Discharge Against Medical Advice from NICU in a Tertiary Hospital of Central Nepal: A Descriptive Cross-Sectional Study

Abstract

Purpose

Discharge against medical advice (DAMA), leave against medical advice (LAMA), and self discharge have been used in similar circumstances to mean abandoning the physician’s advice and deciding to leave the hospital abruptly without caring about possible outcomes. It is a sensitive issue common in NICUs across the developing world. To decrease NMR and under-5 mortality further, it is important to explore the factors leading to DAMA. Hence, this study aims to find the prevalence of DAMA, its causes, and related socio-demographic factors.

Patients and Methods

A cross-sectional descriptive study was conducted in the NICU of College of Medical Sciences Teaching Hospital located in central Nepal from June 2019 to May 2020. Out of 110 cases of DAMA during the study period, 105 cases gave consent to participate in the study. Medical data were recorded from patient records followed by filling out of a semi-structured questionnaire by parents of the patients.

Results

Out of 611 cases admitted to the NICU during the study period, 110 neonates (18%) were self-discharged. The leading cause for parents to take such a decision was poor financial condition (58%), followed by lack of improvement (21%).

Conclusion

The study showed that DAMA in the NICU was 18%. Poor financial condition followed by lack of improvement in patient’s condition were the main reasons for self-discharge.

Keywords:

• LAMA
• DAMA
• self-discharge
• NICU

Acknowledgments

The authors acknowledge contributions made by Dr Binod Gaire and Dr Rizuna Sharma for data collection and Mr. Hari Prasad Chalise for data analysis.

Disclosure

The authors report no conflicts of interest in this work.