Discharge Against Medical Advice : The causes, consequences and possible corrective measures

Gaur, Akshay and Warriner, David and Gilham, Elizabeth and Machin, Laura (2024) Discharge Against Medical Advice : The causes, consequences and possible corrective measures. British Journal of Hospital Medicine. ISSN 1750-8460 (In Press)

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Abstract

Patients who discharge themselves against medical advice (DAMA) comprise 1-2% of hospital admissions. DAMA is defined as when a hospitalised patient chooses to leave the hospital before the treating medical team recommends discharge. The act of DAMA impacts on both the patient, the staff and their ongoing care. Specifically, this means that the patient’s medical problems maybe inadequately assessed or treated. Patients who decide to DAMA tend to be young males, from a lower socioeconomic background and with a history of mental health or substance misuse disorder. DAMA has an associated increased risk of morbidity and mortality. In this review of studies across Western healthcare settings, specifically adult medical inpatients, we will review the evidence and seek to address the causes, consequences and possible corrective measures in this common scenario.