TY  - JOUR
T1  - Effect of the COVID-19 pandemic on discharges against medical advice: a retrospective study
TT  - COVID-19 pandemisinin tıbbi tavsiyeye aykırı taburcu edilmelere etkisi: geriye dönük bir çalışma
AU  - Sarıdaş, Ali
PY  - 2025
DA  - July
Y2  - 2025
DO  - 10.32322/jhsm.1685803
JF  - Journal of Health Sciences and Medicine
JO  - J Health Sci Med /JHSM /jhsm
PB  - MediHealth Academy Yayıncılık
WT  - DergiPark
SN  - 2636-8579
SP  - 542
EP  - 545
VL  - 8
IS  - 4
LA  - en
AB  - 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
KW  - Discharge against medical advice
KW  - emergency department
KW  - patient discharge
KW  - COVID-19
N2  - Giriş:Bu çalışma, COVID-19 pandemisinin acil serviste (AS) taburcu olmadan hastaneden ayrılma (DAMA) insidansı üzerindeki etkisini değerlendirmeyi ve pandemi öncesi ile pandemi dönemlerindeki DAMA hastalarının klinik ve demografik özelliklerini karşılaştırmayı amaçlamaktadır.Yöntemler:Bu retrospektif, gözlemsel ve kesitsel çalışma, COVID-19 salgını sırasında pandemi merkezi olarak belirlenen İstanbul, Türkiye'deki üçüncü basamak bir hastanenin acil servisinde yürütülmüştür. Çalışmaya, 1 Mart 2020 ile 1 Mart 2021 tarihleri arasında acil servise başvuran ve DAMA olarak sınıflandırılan hastalar dahil edilmiştir. Aynı dahil edilme ve dışlanma kriterleri kullanılarak, pandemi öncesi dönemi temsil eden bir kontrol grubu oluşturulmuştur (1 Mart 2018 – 1 Mart 2019).Bulgular:Pandemi döneminde hastanemizdeki toplam acil servis başvuru sayısı, pandemi öncesi döneme kıyasla %19,4 oranında azalırken, DAMA vaka sayısı %28,4 oranında artmıştır. DAMA vakaları arasında, pandemi döneminde yaşlı hasta oranında artış gözlemlenmiştir. Ayrıca, gece vardiyalarında gerçekleşen DAMA vakalarının oranında da istatistiksel olarak anlamlı bir artış saptanmıştır (%38,0 vs. %55,5; p  < 0,001). Pandemi döneminde DAMA hastaları arasında hipertansiyon (%19,8 vs. %6,3; p  < 0,001) ve diabetes mellitus (%16,2 vs. %7,7; p = 0,001) prevalansı anlamlı şekilde artmıştır. Ayrıca, kardiyoloji (%8,9 vs. %4,2; p = 0,011) ve enfeksiyon hastalıkları (%8,4 vs. %2,7; p  < 0,001) konsültasyonu istenen hasta oranlarında da artış gözlenmiştir.Sonuçlar:COVID-19 pandemisi, acil serviste DAMA oranlarında anlamlı bir artışa yol açmıştır. Bu artış, özellikle yaşlı hastalar, diyabet ve hipertansiyon öyküsü olan bireyler ile kardiyoloji veya enfeksiyon hastalıkları konsültasyonu istenen hastalar arasında daha belirgin olmuştur.
CR  - Machin LL, Goodwin D, Warriner D. An alternative view of self-discharge against medical advice: an opportunity to demonstrate empathy, empowerment, and care. Qual Health Res. 2018;28(5):702-710. doi:10.1177/1049732318754514
CR  - Dubow D, Propp D, Narasimhan K. Emergency department discharges against medical advice. J Emerg Med. 1992;10(4):513-516. doi:10.1016/ 0736-4679(92)90289-6
CR  - Shirani F, Jalili M, Asl-E-Soleimani H. Discharge against medical advice from emergency department: results from a tertiary care hospital in Tehran, Iran. Eur J Emerg Med. 2010;17(6):318-321. doi:10.1097/MEJ. 0b013e3283334ef1
CR  - Southern WN, Nahvi S, Arnsten, JH. Increased risk of mortality and readmission among patients discharged against medical advice. Am J Med. 2012;125(6):594-602. doi:10.1016/j.amjmed.2011.12.017
CR  - Robinson K, Lam B. Early emergency department representations. Emerg Med Australas. 2013;25(2):140-146. doi:10.1111/1742-6723.12048
CR  - Levy F, Mareiniss DP, Iacovelli C. The importance of a proper against-medical-advice (AMA) discharge: how signing out AMA may create significant liability protection for providers. J Emerg Med. 2012;43(3): 516-520. doi:10.1016/j.jemermed.2011.05.030
CR  - Quinlan WC, Majoros N. Patients leaving against medical advice: assessing the liability risk. J Healthc Risk Manag. 1993;13(1):19-22. doi: 10.1002/jhrm.5600130106
CR  - İlhan B, Bozdereli Berikol G, Aydın H, Arslan Erduhan M, Doğan H. COVID-19 outbreak impact on emergency trauma visits and trauma surgery in a level 3 trauma center. Ir J Med Sci. 2022;191(5):2319-2324. doi:10.1007/s11845-021-02793-y
CR  - Lange SJ, Ritchey MD, Goodman AB, et al. Potential indirect effects of the COVID-19 pandemic on use of emergency departments for acute life-threatening conditions-United States, January-May 2020. MMWR Morb Mortal Wkly Rep. 2020;69(25):795-800. doi:10.15585/mmwr.mm 6925e2
CR  - Beştemir A, Aydın H, Tuncar A. The impact of the COVID-19 pandemic on emergency surgical operations in state hospitals in Turkey: a retrospective and descriptive study. Euras J Emerg Med. 2023;22:1.
CR  - Aydin H, Doğan H. COVID-19 outbreak impact on discharge against medical advice from the ED: a retrospective study. Am J Emerg Med. 2022;57:21-26. doi:10.1016/j.ajem.2022.04.008
CR  - Mafham MM, Spata E, Goldacre R, et al. COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England. Lancet. 2020;396(10248):381-389. doi:10.1016/S0140-6736(20) 31356-8
CR  - Diegoli H, Magalhães PS, Martins SC, et al. Decrease in hospital admissions for transient ischemic attack, mild, and moderate stroke during the COVID-19 era. Stroke. 2020;51(8):2315-2321. doi:10.1161/STROKEAHA.120.030481
CR  - Reschen ME, Bowen J, Novak A, et al. Impact of the COVID-19 pandemic on emergency department attendances and acute medical admissions. BMC Emerg Med. 2021;21(1):143. doi:10.1186/s12873-021-00529-w
CR  - Adefemi SA, Adeleke IT, Gara P, Ghaney OOA, Omokanye SA, Yusuf AMJ. The rate, reasons and predictors of hospital discharge against medical advice among inpatients of a tertiary health facility in North-central Nigeria. Am J Health Res. 2015;3(1):11-16. doi:10.11648/j.ajhr.s. 2015030101.12
CR  - Aydın H, Berikol GB, Koçak M, Doğan H. The effect of variants and vaccines on prognosis in coronavirus disease 2019 patients: a retrospective observational study. Anat Clin J Med Sci. 2022;27(3): 293-301. doi:10.21673/anadoluklin.1061232
CR  - Rasi S. Impact of language barriers on access to healthcare services by immigrant patients: a systematic review. Asia Pacific J Health Manag. 2020;15(1):35-48.
CR  - Benschop A, Van Bakkum F, Noijen J. Changing patterns of substance use during the coronavirus pandemic: self-reported use of tobacco, alcohol, cannabis, and other drugs. Front Psychiatry. 2021;12:633551. doi:10.3389/fpsyt.2021.633551
CR  - Manthey J, Kilian C, Carr S, et al. Use of alcohol, tobacco, cannabis, and other substances during the first wave of the SARS-CoV-2 pandemic in Europe: a survey on 36,000 European substance users. Subst Abuse Treat Prev Policy. 2021;16:1-11. doi:10.1186/s13011-021-00373-y
CR  - Aydın H, Beştemir A, Berikol GB, Doğan H. Pandemi hastanesinin acil servisine başvuran hastaların analizi: bir retrospektif Türkiye çalışması. Tıbbi Sos Hizmet Derg. 2022;19:76-85. doi:10.46218/tshd.1106381
CR  - Silbergleit R, Kronick SL, Philpott S, Lowell MJ, Wagner C. Quality of emergency care on the night shift. Acad Emerg Med. 2006;13(3):325-330. doi:10.1197/j.aem.2005.09.005
UR  - https://doi.org/10.32322/jhsm.1685803
L1  - https://dergipark.org.tr/tr/download/article-file/4814547
ER  -