informatics, Tabriz University of Medical Sciences, Tabriz, Iran


Background and Objectives: Discharge against medical advice (DAMA) is a significant healthcare problem posing negative impact on effectiveness of patient care and costs of the health system. In order to address this problem, first the potential influencing factor should be identifies. This study followed two major objectives: first, to evaluate the prevalence and potential causes of DAMA, and second, to evaluate the impact of informed interventions on controlling the phenomenon.   Methods: The study enrolled all DAMA patients hospitalized in Sina Hospital of Tabriz (Iran) during the first three months of 2013. A questionnaire asking the reasons for early discharge in terms of staff factors, treatment factors, patient factors, and environmental factors was developed in the Clinical Governance Office and the DAMA patients were asked to complete the questionnaire before leaving the hospital. Based on review of the responses, a number of interventional measures were devised with the consultation of head nurses of different departments. The interventions were executed in a 9-month period and the DAMA rate was compared before and after the interventions.   Findings: Family involvement was found to be the major factor contributing to DAMA followed by job involvement, hospital type, and length of hospitalization. After introducing the interventions, a 36% reduction in the rate of DAMA was achieved.   Conclusions: Our study demonstrates that systematic identification of factors contributing to DAMA followed by interventions based on the resulting insights can lead to remarkable reduction of discharge against medical advice.