Factors Influencing Discharge Against Medical Advice (DAMA) in an Emergency Department in Saudi Arabia

Background: Discharge against medical advice (DAMA) impacts patient morbidity and mortality, with prevalence rates ranging from 0.76% to 4.01% of hospital admissions. This study investigated DAMA within the emergency department (ED) of a Saudi Arabian hospital, aiming to understand its prevalence and associated factors. Methods: A retrospective cohort study was conducted from January to December 2022 at a tertiary center. Demographic and clinical data on DAMA cases, including age, gender, nationality, marital status, admission details, diagnosis category, priority level, and reasons for DAMA, were extracted from the electronic hospital database. Descriptive statistics and the chi-square test were used for analysis. Results: Of the 515 identified DAMA cases, 309 were analyzed after exclusions. The majority of patients were female (52.1%), Saudi nationals (82.5%), and married (38.8%). The most frequent discharge diagnoses involved cardiology (18.1%), obstetrics and gynecology (17.8%), and neurology (14.2%). Common reasons for DAMA were refusal of the physician's plan (40.1%), refusal of admission (21.7%), and long waiting times (13.9%). Significant associations were found between reasons for DAMA and priority levels. Conclusion: The study highlights the multifaceted nature of DAMA in the ED, which is driven by systemic, cultural, and individual factors. Addressing these issues through improved communication, policy adjustments, and patient education could help reduce DAMA incidence. Future research should aim to overcome this study's limitations, such as its retrospective design's low depth of insight, and limited generalizability, given its single-institution scope.