title: Discharge against medical advice from a Tehran emergency department.
abstract: OBJECTIVE
  The purpose of this paper is to identify the main reasons for discharge against medical advice (DAMA) in the emergency department (ED) of a teaching hospital in Tehran, Iran.
  
  
  METHODS
  This cross-sectional study was conducted on all the patients who left the ED of a referral teaching hospital against medical advice (AMA) in 2008. A questionnaire was filled out for each patient to determine the reasons behind patient leaving AMA.
  
  
  RESULTS
  In total, 12.8 percent of the patients left the hospital AMA. Dissatisfaction with being observed in the ED, having a feeling of recovery and hospital personnel encouraging patients to leave the hospital were the main reasons for leaving the hospital AMA.
  
  
  CONCLUSIONS
  Like many other centers, the results showed that poor communication skill and work overload were the main contributing factors to DAMA. The center managed to improve patient satisfaction and thus lowered DAMA rates following this study. Considering the similarities reported in the reports and that of other studies, it could be concluded that policy makers in other centers can also benefit from the results to adopt effective approaches to reduce DAMA rate.
  
  
  CONCLUSIONS
  To the knowledge no study has evaluated the rate and the reasons behind DAMA in the Iranian EDs.
authors.affiliation: Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Azar
authors.initials: A
authors.lastname: Hadadi
authors.forename: Patricia
authors.initials: P
authors.lastname: Khashayar
authors.forename: Mojgan
authors.initials: M
authors.lastname: Karbakhsh
authors.forename: Ali
authors.initials: A
authors.lastname: Vasheghani Farahani
mesh_terms: D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007492:Iran; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000523:psychology / Q000706:statistics & numerical data*
keywords: DAMA; Discharge; Emergency department; Iran; Patients; Public health service; Quality assessment