COVID-19 outbreak impact on discharge against medical advice from the ED: A retrospective study

Abstract

Background: The COVID-19 pandemic has profoundly affected the habits of patients, as well as its negative effects on human health. The aim of this study is to investigate the factors associated with discharge against medical advice (DAMA) from the emergency department (ED) during the COVID-19 pandemic.

Methods: We conducted a retrospective study of the charts of DAMA cases (pandemic group) between May 1 and October 30, 2021 in a tertiary hospital in Istanbul, Turkey. Our data were compared with DAMA cases between May 1 and October 30, 2019 (pre-pandemic group-control group).

Results: During the pandemic period, DAMA cases increased by 24.5% in the ED compared to the previous period. Compared to the pre-COVID-19 period, among DAMA cases during the COVID-19 period, the rate of those arriving by ambulance (10.9 vs. 18.8%), those with one or more comorbid diseases (8.9 vs. 18.4%), those with a high triage level (4.0 vs. 7.4%), those with health tourism or refugee/asylum insurance (2.9 vs. 6.1%), those with trauma (11.5 vs. 19.9%) or alcohol/drug abuse (2.7 vs. 4.0%) increased significantly (p < 0.001). It was observed that DAMA cases' waiting times for total ED and from the door to doctor decreased during the pandemic period compared to the pre-pandemic period.

Conclusion: During the COVID-19 pandemic period, it was observed that the rate of those with severe disease increased among DAMA cases. Necessary precautions should be taken for all patients, especially seriously ill patients, to feel safe in the hospital and to be treated, and the negative consequences that may develop should be prevented by addressing the concerns of the patients and their relatives.

Keywords: Against medical advice; DAMA; ESI; Emergency department; Patient discharge.