English abstract
Discharge against medical advice (DAMA) is a major problem in healthcare delivery as
it can complicate the health problems from which patients are suffering. The aim of this study was to understand
DAMA among children in a tertiary teaching hospital in Oman and to evaluate the documentation of the events
in the medical records. Methods: A retrospective survey of the medical records of patients discharged against
medical advice over a two-year interval was performed (2004–2006). Results: Of the 11,802 admissions, there
were 38 cases of DAMA, giving a prevalence rate of 0.32%. In 39.5% of the cases, the discharge happened within
24 hours of hospital admission. The majority of the cases were infants (n = 24; 63.25%). The diagnosis at discharge
in some cases included life-threatening conditions. However, in 57.9% of the cases, the reasons for DAMA were
neither reported nor documented in the patients' medical records. Conclusion: Although the results of this
study yielded a low prevalence rate compared to the rates reported in other studies, the occurrence of DAMA for
children in a tertiary hospital is a distressing phenomenon. It was evident that the documentation of the DAMA
process was poor. More studies should be conducted to understand the details of the problem. Policies should be
established and implemented in order to attempt to reduce DAMA among child patients and to protect them from
the consequences of such discharges.
