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Predictors of Discharge Against Medical Advice in a Tertiary Paediatric Hospital

1
Community Child Health, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
2
Sydney Informatics Hub, The University of Sydney, Sydney, NSW 2008, Australia
3
Centre for Translational Data Science; The University of Sydney, Sydney, NSW 2006, Australia
4
Faculty of Health Sciences, The University of Sydney, Sydney, NSW 2006, Australia
5
The Children’s Hospital at Westmead, Sydney, NSW 2145, Australia
6
Children’s Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW 2145, Australia
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(8), 1326; https://doi.org/10.3390/ijerph16081326
Received: 4 March 2019 / Revised: 1 April 2019 / Accepted: 8 April 2019 / Published: 12 April 2019
(This article belongs to the Special Issue Health Inequalities in Children)
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PDF [323 KB, uploaded 16 April 2019]

Abstract

Background: Patients who discharge against medical advice (DAMA) from hospital carry a significant risk of readmission and have increased rates of morbidity and mortality. We sought to identify the demographic and clinical characteristics of DAMA patients from a tertiary paediatric hospital. Methods: Data were extracted retrospectively from electronic medical records for all inpatient admissions over a 5-year period. Demographic characteristics (age, sex, Aboriginality, socioeconomic status and remoteness of residence) and clinical characteristics (admitting hospital site, level of urgency on admission, diagnosis and previous DAMA) were extracted and logistic regression models were used to identify predictors of DAMA with 95% confidence intervals. Results: There were 246,359 admissions for 124,757 patients, of which 1871 (0.8%) admissions and 1730 patients (1.4%) DAMA. Predictors of DAMA in a given admission were hospital site (OR 4.8, CI 4.2–5.7, p < 0.01), a mental health/behavioural diagnosis (OR 3.3, CI 2.2–4.8, p < 0.01), Aboriginality (OR 1.6, CI 1.3–2.1, p < 0.01), emergency rather than elective admissions (OR 0.7ha, CI 0.6–0.8, p < 0.01), a gastrointestinal diagnosis (OR 1.5, CI 1.1–2.0, p = 0.04) and a history of previous DAMA (OR 2.0, CI 1.2–3.2, p = 0.05). Conclusions: There are clear predictors of DAMA in this tertiary hospital admission cohort and identification of these provides opportunities for intervention at a practice and policy level in order to prevent adverse outcomes. View Full-Text
Keywords: discharge; self-discharge; treatment refusal; discharge against medical advice; discharge at own risk discharge; self-discharge; treatment refusal; discharge against medical advice; discharge at own risk
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Sealy, L.; Zwi, K.; McDonald, G.; Saavedra, A.; Crawford, L.; Gunasekera, H. Predictors of Discharge Against Medical Advice in a Tertiary Paediatric Hospital. Int. J. Environ. Res. Public Health 2019, 16, 1326.

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