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

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