Discharge Against Medical Advice (DAMA) 🏃‍♂️

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🧠 Definition

  • DAMA occurs when a patient chooses to leave hospital before medical staff recommend discharge.
  • It may be due to frustration, misunderstanding, personal reasons, or distrust.

📞 What to Ask / Orders to Make

  • Why does the patient want to leave? Explore concerns or triggers.
  • Is the patient cognitively intact and medically stable?
  • Has there been appropriate communication with the team?
  • Contact the Registrar and nursing staff to escalate early.

🧾 History

  • Establish patient’s reasoning clearly.
  • Any history of previous DAMA or similar behaviour?
  • Check for misunderstandings, fear, or dissatisfaction with care.

🩺 Examination

  • Assess capacity: alert, oriented, understands situation and consequences.
  • Check for signs of acute illness, intoxication, or psychiatric distress.
  • Ensure vitals are stable.

🔍 Investigations

  • Ensure all relevant investigations are up to date if possible.
  • Document any pending results that the patient should be made aware of.

💬 Management

  • Discuss with patient: risks of leaving, benefits of staying, alternatives.
  • Involve senior clinician and, if appropriate, next of kin.
  • Offer compromise: outpatient review, temporary leave, or review by social work.
  • If patient has capacity and insists on leaving, proceed to DAMA process.

📝 Documentation & Process

  • Clearly document that the patient understands the risks and has decision-making capacity.
  • Write a note: circumstances, discussions, risks explained, senior input.
  • Have the patient sign a DAMA form if willing. If they refuse, document this.
  • Inform GP or relevant outpatient service if appropriate.
  • Ensure the patient leaves with medications, follow-up advice, or discharge summary if possible.

Note Template

Ready-to-use clinical note structure

🕒 20 / 11 / 2025 — 22:38

ATRP re: Discharge Against Medical Advice (DAMA)
Patient: [age] [sex]
Admission Dx: [reason for admission]
PMHx: [relevant comorbidities]

🧾 Hx:
• Reason for DAMA
• Understanding of risks and consequences
• Previous DAMA episodes
• Family or social support

🩺 Exam:
• Vitals: HR __ BP __ Temp __ RR __ SpO₂ __
• Mental status and capacity assessment

📋 Impression:
Patient choosing to leave against advice

📌 Plan:
• Discuss risks and document counselling
• Attempt to address concerns/barriers
• Provide information on follow-up and warning signs
• Notify relevant teams and document thoroughly
• Arrange safe discharge if possible

👤 [Your Name], [Role]
IMC: _______
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