The situation at Government Rajaji Hospital (GRH) Madurai highlights significant issues surrounding discharges Against Medical Advice (AMA) category, representing 1.86% of all in-patients. Experts attributed this trend to various factors.
Overview of AMA Discharges
In 2023, GRH Madurai admitted 94,284 patients, with 177,776 discharged after proper medical care.
3,615 patients (1.86% of total in-patients) were discharged AMA, indicating a notable trend that raises concerns about patient care and decision-making.
AMA discharge remains a significant challenge within the healthcare system, as it reflects the overall quality of healthcare services provided.
An AMA discharge occurs when a patient or their family decides to leave the hospital before the physician has advised them to do so. These discharges are critical to understand because they can help identify individuals at greater risk, allowing for earlier interventions that can reduce morbidity, mortality, and associated healthcare costs.
Reasons for AMA Discharges
End-of-Life-Decision: A significant portion of AMA cases stems from families choosing to take terminally ill patients home, preferring that they pass away in familiar surroundings rather than hospitals.
Preference for Private Care: Patients from affluent backgrounds, especially those involved in accidents, often opt to leave GRH for private facilities, believing they will receive better or more personalized care, even if adequate services are available at GRH.
Perception of Recovery: Some patients, such as those recovering from dengue, may feel well enough to leave prematurely, mistakenly believing they are out of danger.
Said the former dean at GRH Dr. Rathinavel.
Institutional Response
Dr. L Arul Sundareshkumar, Dean of GRH emphasized that while medical staff can provide advice, they cannot compel patients or their families to remain in the hospital. They routinely offer discharge AMA to ensure that the potential risks are communicated to the family.
The hospital conducts internal audits on AMA cases to review medical practices and potentially identify underlying issues contributing to these decisions.
Implications for Healthcare Quality
The prevalence of AMA discharges can be seen as an indicator of the healthcare system's quality.
High rates of AMA may suggest areas of improvement in patient care, communication, and family engagement.
Understanding the reasons behind these discharges can help healthcare providers tailor their approaches to patient and family needs, ultimately enhancing the quality of care and patient satisfaction.
(Input From Various Sources)
(Rehash/Josna Lewis/MSM)