응급실 자의퇴원환자의 요인분석 = THE ANALYSIS OF DESCHARGE AGAINST MEDICAL ADVECE IN THE EMERGENC DEPATTMENT

다국어 초록 (Multilingual Abstract)

Discharge against medical advice(AMA) in the emergency department is a frustrating, painful event to both patients and emergency physicians and emergency physicians. A retrospective chart review of 347 consecutive AMA patient from our emergency department from December 1992 to May 1993. Among them, 185 patients were interviewed with our researcher about primary cause of AMA through telephone contact.
The results were as follows :
1. Total 9,705 patients visited our emergency department during 6-months period and there was 347 AMA patients(3.6%)
2. The main reasons for 185 AMA were ;
1) patients' or family's own problem in 114 cases(61.6%)
2) changes in patient condition(terminal case, improvement) in 56 cases(30.3%).
3) dissatisfaction to medical services in 15 cases(8.1%)
3. During same period, there was 117 cases of drug intoxication mainly due to suicidal attempt and 18 AMA was noted. Among 18 AMA cases, 16 patients discharged against medical advice due to patients' own problem(mainly due to economical problem) but none of them revisited OPD or emergency department.
4. Eight of 40 AMA patients with symptom improvement were managed in OPD, emergency department or other hospital but none of them admitted.
In conclusion, we noticed that the main cause of AMA is non-medical problem in Korea and there should be continuous effert to improve our medical insurance system, emergency medical services system. Only through the judicious use of AMA, it can be used as a tool of determining patient satisfaction and quality improvement in emergency medical field.