شناسایی عوامل مرتبط با ترخیص رضایت شخصی در بخش اورژانس: یک مطالعه مقطعی

نویسندگان
فرزاد میرزاخانی
حمیدرضا ریحانی
سهیل هشترخانی
زهرا رحمتی نژاد
سعید اسلامی
حامد تابش
دانشگاه علوم پزشکی مشهد
چکیده
مقدمه

انتخاب بیمار برای خروج از بیمارستان قبل از اینکه پزشک معالج، وی را مرخص اعلام کند ترخیص با رضایت شخصی (Discharge Against Medical Advice - DAMA) نامیده می‌‌شود. هدف از انجام این مطالعه، شناسایی مشخصات بیماران DAMA و مقایسه آنها با سایر بیماران که با نظر پزشک ترخیص شده‌‌اند (Non-DAMA) است.

مواد و روش‌‌ها

مطالعه حاضر به روش مقطعی بر روی کلیه بیماران ترخیص شده از بخش اورژانس بیمارستان امام رضا (ع) شهر مشهد در سال 1394 انجام گرفت. داده‌‌های بیماران از پرونده پزشکی الکترونیک ایشان بازیابی شد. پس از پیش‌‌پردازش‌‌ داده‌‌ها، در نهایت با استفاده از جدول فراوانی و آزمون کای اسکور آنالیز شدند. تمامی تحلیل‌‌ها با استفاده از نرم افزارSPSS v.22 انجام گرفت.

یافته‌‌ها

تعداد کل بیماران واجد شرایط شرکت کننده در مطالعه، 19313 نفر بود که 6993 نفر از آنها با رضایت شخصی اقدام به ترخیص نموده بودند. میانگین سنی بیماران DAMA، 1/34±38/19 سال بود. 57 درصد بیماران DAMA را مردان تشکیل می‌‌دادند؛ و جوان بودن، متأهل بودن و فقدان بیمه سه عامل مهم مرتبط با DAMA بود. عوامل مرتبط دیگر عبارت بودند از: ملیت ایرانی، روستایی بودن، سکونت در مشهد، طول مدت اقامت، شیفت پذیرش، روز پذیرش، ماه پذیرش و فصل پذیرش.

نتیجه‌‌گیری

اگر چه نرخ DAMA در این مطالعه کم می‌‌باشد اما توجه به این مسئله بسیار حائز اهمیت می‌‌باشد؛ زیرا ریسک مرگ و بازگشت مجدد در بیماران DAMA زیاد است. بنابراین شناسایی مشخصات این بیماران و تعیین عوامل مرتبط با DAMA می‌‌تواند به تصمیم‌‌گیری در خصوص انتخاب مداخلات موثر جهت کاهش نرخ آن کمک شایانی کند.
کلیدواژه‌ها
ترخیص با رضایت شخصی
ترک بر خلاف توصیه پزشکی
بخش اورژانس
مطالعه مقطعی

عنوان مقاله English

Identification of related factors to discharge against medical advice in an emergency department: A cross-sectional study

نویسندگان English

Farzad Mirzakhani
Hamidreza Reihani
Soheil Hashtarkhani
Zahra Rahmatinejad
Saeed Eslami
Hamed Tabesh
Mashhad University of Medical Sciences
چکیده English

Introduction and Aims: The choice of the patient to leave the hospital before the physician discharges him is called discharge against medical advice (DAMA). The purpose of this study was to identify the characteristics of patients with DAMA and compare them with non-DAMA patients.

Materials and Methods: This cross-sectional study was performed on all the patients discharged from the emergency department of Imam Reza Hospital in Mashhad in 2015. The patients' data were retrieved from their electronic medical records. After pre-processing, the data were finally analyzed using a frequency table and a chi-square test. All analyzes were performed using SPSS Statistics Version 22 software.

Results: The total number of the eligible patients in the study was 19,313, of whom 6,993 were discharged against medical advice. The mean age of DAMA patients was 38.1 ± 19.34 years. 57% of DAMA patients were male; and being young, married, and lack of insurance were three major factors associated with DAMA. Other related factors were: Iranian nationality, rurality, residence in Mashhad, length of stay, admission- shift/ day/ month/ season.

Consultation: Although the DAMA rate is low in this study (3.49%), it is very important to pay attention to this issue; because the risk of death and re-admission in DAMA patients is high. Therefore, identifying the general characteristics of these patients and determining the factors associated with DAMA can help decide on the selection of effective interventions to reduce DAMA rate.

کلیدواژه‌ها English

discharge
medical advice
emergency department
cross sectional study
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