Al-Sadoon Muna, Al-Shamousi Khalid
Department of Child Health, Sultan Qaboos University, Muscat, Oman.
Sultan Qaboos Univ Med J. 2013 Nov;13(4):534-8. doi: 10.12816/0003312. Epub 2013 Nov 8.
Discharge against medical advice (DAMA) is a major problem in healthcare delivery as it can complicate the health problems from which patients are suffering. The aim of this study was to understand DAMA among children in a tertiary teaching hospital in Oman and to evaluate the documentation of the events in the medical records.
A retrospective survey of the medical records of patients discharged against medical advice over a two-year interval was performed (2004-2006).
Of the 11,802 admissions, there were 38 cases of DAMA, giving a prevalence rate of 0.32%. In 39.5% of the cases, the discharge happened within 24 hours of hospital admission. The majority of the cases were infants (n = 24; 63.25%). The diagnosis at discharge in some cases included life-threatening conditions. However, in 57.9% of the cases, the reasons for DAMA were neither reported nor documented in the patients' medical records.
Although the results of this study yielded a low prevalence rate compared to the rates reported in other studies, the occurrence of DAMA for children in a tertiary hospital is a distressing phenomenon. It was evident that the documentation of the DAMA process was poor. More studies should be conducted to understand the details of the problem. Policies should be established and implemented in order to attempt to reduce DAMA among child patients and to protect them from the consequences of such discharges.
违反医嘱出院（DAMA）是医疗服务中的一个主要问题，因为它会使患者所患的健康问题复杂化。本研究的目的是了解阿曼一家三级教学医院中儿童的违反医嘱出院情况，并评估病历中这些事件的记录情况。
对在两年期间（2004 - 2006年）违反医嘱出院的患者病历进行回顾性调查。
在11802例入院病例中，有38例违反医嘱出院，患病率为0.32%。在39.5%的病例中，出院发生在入院后24小时内。大多数病例为婴儿（n = 24；63.25%）。部分病例出院时的诊断包括危及生命的情况。然而，在57.9%的病例中，违反医嘱出院的原因在患者病历中既未报告也未记录。
尽管本研究结果显示的患病率与其他研究报告的患病率相比很低，但三级医院中儿童违反医嘱出院的情况是一个令人苦恼的现象。很明显，违反医嘱出院过程的记录情况很差。应该进行更多研究以了解该问题的细节。应制定并实施相关政策，以试图减少儿童患者的违反医嘱出院情况，并保护他们免受此类出院后果的影响。
