Discharge against medical advice in rural and remote emergency departments: views of healthcare providers

• Published in: Rural and Remote Health
• Main Authors: Jacky Oribin, Yaqoot Fatima, Catherine Seaton, Shaun Solomon, Maureen Khan, Alice Cairns
• Format: Article in Journal/Newspaper
• Language: English
• Published: James Cook University 2024
• Subjects: Aboriginal; Australia; cultural competency; cultural safety; discharge planning; First Nations; Special situations and conditions; RC952-1245; Public aspects of medicine; RA1-1270
• Online Access: https://doi.org/10.22605/RRH8231; https://doaj.org/article/5e0f3b500e014f5eb4a7ec3f21c5e6bd

Introduction: The aim of the study was to explore, in one remote hospital, emergency department healthcare providers' experience and perceptions of the factors surrounding a patient's decision to discharge against medical advice (DAMA). The secondary objective was to gain insight into staff experiences of the current protocols for managing DAMA cases and explore their recommendations for reducing DAMA incidence. Methods: This was a cross-sectional study involving a survey and semi-structured interviews exploring healthcare providers' (n=19) perceptions of factors perceived to be influencing DAMA, current practice for managing DAMA and recommendations for practice improvements. Health professionals (doctors, nurses, Aboriginal Health Workers) all worked in the emergency department of a remote community hospital, Queensland, Australia. Responses relating to influencing factors for DAMA were provided on a three-point rating scale from 'no influence/little influence' to 'very strong influence'. DAMA management protocol responses were a three-point rating scale from 'rarely/never' to 'always'. Semi-structured interviews were conducted after the survey and explored participants' perceptions in greater detail and current DAMA management protocol. Results: Feedback from the total of 19 participants across the professions presented four prominent yet interconnected themes: patient, culture, health service and health provider, and health literacy and education-related factors. Factors that were perceived to have a strong influence on DAMA events included alcohol and drug abuse (100%), a lack of culturally sensitive healthcare services (94.7%), and family commitments or obligations (89.5%). Healthcare provider recommendations for preventing DAMA presented themes of right communication, culturally safe care (right place, right time) and the right staff to support DAMA prevention. The healthcare providers described the pivotal role the Indigenous Liaison Officer (ILO) plays and the importance of this position being filled. ...