Gautam Nikhil, Sharma J P, Sharma Anita, Verma Vivek, Arora Poonam, Gautam Parshotam Lal
Department of Anaesthesia, HIMS, Swami Rama Himalayan University, Dehradun, Uttarakhand, India.
Department of Anaesthesiology, HIMS, Swami Rama Himalayan University, Dehradun, Uttarakhand, India.
Indian J Crit Care Med. 2018 Aug;22(8):591-596. doi: 10.4103/ijccm.IJCCM_375_17.
Discharge against medical advice or leave against medical advice (DAMA or LAMA) is a global phenomenon. The magnitude of LAMA phenomenon has a wide geographical variation. LAMA reasons are an area of concern for all involved in health-care delivery system.
The study aimed to evaluate cases of LAMA retrospectively in a tertiary teaching care institute (1) to find the magnitude of LAMA cases (2) to evaluate demographic and patient characteristics of these cases.
We screened hospital record of a referral institute over 1 year after approval from IEC and ICMR, New Delhi. Patient demographics and disease characteristics were noted and statistically analyzed after compilation.
A total of 47,583 patients were admitted in the year 2015 through emergency and outpatient department. One thousand five hundred and fifty-six (3.3%) patients got DAMA. The mean age of patient excluding infants was 46.64 ± 20.55 years. There were 62.9% of males. Average hospital stay of these cases was 4.09 ± 4.39 days. Most of the patients (70%) belonged to medical specialties and had longer stay as compared to surgical specialties. Most of LAMA patients were suffering from infections, trauma, and malignancies. Most of the patients had LAMA from ward (62%) followed by Intensive Care Unit (ICU) (28.8%) and emergency (9.2%). In 592 (38%) of LAMA patients, the reason for leaving was not clear. The common cited reasons for LAMA were financial (27.6%) and poor prognosis (20.5%).
About 3.3% of patients left hospital against medical advice in our retrospective analysis. Most of these cases did so from ward followed by ICU. Financial reasons and expected poor outcome played a significant role.
违反医疗建议出院（DAMA）或违反医疗建议离开（LAMA）是一种全球现象。LAMA现象的严重程度在地域上有很大差异。LAMA的原因是医疗服务提供系统中所有相关方关注的领域。
本研究旨在对一家三级教学医疗机构的LAMA病例进行回顾性评估，（1）以确定LAMA病例的数量，（2）评估这些病例的人口统计学和患者特征。
在获得新德里IEC和ICMR的批准后，我们筛选了一家转诊机构超过1年的医院记录。记录患者的人口统计学和疾病特征，并在汇总后进行统计分析。
2015年共有47583名患者通过急诊科和门诊部入院。1556名（3.3%）患者违反医疗建议出院。排除婴儿后患者的平均年龄为46.64±20.55岁。男性占62.9%。这些病例的平均住院时间为4.09±4.39天。大多数患者（70%）属于内科专科，与外科专科相比住院时间更长。大多数LAMA患者患有感染、创伤和恶性肿瘤。大多数患者从病房（62%）违反医疗建议离开，其次是重症监护病房（ICU）（28.8%）和急诊科（9.2%）。在592名（38%）LAMA患者中，离开的原因不明。常见的LAMA原因是经济因素（27.6%）和预后不良（20.5%）。
在我们的回顾性分析中约3.3%的患者违反医疗建议出院。这些病例大多从病房离开，其次是ICU。经济因素和预期的不良结果起了重要作用。
