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J Korean Soc Emerg Med > Volume 34(2); 2023 > Article
Journal of The Korean Society of Emergency Medicine 2023;34(2): 154-165.
응급실 자의퇴원 환자에 대한 분석 및 개선 방향: 수도권의 한 종합병원 사례를 중심으로
인연재1 , 정창환1 , 최규진2 , 김윤희3
1가톨릭관동대학교 국제성모병원 응급의학과
2인하대학교 의과대학 의학교육 및 의료인문학교실
3인하대학교 의과대학 사회의학교실
How can be reduced discharges against medical advice from the emergency department?
Yeon Jae In1 , Chang Whan Jung1 , Kyu Jin Choi2 , Youn Hee Kim3
1Department of Emergency Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
2Department of Medical Education and Medical Humanities, Inha University College of Medicine, Incheon, Korea
3Department of Social and Preventive Medicine, Inha University College of Medicine, Incheon, Korea
Correspondence  Chang Whan Jung ,Tel: 032-290-3030, Fax: 032-290-2884, Email: 8hal10jung@hanmail.net,
Received: August 31, 2022; Revised: October 6, 2022   Accepted: October 15, 2022.  Published online: April 30, 2023.
Discharge against medical advice (DAMA) from emergency departments (EDs) accounts for 0.1% to 2.7%. DAMA carries a risk of increased mortality and readmissions, and higher medical nationwide cost. Our aim was to investigate the general characteristics of DAMA patients from ED and discover for methods to reduce DAMA.
In this study, we collected and analyzed the medical records of patients who visited the ED of a general hospital from 2015 to 2020. The subjects were categorized into a DAMA group and a non-DAMA group. We compared these groups with respect to gender, age, duration of ED stay, way to visit, the reason for the visit, insurance type, accompanied by guardian, and severity classification. In addition, the factors related to ED revisits or hospitalization within one month after DAMA were analyzed.
Of the 209,076 patients, 1,982 were subject to DAMA from ED. The DAMA group had a higher ratio of visits to ED by ambulance (53.2% vs. 21.4%, P<0.001), critically ill patients (74.1% vs. 51.7%, P<0.001), and medical aid type 1 (7.7% vs. 3.4%, P<0.001). The factors for the high ratio of ED revisit within one month after DAMA were as follows: critically ill patients (odds ratio [OR], 1.916; 95% confidence interval [CI], 1.305-2.814), accompanied by a guardian (OR, 1.525; 95% CI, 1.105-2.105), and medical aid type 1 (OR, 2.025; 95% CI, 1.358-3.02).
Developing a manual on DAMA procedures and a system that can provide economic and social support to patients is to be established to reduce DAMA from ED.
Key words: Organization and administration; Patient discharge; Emergency service, hospital
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