Percentage of admitted patients who discharged against medical advice
Rationale
Discharge against medical advice (DAMA) refers to patients leaving hospital against the advice of their treating medical team or without advising hospital staff (e.g. absconding or missing and not found). Patients who do so have a higher risk of readmission and mortality and have been found to cost the health system 50% more than patients who are discharged by their physician.
Between July 2015 and June 2017 Aboriginal patients (3.4%) in WA were over 11 times more likely than non-Aboriginal patients (0.3%) to discharge against medical advice, compared with 6.2 times nationally (3.1% and 0.5% respectively). This statistic indicates a need for improved responses by the health system to the needs of Aboriginal patients.
This indicator provides a measure of the safety and quality of inpatient care. Reporting the results by Aboriginal status measures the effectiveness of initiatives within the WA health system to deliver culturally secure services to Aboriginal people. While the aim is to achieve equitable treatment outcomes, the targets reflect the need for a long-term approach to progressively closing the gap between Aboriginal and non-Aboriginal patient cohorts.
DAMA performance measure is also one of the key contextual indicators of Outcome 1 “Aboriginal and Torres Strait Islander people enjoy long and healthy lives” under the new National Agreement on Closing the Gap, which was agreed to by the Coalition of Aboriginal and Torres Strait Islander Peak Organisations, and all Australian Governments in July 2020.
Target
The 2021 targets for admitted patients who discharged against medical advice are:
| Procedure | Target |
|---|---|
| (a) Aboriginal patients | ≤ 2.78% |
| (b) Non-Aboriginal patients | ≤ 0.99% |
Improved or maintained performance is demonstrated by a result below or equal to target.
Results
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(a) Aboriginal patients
| Year | Target | Actual | |
|---|---|---|---|
| Year 2021 | Target 2.78% | Actual 5.87% |
|
| Year 2020 | Target 2.78% | Actual 7.51% |
|
| Year 2019 | Target 0.77% | Actual 7.10% |
|
| Year | Target | Actual | |
|---|---|---|---|
| Year 2021 | Target 0.99% | Actual 1.16% |
|
| Year 2020 | Target 0.99% | Actual 1.44% |
|
| Year 2019 | Target 0.77% | Actual 1.32% |
|
Commentary
In 2021-22 key strategies were operationalised, with results demonstrating a reduction in DAMA rates for both Aboriginal and non-Aboriginal patients.
EMHS continues to work to improve the DAMA KPI. Key new strategies supporting DAMA performance across EMHS in 2021-22, include:
- EMHS undertook a deep review and analysis of patients with frequent or multiple DAMA, to identify targeted actions to reduce DAMAs in this cohort
- a Patient-Initiated Discharge (PID) process and form was introduced at RPH, allowing patients to be safely discharged in line with their health and social needs
- key consultation with Walk with Me and Homeless Health Care Leads to identify best practice management strategies for patients presenting with alcohol intoxication with or without homelessness.
EMHS is continuing to implement the following targeted strategies:
- improving cultural sensitivity in the organisation with Welcome to Country and DAMA videos and an Aboriginal Champion program, Kadadjiny Marr
- medical education, targeting safe discharge language and avoiding inappropriate use of the term DAMA in medical records
- sites to implement a process for safely discharging surgical patients whose surgery has been delayed or cancelled in target areas
- sites to implement a process for safely discharging the cohort of known and frequent DAMA patients admitted with alcohol intoxication.
Period: 2019 – 2021 calendar years
Contributing sites: Armadale Health Service, Bentley Health Service, Kalamunda Hospital, Royal Perth Hospital, St John of God Midland Public Hospital
Data source: HMDC
Outcome one // Effectiveness KPI