Factors associated with discharge against medical advice in a Saudi teaching hospital

BackgroundPatients discharged against medical advice (AMA) are at increased risk for a poor outcome and higher cost to the health care system. The pattern and predictors of discharge AMA have not been studied in Saudi Arabian hospitals. Thus, we assessed the prevalence and predictors of discharge AMA in a major teaching hospital in Saudi Arabia.MethodsThis study was conducted at a university teaching hospital in the Eastern Province, Saudi Arabia. A case-control design and multivariate logistic regression were used to assess factors predicting discharge AMA from hospital discharge data between January 2007 and December 2009 from the departments of surgery, obstetrics, psychiatry and general medicine.ResultsOf 16175 discharges during the study period, 648 were AMA (4.01%). Younger age (OR, 1.3; 95% CI, 1.11–1.43), number of comorbid conditions (OR, 1.6; 95% CI, 1.4–1.8), short length of stay (OR, 1.05; 95% CI, 1.03–1.05), male gender (OR, 1.9; 95% CI, 1.4–2.5) and Saudi national (OR, 2.3; 95% CI, 1.6–3.3) increased the odds for discharge AMA. Other factors associated with increased discharge AMA included admission to the psychiatry department and the holy feast of Eid Al-Adha.ConclusionDischarge AMA in one Saudi teaching hospital was much more common than in western countries. Younger age, male gender, Saudi nationality and having more comorbid conditions were associated with increased discharge AMA. The findings of this study might assist in reducing the prevalence of discharge AMA.