A 5 Year Retrospective Analysis of Leave against Advice from the Medical Wards of a Nigerian Tertiary Hospital

Self discharge (SD) of hospitalized patients is an adverse clinical event often resulting from a fundamental disagreement between the patient or an interested third party and the attending physician and / or the hospital environment. This culminates in the patient’s withdrawal of their initial voluntary consent for hospitalisation and abrupt termination of in - patient medical care. Patients who left hospital admission against the advice of their doctors are both a concern and a challenge for individuals in the health industry. It negatively impacts treatment outcomes and exposes the clinician and health care administrators to the hazards of litigations. The study was aimed at determining the incidence of SD and associated factors in medical admissions. It was a retrospective descriptive hospital based study of patients who self discharged from medical wards of Federal Medical Center, Makurdi from June 2012 – May 2017. Approval was obtained from the institution’s research ethics board. Thirty one individuals (0.62% of total admission) self discharged within the study period. Financial constraints was responsible for 32.2% (10) of SD followed by proximity to social support 19.4% (6). Five patients (16.1%) elected not to disclose any reasons. The incidence reduced from 0.21% to 0.02% at the start and end of study period respectively. Though SD was relatively low in this study, the incidence could be reduced further by expanding the scope of health insurance scheme, skilful communication and negotiating patient management using patient – centred methods.