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Original article
Discharge against medical advice in culturally and linguistically diverse Australian children
  1. Xin Yue Guo1,2,
  2. Susan Woolfenden2,3,
  3. Gordon McDonald4,
  4. Aldo Saavedra5,6,
  5. Raghu Lingam2
  1. 1 Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  2. 2 School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
  3. 3 Community Child Health, Sydney Children’s Hospitals Network Randwick, Randwick, New South Wales, Australia
  4. 4 Sydney Informatics Hub, University of Sydney, Sydney, New South Wales, Australia
  5. 5 Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
  6. 6 Centre for Translational Data Science, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Xin Yue Guo, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; angelaguo72103{at}gmail.com

Abstract

Objectives This study quantifies the prevalence and rates of discharge against medical advice (DAMA) in culturally and linguistically diverse (CALD) children and assesses the independent association between CALD status and DAMA accounting for key demographic confounders in a large tertiary Australian hospital network.

Methods Prospectively collected data between 2010 and 2018 were extracted from the hospital network electronic medical records system for admitted patients (n=192 037), outpatients (n=268 904) and between 2015 and 2018 for emergency department (ED) patients (n=158 903). CALD status was defined as ‘preferred language being not English’ and DAMA was measured as ‘discharge at own risk’ in admissions, ‘no show’ in outpatients, ‘left without being seen’ and ‘did not wait’ in ED. Data were analysed using χ² test, bivariate analysis and multivariate logistic regression.

Results The prevalence of DAMA was 1.34% in admitted patients, 19.31% in outpatients and 12.64% in ED patients. Rates of DAMA were higher among CALD children compared to non-CALD children (1.75% vs 1.29% in admitted patients, 26.53% vs 17.92% in outpatients and 18.74% vs 11.61% in ED patients). CALD status was independently associated with DAMA in admitted children (OR=1.30, 95% CI 1.15 to 1.44), outpatients (OR=1.55; 95% CI 1.51 to 1.58) and ED patients (OR=1.60; 95% CI 1.53 to 1.66).

Conclusion Being from a CALD background places children at increased risks to DAMA. Implementing appropriate health service responses may ensure equitable access and quality care for children from CALD backgrounds to reduce the rates of DAMA and its associated ramifications.

  • clinical procedures
  • comm child health
  • epidemiology
  • health service
  • health services research

https://doi.org/10.1136/archdischild-2019-317063

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    Footnotes

    • Contributors XYG reviewed the appropriate literature, drafted the original manuscript under the guidance of RL and SW. AS and GM provided data support during data analysis. All authors revised the manuscript and approved the final manuscript as submitted.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval Granted by the Sydney Children’s Hospital Network Human Research Ethics Committee; Reference Number: LNR/15/SCHN/400

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.