REASONS OF SELF-DISCHARGE FROM NURSERY OF A TERTIARY CARE HOSPITAL
AbstractBackground: Patients who leave against medical advice (LAMA) from a health facility is a recognized problem. In neonatology practice this issue is particularly sensitive as repercussions can be severe. The purpose of this study was to evaluate the factors influencing the decision of parents to self-discharge their babies against medical advice. Methods: This descriptive case series was conducted in the Department of Neonatology, of the Children’s Hospital and the Institute of Child Health, Lahore from January to June 2015. A total of 240 patients who self-discharged/were included. Results: There were (59.6%) males and (40.4%) females with a male to female ratio of 2:1.5. Term babies constituted (67.9%), spontaneous vaginal deliveries (59.1%) and (55.8%) were delivered at hospitals. Seventy seven new-borns (32.2%) had birth asphyxia followed by neonatal sepsis (27.9%). Sixty four (64.5%) self-discharged within first week of admission. More babies were signed LAMA at week end (32.1%). Likewise (53.1%) babies were self- discharged during the night shift. Highest rate of LAMA was seen in parents belonging to low socioeconomic class (72.1%). Ninety eight parents (40.8%) had no formal education while well-educated parents were found to be 35 (14.6%). The commonest reason for self-discharge was "perceived poor clinical outcome" (36.7%) by parents. Conclusion: Multiple factors were implicated in self-discharges from neonatology unit. Commonest reasons cited by parents were perception of poor clinical outcome and family pressures. Other contributory factors were male gender; those delivered vaginally, diagnosis of birth asphyxia, first week of life, at weekends and night hours. Low socioeconomic class and education of parents was also a major causative factor.Keywords: LAMA, Self-discharge, Neonates, Tertiary care
Roodpeyma S, Hoseyni SAE. Discharge of children from hospital against medical advice. World J Pediatr 2010;6(4):353–6.
Alfandre DJ. “I’m going home”: discharges against medical advice. Mayo Clin Proc. 2009;84(3):255–60.
Brook M, Hilty DM, Liu W, Hu R, Frye MA. Discharge against medical advice from inpatient psychiatric treatment: a literature review. Psychiatr Serv 2006;57(8):1192–8.
Hwang SW, Li J, Gupta R, Chien V, Martin RE. What happens to patients who leave hospital against medical advice? CMAJ 2003;168(4):417–20.
Berger JT. Discharge against medical advice: Ethical considerations and professional obligations. J Hosp Med 2008;3(5):403–8.
Moïsi JC, Gatakaa H, Berkley JA, Maitland K, Mturi N, Newton CR, et al.Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis. Bull World Health Organ 2011;89(10):725–32.
Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths : When ? Where ? Why ? Lancet 2005;365(9462):891–900.
Onyiriuka AN. Pediatric discharge against medical advice: experience from a Nigerian secondary healthcare institution. Med J Islam Repub Iran 2011;25(4):194–9.
Osifo OD, Oku OR. Causes, spectrum and effects of surgical child abuse and neglect in a Nigerian city. West Afr J Med 2009;28(5):313–7.
Masud F, Farooq S. Gender Differentials in Preventive Health Care: Incidences and Determinants among Pakistani Children. Pak J Commer Soc Sci 2012;6(2):308–24.
Pongou R. Why Is Infant Mortality Higher in Boys Than in Girls? A New Hypothesis Based on Preconception Environment and Evidence From a Large Sample of Twins. Demography 2013;50(2):421–44.
Al-Turkistani HK. Discharge against medical advice from Neonatal Intensive Care Unit: 10 years experience at a University Hospital. J Family Community Med 2013;20(2):113–5.
Eke GK, Opara PI. Discharge against medical advice amongst patients admitted into the Paediatric wards of the University of Port Harcourt Teaching Hospital. Niger J Paediatr 2013;40(1):40–4.
Onankpa B, Ali T, Abolodje E. A study on prevalence of discharge against medical advice in a tertiary care hospital in Nigeria. Int J Med Res Health Sci 2014;3(2):297–301.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.