DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20185204

Leave against medical advice from SNCU of a teaching hospital in Garhwal, Uttarakhand, India

Rakesh Kumar

Abstract


Background: Patients who leave against medical advice (LAMA) is a universal problem. Neonates being unable to decide for their own, are dependent on parents for all decisions for their treatment. LAMA is a sensitive issue in neonatology practice with ethical and medico legal ramifications. This study was done to evaluate the factors associated with the decision of LAMA by care givers in our special newborn care unit (SNCU).

Methods: This is a retrospective hospital based observational study and was conducted in SNCU of HNB Base Teaching Hospital, Srinagar, Garhwal. Data pertaining to LAMA between 1st August 2017 and 31st July 2018 was retrieved. Information obtained included place of birth, gestational age, weight, diagnoses, duration of hospital stay and reasons for LAMA. Data were entered into a Microsoft Excel Spread Sheet and analyzed using software. Graph Pad Prism v 7.04. Chi-Square test was used to test for significant difference among various groups.

Results: Out of 689 neonates admitted in SNCU during the study period, 167 (24.24%) took LAMA. Male to female ratio of 1:1.1. 102 (61%) were inborn and 65 (39%) were out born. Term babies constituted 62.87%. 78.44% neonates were discharged within 7 days of admission. 58 (34.73%) neonates had sepsis and 30 (17.96%) had birth asphyxia. The commonest reason in 25.15% for taking LAMA was to take the neonate to better equipped facility followed by false perception that the baby is well enough to be discharged.

Conclusions: Multiple factors contribute for getting a neonate discharged against medical advice. Improvement of infrastructure, training of health care staff for proper counselling, sensitivity and empathy towards neonate and the care givers can decrease the rate of LAMA.


Keywords


DAMA, Garhwal, LAMA, Neonate, SNCU

Full Text:

PDF

References


Roodpeyma S, Hoseyni SAE. Discharge of children from hospital against medical advice. World J Pediatr. 2010;6(4):353-6.

Alfandre DJ. “I’m going home”: discharges against medical advice. Mayo Clin Proc. 2009;84(3):255-60.

Care of small and sick neonates in special newborn care units (SNCUs) of India. Two year report. Available at: https://www.savethechildren.in/sci-in/files/46/4661cab4-37ac-4ee1-869d-8adf8b5ab155.pdf.

Devpura B, Bhadesia P, Nimbalkar S, Desai S, Phatak A. Discharge against medical advice at neonatal intensive care unit in Gujarat, India. Int J Pediatr. 2016;2016.

Rakholia R, Rawat V, Bano M, Singh G. Neonatal morbidity and mortality of sick newborns admitted in a teaching hospital of Uttarakhand. Chris Med J Health Res. 2014;1:228-34.

Modi R, Modi B, Patel JK, Punitha KM. Study of the morbidity and the mortality pattern in the neonatal intensive care unit at a tertiary care teaching hospital in Gandhinagar District, Gujarat, India. J Res Med Den Sci. 2015;3(3):208-12.

Mohseni M, Alikhani M, Tourani S, Azami-Aghdash S, Royani S, Moradi-Joo M. Rate and causes of discharge against medical advice in Iranian hospitals: a systematic review and meta-analysis. Iranian J Public Heal. 2015;44(7):902-12.

Duru CO, Peterside O, Ududua AO. Paediatric discharges against medical advice at a tertiary health centre in Bayelsa State, Nigeria. Nig J Paed. 2014;41(2):90-5.

Al-Ghafri M, Al-Bulushi A, Al-Qasmi A. Prevalence of and reasons for patients leaving against medical advice from paediatric wards in Oman. Sultan Qaboos Univ Med J. 2016;16(1):e74-7.

Opara P, Eke G. Discharge against medical advice amongst neonates admitted into a Special Care Baby Unit in Port Harcourt, Nigeria. Internet J Pediatr Neonatol. 2010;40(1):12-5.

Abbas R, Waheed KAI, Waqar T, Anwar M, Gul R, Hayat S, et al. Reasons of self-discharge from nursery of a tertiary care hospital. J Ayub Med Coll Abbottabad. 2017;29(4):658-61.

Onankpa BO, Ali T, Abolodje E. A study on prevalence of discharge against medical advice in a tertiary care hospital in Nigeria. Int J Med Res Health Sci. 2014;3(2):297-301.

Al-Turkistani HK. Discharge against medical advice from Neonatal Intensive Care Unit: 10 years’ experience at a University Hospital. J Family Comm Med. 2013;20(2):113-5.

Aliyu I, Lawal TO. Signing against medical advice in a special care baby unit in a tertiary center in Northwestern Nigeria. Trop J Med Res. 2017;20:16-9.

National Health Mission, ASHA Training Modules, January 2016. Available at: http://nrhm.gov.in/communitisation/asha/resources/ asha-training-modules.html.

Bansal SC, Nimbalkar SM, Shah NA, Shrivastav RS, Phatak AG. Evaluation of knowledge and skills of home based newborn care among Accredited Social Health Activists (ASHA). Indian Pediatr. 2016;53(8):689-91.