Demographic and Clinical Characteristics of Discharge Against Medical Advice (DAMA) in Emergency Departments of Madinah Hospitals: A Retrospective Cross-Sectional Study

Background Discharge against medical advice (DAMA) is a significant global healthcare challenge, occurring when a patient or caregiver, in pediatric cases, leaves the hospital against medical recommendations. DAMA can lead to adverse health outcomes, increased hospital readmissions, and strain on healthcare resources. This study examines the characteristics of DAMA in emergency departments (EDs) at Madinah hospitals in Saudi Arabia and explores its distribution according to demographic factors. Methodology A retrospective cross-sectional study was conducted using secondary quantitative data from hospital records at King Fahad Hospital and King Salman Bin Abdulaziz Medical City in Madinah, Saudi Arabia. Ethical approval was obtained, and descriptive statistical analyses were performed to assess demographic trends and reasons for DAMA. Results Starting from January to December 2022, a total of 1,120 DAMA cases were recorded. The highest proportion of cases was observed among middle-aged adults (30-49 years), with males accounting for 57.5% (n = 645) of cases. DAMA was more frequent on weekdays, peaking on Sundays, and most cases occurred in the afternoon and night shifts. A large proportion of patients (59.1%, n = 663) did not provide a reason for DAMA, while 28.7% (n = 322) refused admission, 4.6% (n = 52) cited long wait times, 1.7% (n = 20) had financial constraints, and 2.5% (n = 29) left after feeling better. Conclusion DAMA remains a critical concern in Saudi Arabian EDs, with a higher proportion of recorded cases among males and middle-aged adults. Contributing factors include refusal of medical care, long wait times, financial limitations, and perceived early recovery. The high prevalence of DAMA during peak hours suggests systemic challenges in hospital resource management. Addressing these issues requires improved patient education, streamlined hospital processes, and enhanced communication strategies to reduce DAMA rates and improve patient outcomes.