Analysis of discharge against medical advice in Gunma

2023 Fiscal Year Final Research Report

• Project/Area Number: 21K17224
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 58010:Medical management and medical sociology-related
• Research Institution: Gunma University
• Principal Investigator: OHISHI Yuko 群馬大学, 医学部附属病院, 助教 (90846924)
• Project Period (FY): 2021-04-01 – 2024-03-31
• Keywords: 自主退院

Outline of Final Research Achievements

The aim of this study was to clarify the background and issues leading to discharge against medical advice (DAMA) retrospectively using a questionnaire. We obtained 57 cases from 8 hospital. DAMA occurred most frequently in people aged 40-59 and in men, and the median length of hospital stay before DAMA was 6 days. 96% were due to patient's factors, and 49% were due to factors of the medical institution. Of the 40 patients whose progress could be followed after DAMA, 55% were hospitalized or had unscheduled visits to the medical institution where they discharged or the medical institution to which they were referred. There was also one death. Seven patients had left the hospital without permission before discharge against medical advice. Leaving against medical advice may be a sign of discharge against medical advice.

Free Research Field

Healthcare Quality and Safety

Academic Significance and Societal Importance of the Research Achievements

患者側の要因でDAMAに至るケースを多く認める中には、患者による暴言・暴力によるものも含まれていた。自主退院症例には、医療機関側にとっての患者要因により入院継続が困難となり、半ば強制的に退院に至った症例が含まれていることが示唆された。自主退院は医療者にとって精神的・身体的負担になっているうえ、自主退院に対する院内統一の文書を作成している医療機関はいずれも病院、医師の免責について言及していることから、法律的な対応もうかがえた。患者、医療者ともに安心して入院継続できるような社会的な支援体制が必要と考えられる。今後は前方視的な全国調査を行うことで、本邦におけるDAMAに対する施策立案が望まれる。