Enhancing Understanding and Mitigation of Discharge against Medical Advice (DAMA) Cases in a Tertiary Care Teaching Hospital: Recommendations and Strategies

Abstract

The issue of Discharge against Medical Advice (DAMA) has garnered significant attention in healthcare literature due to its implications for patient outcomes and healthcare system efficiency. Several studies have explored the prevalence, causes, and consequences of DAMA across different healthcare settings and patient populations. This presents a significant challenge in healthcare systems globally. This retrospective study aimed to analyze DAMA cases in a tertiary care teaching hospital to identify major contributing factors. A thorough review of medical records spanning July 1 to December 31, 2022, revealed 580 DAMA cases out of 16,993 inpatient admissions. Financial reasons emerged as the primary cause (64%), followed by personal reasons (17%) and unwillingness to continue treatment (11%). Extended length of stay and dissatisfaction with service were comparatively less frequent. Understanding these factors is crucial for implementing targeted interventions to reduce DAMA rates and enhance patient care. This study highlights the prevalence of DAMA cases in a tertiary care teaching hospital and identifies financial constraints as the leading cause. Addressing financial barriers and implementing interventions to improve patient education and communication may help reduce DAMA rates. Further research is warranted to explore additional factors contributing to DAMA and develop targeted strategies for mitigation.