Factors Influencing Patient Decisions to Discharge Against Medical Advice from Hospital Emergency: Insights From a Saudi Tertiary Hospital.

Abstract

Discharge against medical advice (DAMA) is a critical global issue in emergency departments (EDs), as it leads to adverse patient outcomes, higher readmission rates, and increased hospital costs. In Saudi Arabia, evidence on the underlying causes of DAMA and its impact on healthcare operations remains limited. This study aimed to identify the factors contributing to DAMA among Saudi patients and explore potential strategies for its reduction. A descriptive cross-sectional study was conducted in 2024 at our University Hospital using a convenience sampling method through a self-reported online questionnaire, with a response rate of 78%. A total of 297 participants were included, with females comprising 54.4% and males 45.5%. The most represented age group in the DAMA category was 31-42 years (39.5%). Educational backgrounds varied, with 18.9% having no formal education and another 18.9% holding a master's degree. Most participants (54.2%) received care at government hospitals, 72.4% lacked medical insurance, and 14.5% had previous DAMA incidents. The leading reasons for DAMA were financial burden (53.5%), lack of available beds (52.5%), and patient/relative fatigue (50.5%). Nationality was significantly associated with DAMA, with 30.2% of non-Saudis affected compared to 15.7% of Saudis (P =  .038). Findings suggest that financial and systemic challenges outweigh staff-related factors, emphasizing the need for targeted interventions and policy reforms to minimize DAMA and improve patient outcomes in Saudi healthcare settings. Further longitudinal and interventional studies are recommended to evaluate the long-term impacts of DAMA and to test strategies aimed at reducing its occurrence.