Discharge Against Medical Advice in the Emergency Department

Document Type : Original Article


1 Department of Health Services Administration, Sciences, and Research, Islamic Azad University, Tehran, IR Iran.

2 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.


Background: Discharge against medical advice (DAMA) is a process during which the patient leaves the hospital voluntarily without completing the course of treatment, which can indicate a significant problem. The present study was conducted in one of the hospitals of Tehran to identify the causes of DAMA and design its dashboard.
Methods: The present descriptive cross-sectional study examined the causes of DAMA in 2018 in a hospital in Tehran. Data were collected through a checklist prepared by the accreditation office. The collected data were inserted into QlikView software to design the dashboard.
Results: The results demonstrated that the prevalence of DAMA from the hospital under study was 0.7% in the outpatient department and 0.25% in the inpatient department compared with the total number of patients discharged in these departments. The most common reasons for DAMA were, respectively, unwillingness to undergo surgery or procedures and financial problems.
Conclusions: The findings allow hospital managers to take measures aimed at lessening DAMA and, thus, side effects, returns to the hospital, and additional costs. DAMA is a multidimensional phenomenon and is subject to several factors. Therefore, predicting the rate of DAMA and its determining factors can play an effective role in its control. (Iranian Heart Journal 2022; 23(1): 34-41)


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