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Predictors of Discharge Against Medical Advice in a Tertiary Paediatric Hospital

Author

Listed:
  • Louise Sealy

    (Community Child Health, Sydney Children’s Hospital, Randwick, NSW 2031, Australia)

  • Karen Zwi

    (Community Child Health, Sydney Children’s Hospital, Randwick, NSW 2031, Australia)

  • Gordon McDonald

    (Sydney Informatics Hub, The University of Sydney, Sydney, NSW 2008, Australia)

  • Aldo Saavedra

    (Centre for Translational Data Science; The University of Sydney, Sydney, NSW 2006, Australia
    Faculty of Health Sciences, The University of Sydney, Sydney, NSW 2006, Australia)

  • Lisa Crawford

    (The Children’s Hospital at Westmead, Sydney, NSW 2145, Australia)

  • Hasantha Gunasekera

    (The Children’s Hospital at Westmead, Sydney, NSW 2145, Australia
    Children’s Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW 2145, Australia)

Abstract

Background: Patients who discharge against medical advice (DAMA) from hospital carry a significant risk of readmission and have increased rates of morbidity and mortality. We sought to identify the demographic and clinical characteristics of DAMA patients from a tertiary paediatric hospital. Methods: Data were extracted retrospectively from electronic medical records for all inpatient admissions over a 5-year period. Demographic characteristics (age, sex, Aboriginality, socioeconomic status and remoteness of residence) and clinical characteristics (admitting hospital site, level of urgency on admission, diagnosis and previous DAMA) were extracted and logistic regression models were used to identify predictors of DAMA with 95% confidence intervals. Results: There were 246,359 admissions for 124,757 patients, of which 1871 (0.8%) admissions and 1730 patients (1.4%) DAMA. Predictors of DAMA in a given admission were hospital site (OR 4.8, CI 4.2–5.7, p < 0.01), a mental health/behavioural diagnosis (OR 3.3, CI 2.2–4.8, p < 0.01), Aboriginality (OR 1.6, CI 1.3–2.1, p < 0.01), emergency rather than elective admissions (OR 0.7ha, CI 0.6–0.8, p < 0.01), a gastrointestinal diagnosis (OR 1.5, CI 1.1–2.0, p = 0.04) and a history of previous DAMA (OR 2.0, CI 1.2–3.2, p = 0.05). Conclusions: There are clear predictors of DAMA in this tertiary hospital admission cohort and identification of these provides opportunities for intervention at a practice and policy level in order to prevent adverse outcomes.

Suggested Citation

  • Louise Sealy & Karen Zwi & Gordon McDonald & Aldo Saavedra & Lisa Crawford & Hasantha Gunasekera, 2019. "Predictors of Discharge Against Medical Advice in a Tertiary Paediatric Hospital," IJERPH, MDPI, vol. 16(8), pages 1-11, April.
    • Handle: RePEc:gam:jijerp:v:16:y:2019:i:8:p:1326-:d:222447
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    References listed on IDEAS

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    1. Nicholas G. Polson & James G. Scott & Jesse Windle, 2013. "Bayesian Inference for Logistic Models Using Pólya--Gamma Latent Variables," Journal of the American Statistical Association, Taylor & Francis Journals, vol. 108(504), pages 1339-1349, December.
    2. Patricia M Davidson & Leila Gholizadeh & Abbas Haghshenas & Arie Rotem & Michelle DiGiacomo & Maurice Eisenbruch & Yenna Salamonson, 2010. "A review of the cultural competence view of cardiac rehabilitation," Journal of Clinical Nursing, John Wiley & Sons, vol. 19(9‐10), pages 1335-1342, May.
    3. Ibrahim, S.A. & Kwoh, C.K. & Krishnan, E., 2007. "Factors associated with patients who leave acute-care hospitals against medical advice," American Journal of Public Health, American Public Health Association, vol. 97(12), pages 2204-2208.
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    Cited by:

    1. Rebecca Singer & Karen Zwi & Robert Menzies, 2019. "Predictors of In-Hospital Mortality in Aboriginal Children Admitted to a Tertiary Paediatric Hospital," IJERPH, MDPI, vol. 16(11), pages 1-12, May.

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