Effect of the COVID-19 pandemic on discharges against medical advice: a retrospective study

Authors : Ali Sarıdaş
Pages : 542-545
Doi:10.32322/jhsm.1685803
View : 102 | Download : 80
Publication Date : 2025-07-30
Article Type : Research Paper
Abstract :Aims: This study aims to evaluate the impact of the COVID-19 pandemic on the incidence of discharge against medical advice (DAMA) in the emergency department (ED) and to compare the clinical and demographic characteristics of DAMA patients between the pre-pandemic and pandemic periods. Methods: This retrospective, observational, cross-sectional study was conducted in the ED of a tertiary care hospital in Istanbul, Turkey, which was designated as a pandemic center during the COVID-19 outbreak. The study included patients who presented to the ED between March 1, 2020, and March 1, 2021, and were classified as DAMA. A control group representing the corresponding pre-pandemic period (March 1, 2018-March 1, 2019) was established using the same inclusion and exclusion criteria. Results: During the pandemic period, the total number of ED visits at our hospital decreased by 19.4% compared to the pre-pandemic period, while the number of DAMA cases increased by 28.4%. Among DAMA cases, an increase in the proportion of elderly patients was observed during the pandemic. There was also a statistically significant rise in the proportion of DAMA cases occurring during night shifts (38.0% vs. 55.5%; p<0.001). Furthermore, during the pandemic, the prevalence of hypertension (19.8% vs. 6.3%; p<0.001) and diabetes mellitus (16.2% vs. 7.7%; p=0.001) among DAMA patients increased significantly. The proportion of patients for whom cardiology (8.9% vs. 4.2%; p=0.011) and infectious diseases (8.4% vs. 2.7%; p<0.001) consultations were requested also showed increase during the pandemic period. Conclusion: COVID-19 pandemic led to a significant increase in the rate of DAMA in the ED. This increase was particularly pronounced among elderly patients, individuals with a history of diabetes or hypertension, and those for whom cardiology or infectious disease consultations were requested.
Keywords : tıbbi tavsiyeye aykırı taburcu etme, acil servis, hasta taburcu etme, COVID-19

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