Predictors of discharge against medical advice in a tertiary paediatric hospital

Patients who discharge against medical advice (DAMA) from hospital carry a significant risk of readmission and have increased rates of morbidity and mortality. Using five years of admissions and diagnosis data, we sought to identify the demographic, clinical and administrative characteristics of DAMA patients in the Sydney Children’s Hospital Network. Using a Bayesian logistic regression framework, we found statistically significant predictors of DAMA in a given admission were hospital site, a mental health/behavioural diagnosis, Aboriginality, emergency rather than elective admissions, a gastrointestinal diagnosis and a history of previous DAMA. Identification of these predictors of DAMA provides opportunities for intervention at a practice and policy level in order to prevent adverse outcomes for patients.

Journal Reference:

Predictors of Discharge Against Medical Advice in a Tertiary Paediatric Hospital

https://www.mdpi.com/1660-4601/16/8/1326

Louise Sealy, Karen Zwi, Gordon McDonald, Aldo Saavedra, Lisa Crawford and Hasantha Gunasekera

Int. J. Environ. Res. Public Health 2019, 16(8), 1326; doi:10.3390/ijerph16081326

The study Discharge against medical advice (DAMA) in culturally and linguistically diverse (CALD) Australian children examined the independent association of CALD status and DAMA. In a multicultural country like Australia, the rates of DAMA were found to be significantly higher among CALD children compared to non CALD children. CALD children were found to be at 1.3 folds risk to DAMA from their admissions, 1.55 times the risk to miss their outpatient appointments and 1.60 folds the risk to leave the ED before the clinician recommends discharge. These findings highlight the importance of implementing appropriate health services to ensure equitable access and care quality for children from CALD backgrounds.