Student Dissertation

Agency : Monitoring; Lama Discharges; Dama Discharge; Quality Improvement

Objective : The main objective of the study is profiling of LAMA/DAMA discharges at Narayana Multispecialty Hospital, Jaipur. To identify the reasons of LAMA/DAMA discharges at Narayana Multispecialty Hospital, Jaipur.

Background : Left against medical advice/ Discharge against medical advice is defined as patient discharges or leaves the hospital or health care facility before the treating physician recommends discharge, this has emerged as a pervasive problem in general hospitals. LAMA/DAMA encounters lead to frustration and resentment on the part of clinicians and poor outcomes and worsening health of patients. It is a challenge to provide quality healthcare when patients do not adhere to their physician’s recommendations for treatment. The need for a clearly documented system or guidelines for assessing and managing such patient is highlighted.

Methodology : Study setting: The study was undertaken at Narayana Multispecialty Hospital in Jaipur. The hospital is a 240 bedded multi-specialty hospital. Study design: Descriptive study with cross-sectional design Study Participants: All inpatient admissions in the wards (general, intensive care unit, private, semiprivate) facilities and leaving against medical advice of the treating consultants were included in the study Sample size: 107 patients who left/discharged against medical advice admissions in the wards (general, intensive care unit, private, semi-private) Study tools: Secondary data collection: Direct observation and hospital record review and discussions with the consultants, and nursing incharges. Cause and effect diagram (fishbone diagram). Primary data collection by: Telephonic Survey comprising of open-ended questions.

Findings : The reveals that the patients leaving against medical advice were majority males (63%) of old age group (61-70 years). Out of the 107 subjects leaving against medical advice (n=75) were uninsured patients. Furthermore, road traffic incidents (RTA) cases (22%), chronic obstructive pulmonary lung disease(COPD) (17%), hypertension and diabetes mellitus (15%) were diagnosis primarily associated with LAMA/DAMA discharges. The most common reasons for signing against medical advice were financial constraints (n=35), poor prognosis (30,), dissatisfaction with treatment plan(n=12), referral to higher centre (n=5).

Recommendations : The present study reveals that majority of people who left/discharged against medical advice were: ï‚· Those from low income families under financial burden; ï‚· Those who had poor prognosis; and ï‚· Those who were dissatisfied with treatment plan.


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