title: Reasons for Discharge against Medical Advice: A Case Study of Emergency Departments in Iran.
abstract: BACKGROUND
  Incomplete hospitalization is the cause of disease relapse, readmission, and increase in medical costs. Discharge Against Medical Advice (DAMA) in emergency department (ED) is critical for hospitals. This paper aims to explore the underlying reasons behind DAMA in ED of four teaching hospitals in Kerman, Iran.
  
  
  METHODS
  This was a cross-sectional study in which the samples were drawn from the patients who chose to leave against medical advice from the ED of teaching hospitals in Kerman from February to March 2011. The sampling was based on census. Data were gathered by a self-constructed questionnaire. The reasons for DAMA were divided into three parts: reasons related to patient, medical staff, and hospital environment. The questionnaire was filled out by a face-to-face interview with patient or a reliable companion.
  
  
  RESULTS
  There were 121 cases (5.6%) of DAMA out of the total admissions. The main reason of AMA discharges was related to patient factors in 43.9% of cases, while two other factors (i.e., hospital environment and medical staff) constituded 41.2% and 35.2% of cases, respectively. The majority of patients 65.9% (80 cases) were either uninformed or less informed of the entailing side effects and outcomes of their decision to DAMA.
  
  
  CONCLUSIONS
  In comparison to studies conducted in other countries, the rate of DAMA is markedly higher in Iran. The results revealed that patients awareness of the consequences of their decisions is evidently inadequate. The study suggests a number of recommendations. These include, increasing patient awareness of the potential side effects of DAMA and creating the necessary culture for this, improving hospital facilities, and a more careful supervision of medical staff performance.
authors.affiliation: Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Kaveh
authors.initials: K
authors.lastname: Noohi
authors.affiliation: Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Samaneh
authors.initials: S
authors.lastname: Komsari
authors.affiliation: Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Nouzar
authors.initials: N
authors.lastname: Nakhaee
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Vahid
authors.initials: V
authors.lastname: Yazdi Feyzabadi
keywords: Discharge against Medical Advice; Emergency Department; Iran; Teaching Hospital