Study of the impact of quality of patient care on discharge against medical advice patients in a tertiary care hospital

L. Aswathi Raj, Rajesh Kamath, G. Somu, Biju Soman, Brayal D'Souza, Sagarika Kamath, Sneha R. Bhat

Research output: Contribution to journalArticle

Abstract

A cross sectional study was conducted with a sample size of 200.Among the 200 cases of DAMA, 7.5% of cases were in the age range of 15–25 years, 11% were in the age range of 26–30 years, 19% were in the age range of 36–45 years,16.5% were in the age range of 46–55 years, 20% were in the age range of 56-65 years.26% were above the age of 65 years.35.5% of patients who took discharge against medical advice were illiterate (n = 200), followed by 28.5% with secondary education. The least number was distributed among pre-degree and graduation (5%, 14%). The peak DAMA rate was seen among dependent participants(43.5%),followed by the self-employed (36%) and private employees(15%).The least was noted among government employees(5.5%). 68% of the cases were diagnosed with acute illness and 32% were diagnosed with chronic illness. DAMA cases were considered from 11 units of in-patient service such as Medicine, Gastrology, Neuro Surgery,Neurology,Pulmonary Medicine, Obstetrics and Gynaecology, Orthopaedic Surgery,Oncology and Cardiology. The reasons for DAMA can be considered under two categories: patient related factors and hospital related factors. Patient related factors include the following: Wanting to go to another hospital (77.5%), financial burden (53%), no improvement in condition (45%),distance from hospital (43.5%),unsatisfied with treatment (43.5%),worsening of symptoms (18.5%),family issues (9.5%),re–admission (7.5%), influenced by other patients (1%) and language barrier (0.5%). Medical conditions included addiction to alcohol (2%) and decision to go for alternative treatment (2%). The hospital related factors were: Expensive hospital stay (60%), ineffective care (28.5%), inefficient staff (27%), unnecessary diagnostic procedures (25.5%), long waiting time (18%),neglected by hospital staff (16%), uncomfortable hospital stay (11.5%), crowded hospital (4%), inadequate facilities (3.5%), improper communication by staff and strict hospital policies(3%). The third objective was to assess the impact of the quality of patient care on discharge against medical advice patients in a tertiary care hospital. The study result shows that Quality related issues do have a significant impact on DAMA. The quality related issues consist of the following sub areas: Wanted to go to other hospital (77.5%), no improvement in patient condition (45%), unsatisfied with treatment (44.5%), inefficient staff (27%),ineffective care (20.5%),worsening of symptoms (18.5%), neglected by hospital staff (16%) and uncomfortable hospital stay (11.5%).

Original languageEnglish
Pages (from-to)82-88
Number of pages7
JournalMedico-Legal Update
Volume19
Issue number1
DOIs
Publication statusPublished - 01-01-2019

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Quality of Health Care
Tertiary Healthcare
Tertiary Care Centers
Patient Care
Length of Stay
Communication Barriers
Unnecessary Procedures
Pulmonary Medicine
Neurology
Cardiology
Gynecology
Sample Size
Alcoholism
Obstetrics
Orthopedics
Chronic Disease
Therapeutics
Cross-Sectional Studies
Communication
Medicine

All Science Journal Classification (ASJC) codes

  • Pathology and Forensic Medicine

Cite this

Aswathi Raj, L. ; Kamath, Rajesh ; Somu, G. ; Soman, Biju ; D'Souza, Brayal ; Kamath, Sagarika ; Bhat, Sneha R. / Study of the impact of quality of patient care on discharge against medical advice patients in a tertiary care hospital. In: Medico-Legal Update. 2019 ; Vol. 19, No. 1. pp. 82-88.
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Study of the impact of quality of patient care on discharge against medical advice patients in a tertiary care hospital. / Aswathi Raj, L.; Kamath, Rajesh; Somu, G.; Soman, Biju; D'Souza, Brayal; Kamath, Sagarika; Bhat, Sneha R.

In: Medico-Legal Update, Vol. 19, No. 1, 01.01.2019, p. 82-88.

Research output: Contribution to journalArticle

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AU - Kamath, Rajesh

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AU - Kamath, Sagarika

AU - Bhat, Sneha R.

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N2 - A cross sectional study was conducted with a sample size of 200.Among the 200 cases of DAMA, 7.5% of cases were in the age range of 15–25 years, 11% were in the age range of 26–30 years, 19% were in the age range of 36–45 years,16.5% were in the age range of 46–55 years, 20% were in the age range of 56-65 years.26% were above the age of 65 years.35.5% of patients who took discharge against medical advice were illiterate (n = 200), followed by 28.5% with secondary education. The least number was distributed among pre-degree and graduation (5%, 14%). The peak DAMA rate was seen among dependent participants(43.5%),followed by the self-employed (36%) and private employees(15%).The least was noted among government employees(5.5%). 68% of the cases were diagnosed with acute illness and 32% were diagnosed with chronic illness. DAMA cases were considered from 11 units of in-patient service such as Medicine, Gastrology, Neuro Surgery,Neurology,Pulmonary Medicine, Obstetrics and Gynaecology, Orthopaedic Surgery,Oncology and Cardiology. The reasons for DAMA can be considered under two categories: patient related factors and hospital related factors. Patient related factors include the following: Wanting to go to another hospital (77.5%), financial burden (53%), no improvement in condition (45%),distance from hospital (43.5%),unsatisfied with treatment (43.5%),worsening of symptoms (18.5%),family issues (9.5%),re–admission (7.5%), influenced by other patients (1%) and language barrier (0.5%). Medical conditions included addiction to alcohol (2%) and decision to go for alternative treatment (2%). The hospital related factors were: Expensive hospital stay (60%), ineffective care (28.5%), inefficient staff (27%), unnecessary diagnostic procedures (25.5%), long waiting time (18%),neglected by hospital staff (16%), uncomfortable hospital stay (11.5%), crowded hospital (4%), inadequate facilities (3.5%), improper communication by staff and strict hospital policies(3%). The third objective was to assess the impact of the quality of patient care on discharge against medical advice patients in a tertiary care hospital. The study result shows that Quality related issues do have a significant impact on DAMA. The quality related issues consist of the following sub areas: Wanted to go to other hospital (77.5%), no improvement in patient condition (45%), unsatisfied with treatment (44.5%), inefficient staff (27%),ineffective care (20.5%),worsening of symptoms (18.5%), neglected by hospital staff (16%) and uncomfortable hospital stay (11.5%).

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