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Davison M, Chan J, Clarke M, Mitchell C, Yan A, Ballard E, Henaway E. Evaluation of a pathway to address take own leave events for First Nations peoples presenting for emergency care: The Deadly RED project. Emerg Med Australas 2024. [PMID: 38556708 DOI: 10.1111/1742-6723.14397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE The 'Deadly RED' project primarily aimed to improve culturally competent care to reduce the number of First Nations patients presenting to a Queensland ED who 'Take own leave' (TOL). The secondary aim was to evaluate the implementation project. METHODS A pre/post-test quasi experimental study design using mixed methods was co-designed with adherence to Indigenous research considerations. Quantitative analysis of First Nations presentations before and after Deadly RED implementation was performed using SPSS. Qualitative analysis of transcribed research yarns in NVIVO was coded and themed for analysis. Staff experiences and perspectives were collated using electronically distributed surveys and process audits were performed. RESULTS A total of 1096 First Nations presentations June to August 2021 and 1167 in the matched 2022 post-implementation period were analysed. Significantly more patients were recorded as TOL post-implementation (13.0% pre vs 21.3% post) and representations rates were unchanged. Forty-six staff surveyed identified improvements in all parameters including cultural appropriateness and quality of care. Qualitative analysis of 85 research yarns revealed themes migrated to increasingly acceptable, accessible, and usable care. Notably, 45% of the First Nation's patients recorded as TOL self-reported that their treatment was complete. The study was feasible as 80% of packs distributed and 73% follow-up screening after TOL. CONCLUSIONS The Deadly RED evaluation revealed significant discrepancies in the reported data points of TOL and the 'story' of the First Nations persons experience of appropriate and completed care. Staff awareness and cultural capability improved significantly, and yarning allowed knowledge translation and improvements in communication which contributed to a better healthcare experience for First Nations patients attending our ED.
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Affiliation(s)
- Michelle Davison
- Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
- Redcliffe Hospital Emergency Department, Redcliffe, Queensland, Australia
- Griffith University School of Medicine and Dentistry, Sunshine Coast, Queensland, Australia
| | - Jason Chan
- Redcliffe Hospital Emergency Department, Redcliffe, Queensland, Australia
| | - Meg Clarke
- Redcliffe Hospital Emergency Department, Redcliffe, Queensland, Australia
| | - Caroline Mitchell
- Redcliffe Hospital Emergency Department, Redcliffe, Queensland, Australia
| | - Alan Yan
- Redcliffe Hospital Emergency Department, Redcliffe, Queensland, Australia
| | - Emma Ballard
- Statistics Unit, QIMR Berghofer, Brisbane, Queensland, Australia
| | - Elwyn Henaway
- Redcliffe Hospital Emergency Department, Redcliffe, Queensland, Australia
- Research Unit, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
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Pierson SB, Dongarwar D, Bini T, Onwukwe JT, House K, Rosiji FO, Salihu HM. Factors Associated With Discharge Against Medical Advice in US Adolescents Hospitalized for Suicidal Ideation or Suicide Attempt. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00009-1. [PMID: 38280417 DOI: 10.1016/j.jaac.2023.09.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 09/19/2023] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVE Little is known about factors associated with discharge against medical advice (DAMA) in adolescent acute care hospitalization for suicidal ideation (SI) and suicide attempt (SA). Our study seeks to determine whether certain socioeconomic factors or hospital characteristics are associated with DAMA in this population. METHOD This retrospective cross-sectional study used data from the National Inpatient Sample from the 2015 fourth quarter to 2019. We included children 10 to 19 years of age hospitalized with a primary or secondary International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis of SI or SA. Exposures were patient socio-demographics and hospital characteristics. The outcome was DAMA. Logistic regression generated odds ratios (ORs) with 95% CIs to measure the association between each patient and hospital characteristics and DAMA. RESULTS Of 476,755 hospitalizations meeting inclusion criteria, 3,825 (0.8%) were DAMA. After adjusting for socio-demographics and hospital characteristics, predictive factors for DAMA were age 16 to 19 years (OR = 1.41; CI = 1.08-1.82), self-pay status (OR = 1.43; CI = 1.12-1.83), hospital region South and West (OR = 1.55; CI = 1.10-2.20 and OR = 1.79; CI = 1.26-2.54, respectively), and urban non-teaching status of the hospital (OR = 1.90; CI = 1.42-2.55). Hispanic patients were less likely to be DAMA (OR = 0.66; CI = 0.51-0.85). CONCLUSION Variations in DAMA probabilities by age, insurance status, hospital teaching status, and hospital regions suggest a need for a better understanding of this uncommon outcome.
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Christensen D, Gibberd A, McNamara B, Eades S, Shepherd C, Preen DB, McAullay D, Strobel N. Hospital and emergency department discharge against medical advice in Western Australian Aboriginal children aged 0-4 years from 2002 to 2018: A cohort study. Paediatr Perinat Epidemiol 2023; 37:691-703. [PMID: 37983972 PMCID: PMC10946741 DOI: 10.1111/ppe.13018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Discharge against medical advice (DAMA) is a priority issue for the health system. Little is known about the factors associated with DAMA for Aboriginal and/or Torres Strait Islander (Aboriginal) children in Australia. OBJECTIVES Investigate the associations between DAMA for hospital admissions and emergency department (ED) presentations and: (i) child, family and episode of service characteristics and (ii) 30-day readmission/ re-presentation. METHODS We conducted a cohort study of Aboriginal children born in Western Australia (2002-2013) who had ≥1 hospital admissions (n = 16,931) or ED presentations (n = 26,546) within the first 5 years of life. The outcome of interest was hospital and ED DAMA and adjusted odds ratio were derived using multilevel mixed-effects logistic regression. RESULTS In the Hospital Cohort, there were 43,149 hospitalisations for 16,931 children, with 684 hospitalisations (1.6%) recorded as DAMA. In the ED Cohort, there were 232,082 ED presentations in 26,546 children, with 10,918 ED presentations (4.7%) recorded as DAMA. DAMA occurring in hospitals between 2014 and 2018, the adjusted odds decreased by 75% compared to the period between 2002 and 2005. The adjusted odds of ED DAMA increased by 46% over the same period. Hospital admissions in regional and remote hospitals were almost seven times the adjusted odds of DAMA compared with hospital admissions in Perth metropolitan hospitals. The adjusted odds of ED DAMA decreased by 12% for ED presentations in regional and remote hospitals compared to those in Perth metropolitan hospitals. There was no evidence of hospital DAMA being associated with hospital readmission within 30 days and limited evidence of ED DAMA being associated with re-presenting to an ED within 30 days. CONCLUSIONS The study identified several important determinants of DAMA, including admission status, triage status, location and calendar year. These findings could inform targeted measures to decrease DAMA, particularly in regional and remote communities.
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Affiliation(s)
- Daniel Christensen
- Centre for Improving Health Services for Aboriginal and Torres Strait Islander Children and Families (ISAC), Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
| | - Alison Gibberd
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Data Sciences, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Bridgette McNamara
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Barwon South West Public Health Unit, Barwon Health, Geelong, Victoria, Australia
| | - Sandra Eades
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carrington Shepherd
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, Western Australia, Australia
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Daniel McAullay
- Centre for Improving Health Services for Aboriginal and Torres Strait Islander Children and Families (ISAC), Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
| | - Natalie Strobel
- Centre for Improving Health Services for Aboriginal and Torres Strait Islander Children and Families (ISAC), Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
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Mahmoud I, Sanjida S, Schwenn P, Hashem IA, Collin H, Chu K, Bainbridge R, Hou XY. Incidence of Discharge Against Medical Advice in Queensland Hospital Emergency Departments Among Indigenous Patients from 2016 to 2021. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01786-0. [PMID: 37737935 DOI: 10.1007/s40615-023-01786-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/19/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The incidence of discharge against medical advice (DAMA) in emergency departments (EDs) among Indigenous people is a growing concern in Australia. This study aimed to determine the incidence of ED DAMA in public hospitals in Queensland (QLD) from 2016 to 2021 and investigate the disparities in ED DAMA between Indigenous and non-Indigenous patients. The study also assessed the impact of the COVID-19 pandemic on the incidence of ED DAMA. METHODS A descriptive epidemiological study was conducted using aggregated data from QLD public hospital EDs. The data was retrieved from Clinical Excellence QLD, Healthcare Improvement Unit, in the QLD Health Open Data Portal for the period 1 January 2016 to 31 December 2021. Incidence rates and unadjusted odds ratios were calculated and compared using the chi-square test to identify differences between Indigenous and non-Indigenous patients. RESULTS The annual incidence of DAMA in EDs was 7.7% among Indigenous patients, compared to 4.8% among non-Indigenous patients, with the highest rate (8.9%) reported in 2021 among Indigenous patients. The incidence of ED DAMA was higher for Indigenous patients in major cities (20.0%) than in very remote areas (7.4%). Patients in triage categories 4 (10.0%) and 3 (7.3%) accounted for the vast majority of ED DAMA events among Indigenous patients. The acute group A hospitals had the highest incidence of ED DAMA (10.9% for Indigenous patients and 6.5% for non-Indigenous patients). The COVID-19 pandemic had no impact on the incidence of ED DAMA. CONCLUSION Indigenous patients experience a disparity in ED DAMA incidence. Addressing this issue requires collaborative efforts from healthcare providers, policymakers, and community organizations.
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Affiliation(s)
- Ibrahim Mahmoud
- Department of Family and Community Medicine and Behavioral Sciences, College of Medicine, University of Sharjah, Sharjah, UAE.
| | - Saira Sanjida
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Australia
| | - Paul Schwenn
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Australia
| | - Ibrahim Abaker Hashem
- Department of Computer Science, College of Computing and Informatics, University of Sharjah, Sharjah, UAE
| | - Harry Collin
- Faculty of Medicine, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Kevin Chu
- Faculty of Medicine, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Roxanne Bainbridge
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Australia
| | - Xiang-Yu Hou
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Australia
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Coombes J, Hunter K, Bennett-Brook K, Porykali B, Ryder C, Banks M, Egana N, Mackean T, Sazali S, Bourke E, Kairuz C. Leave events among Aboriginal and Torres Strait Islander people: a systematic review. BMC Public Health 2022; 22:1488. [PMID: 35927686 PMCID: PMC9354286 DOI: 10.1186/s12889-022-13896-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leave events are a public health concern resulting in poorer health outcomes. In Australia, leave events disproportionally impact Aboriginal and Torres Strait Islander people. A systematic review was conducted to explore the causes of leave events among Aboriginal and Torres Strait Islander people and strategies to reduce them. METHODS A systematic review was conducted using Medline, Web of Science, Embase and Informit, a database with a strong focus on relevant Australian content. Additionally, we examined the references of the records included, and performed a manual search using Google, Google scholar and the Australia's National Institute for Aboriginal and Torres Strait Islander Health Research. Two independent reviewers screened the records. One author extracted the data and a second author reviewed it. To appraise the quality of the studies the Mixed Methods Appraisal Tool was used as well as the Aboriginal and Torres Strait Islander Quality Appraisal Tool. A narrative synthesis was used to report quantitative findings and an inductive thematic analysis for qualitative studies and reports. RESULTS We located 421 records. Ten records met eligibility criteria and were included in the systematic review. From those, four were quantitative studies, three were qualitative studies and three reports. Five records studied data from the Northern Territory, two from Western Australia, two from New South Whales and one from Queensland. The quantitative studies focused on the characteristics of the patients and found associations between leave events and male gender, age younger than 45 years and town camp residency. Qualitative findings yielded more in depth causes of leave events evidencing that they are associated with health care quality gaps. There were multiple strategies suggested to reduce leave events through adapting health care service delivery. Aboriginal and Torres Strait Islander representation is needed in a variety of roles within health care provision and during decision-making. CONCLUSION This systematic review found that multiple gaps within Australian health care delivery are associated with leave events among Aboriginal and Torres Strait Islander people. The findings suggest that reducing leave events requires better representation of Aboriginal and Torres Strait Islander people within the health workforce. In addition, partnership with Aboriginal and Torres Strait Islander people is needed during the decision-making process in providing health services that meet Aboriginal and Torres Strait Islander cultural needs.
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Affiliation(s)
- J Coombes
- The George Institute for Global Health, Newtown, Australia.
| | - K Hunter
- The George Institute for Global Health, Newtown, Australia.,The University of New South Wales, Sydney, Australia
| | | | - B Porykali
- The George Institute for Global Health, Newtown, Australia
| | - C Ryder
- The George Institute for Global Health, Newtown, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - M Banks
- Australian Commission On Safety and Quality in Health Care, Sydney, Australia
| | - N Egana
- Australian Commission On Safety and Quality in Health Care, Sydney, Australia
| | - T Mackean
- The George Institute for Global Health, Newtown, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - S Sazali
- The George Institute for Global Health, Newtown, Australia
| | - E Bourke
- The George Institute for Global Health, Newtown, Australia
| | - C Kairuz
- The George Institute for Global Health, Newtown, Australia
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Weaver MS, Morreim H, Pecker LH, Alade RO, Alfandre DJ. Pediatric Discharge From the Emergency Department Against Medical Advice. Pediatrics 2022; 149:183777. [PMID: 34972220 PMCID: PMC9647524 DOI: 10.1542/peds.2021-050996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 01/03/2023] Open
Abstract
In this Ethics Rounds we present a conflict regarding discharge planning for a febrile infant in the emergency department. The physician believes discharge would be unsafe and would constitute a discharge against medical advice. The child's mother believes her son has been through an already extensive and painful evaluation and would prefer to monitor her well-appearing son closely at home with a safety plan and a next-day outpatient visit. Commentators assess this case from the perspective of best interest, harm-benefit, conflict management, and nondiscriminatory care principles and prioritize a high-quality informed consent process. They characterize the formalization of discharge against medical advice as problematic. Pediatricians, a pediatric resident, ethicists, an attorney, and mediator provide a range of perspectives to inform ethically justifiable options and conflict resolution practices.
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Affiliation(s)
- Meaghann S. Weaver
- Department of Pediatrics, University of Nebraska, Omaha, Nebraska,VA National Center for Ethics in Health Care, Washington, District of Columbia,Address correspondence to Meaghann S Weaver, MD, MPH, FAAP, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, 68198. E-mail:
| | - Haavi Morreim
- University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee,Center for Conflict Resolution in Healthcare LLC, Memphis, Tennessee
| | - Lydia H. Pecker
- Division of Hematology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Rachel O. Alade
- Department of Pediatrics, University of Pittsburgh, Pittsburg, Pennsylvania
| | - David J. Alfandre
- VA National Center for Ethics in Health Care, Washington, District of Columbia,Department of Medicine and Department of Population Health, New York University, New York, New York
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Askew DA, Foley W, Kirk C, Williamson D. "I'm outta here!": a qualitative investigation into why Aboriginal and non-Aboriginal people self-discharge from hospital. BMC Health Serv Res 2021; 21:907. [PMID: 34479571 PMCID: PMC8414851 DOI: 10.1186/s12913-021-06880-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background Occasions of self-discharge from health services before being seen by a health profession or against medical advice are often used by health systems as an indicator of quality care. People self-discharge because of factors such as dissatisfaction with care, poor communication, long waiting times, and feeling better in addition to external factors such as family and employment responsibilities. These factors, plus a lack of cultural safety, and interpersonal and institutional racism contribute to the disproportionately higher rates of Indigenous people self-discharging from hospital. This qualitative study aimed to increase understanding about the causative and contextual factors that culminate in people self-discharging and identify opportunities to improve the hospital experience for all. Methods Semi-structured interviews with five Aboriginal and/or Torres Strait Islander (hereafter, respectfully, Indigenous) people and six non-Indigenous people who had self-discharged from a major tertiary hospital in Brisbane, Australia, were audio-recorded, transcribed and thematically analysed. Results Study participants all respected hospitals’ vital role of caring for the sick, but the cumulative impact of unmet needs created a tipping point whereby they concluded that remaining in hospital would compromise their health and wellbeing. Five key categories of unmet needs were identified – the need for information; confidence in the quality of care; respectful treatment; basic comforts; and peace of mind. Although Indigenous and non-Indigenous participants had similar unmet needs, for the former, the deleterious impact of unmet needs was compounded by racist and discriminatory behaviours they experienced while in hospital. Conclusions Respectful, empathetic, person-centred care is likely to result in patients’ needs being met, improve the hospital experience and reduce the risk of people self-discharging. For Indigenous people, the ongoing legacy of white colonisation is embodied in everyday lived experiences of interpersonal and institutional racism. Racist and discriminatory behaviours experienced whilst hospitalised are thus rendered both more visible and more traumatic, and exacerbate the deleterious effect of unmet needs. Decreasing self-discharge events requires a shift of thinking away from perceiving this as the behaviour of a deviant individual, but rather as a quality improvement opportunity to ensure that all patients are cared for in a respectful and person-centred manner. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06880-9.
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Affiliation(s)
- Deborah A Askew
- Primary Care Clinical Unit, The University of Queensland, Royal Brisbane & Women's Hospital, Level 8, Health Sciences Building, Qld, 4029, Brisbane, Australia. .,Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, 37 Wirraway Parade, 4077, Inala, Qld, Australia.
| | - Wendy Foley
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, 37 Wirraway Parade, 4077, Inala, Qld, Australia
| | - Corey Kirk
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, 37 Wirraway Parade, 4077, Inala, Qld, Australia
| | - Daniel Williamson
- Aboriginal and Torres Strait Islander Health Division, Queensland Health, 33 Charlotte Street, Qld, 4001, Brisbane, Australia
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Yang S, Liao J, Li S, Hua K, Wang P, Zhang Y, Zhao Y, Gu Y, Li S, Huang J. Risk Factors and Reasons for Treatment Abandonment for Patients With Esophageal Atresia: A Study From a Tertiary Care Hospital in Beijing, China. Front Pediatr 2021; 9:634573. [PMID: 33987150 PMCID: PMC8112547 DOI: 10.3389/fped.2021.634573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study aims to identify the risk factors and reasons for treatment abandonment for patients with esophageal atresia (EA) in a tertiary care hospital in China. Methods: A retrospective study was conducted on 360 patients with EA admitted to Beijing Children's Hospital between January 1, 2007 and June 1, 2020. Medical records for treatment abandonment and non-treatment abandonment patients were compared. Univariate and multivariate logistic regression analyses were conducted to identify potential risk factors for treatment abandonment. Results: After the diagnosis of EA, parents of 107 patients refused surgical repair and discharged against medical advice, and 253 patients underwent surgical repair. Among these 253 patients, parents of 59 patients abandoned treatment after surgery; 52 patients were discharged in an unstable condition, and parents of seven patients abandoned resuscitation leading to death in the hospital. By comparing clinical characteristics between treatment abandonment before surgery (n = 107) and non-treatment abandonment (n = 253) groups, we found that mother's parity >1, unplanned admission to intensive care unit before surgery, associated anomalies, and Gross type A/B were significant independent risk factors for treatment abandonment before surgery. Furthermore, birth weight <2,545 g, being discharged from neonatal center/intensive care unit and other departments, unplanned admission to intensive care unit after surgery, operative time >133 min, admission before 2016, pneumothorax, and anastomotic leakage were significant independent risk factors for treatment abandonment after surgery. The reasons for treatment abandonment included financial difficulties, multiple malformations with poor prognosis, belief of incurability and concerns about the prognosis of the diseases, postoperative complications, and extensive length of intensive care unit stay. Conclusions: Treatment abandonment of children with EA/TEF is still a common and serious problem in China. This study showed that EA/TEF patients in critical conditions, with associated anomalies, Gross type A/B, and who had occurrence of complications had high-risk for treatment abandonment.
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Affiliation(s)
- Shen Yang
- Department of Neonatal Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Junmin Liao
- Department of Neonatal Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Siqi Li
- Department of Neonatal Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Kaiyun Hua
- Department of Neonatal Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Peize Wang
- Department of Neonatal Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yanan Zhang
- Department of Neonatal Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yong Zhao
- Department of Neonatal Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yichao Gu
- Department of Neonatal Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Shuangshuang Li
- Department of Neonatal Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jinshi Huang
- Department of Neonatal Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Liu H, Su D, Guo X, Dai Y, Dong X, Zhu Q, Bai Z, Li Y, Wu S. Withdrawal of treatment in a pediatric intensive care unit at a Children's Hospital in China: a 10-year retrospective study. BMC Med Ethics 2020; 21:71. [PMID: 32787834 PMCID: PMC7425042 DOI: 10.1186/s12910-020-00517-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 08/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background Published data and practice recommendations on end-of-life care generally reflect Western practice frameworks; there are limited data on withdrawal of treatment for children in China. Methods Withdrawal of treatment for children in the pediatric intensive care unit (PICU) of a regional children’s hospital in eastern China from 2006 to 2017 was studied retrospectively. Withdrawal of treatment was categorized as medical withdrawal or premature withdrawal. The guardian’s self-reported reasons for abandoning the child’s treatment were recorded from 2011. Results The incidence of withdrawal of treatment for children in the PICU decreased significantly; for premature withdrawal the 3-year average of 15.1% in 2006–2008 decreased to 1.9% in 2015–2017 (87.4% reduction). The overall incidence of withdrawal of care reduced over the time period, and withdrawal of therapy by guardians was the main contributor to the overall reduction. The median age of children for whom treatment was withdrawn increased from 14.5 months (interquartile range: 4.0–72.0) in 2006 to 40.5 months (interquartile range: 8.0–99.0) in 2017. Among the reasons given by guardians of children whose treatment was withdrawn in 2011–2017, “illness is too severe” ranked first, accounting for 66.3%, followed by “condition has been improved” (20.9%). Only a few guardians ascribed treatment withdrawal to economic reasons. Conclusions The frequency of withdrawal of medical therapy has changed over time in this children’s hospital PICU, and parental decision-making has been a large part of the change.
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Affiliation(s)
- Huaqing Liu
- Health Supervision Institute of Gusu District, Suzhou, 215000, Jiangsu, China
| | - Dongni Su
- Department of Intensive Care Unit, Children's Hospital of Soochow University, No.92, Zhongnan street, Suzhou Industrial Park, Suzhou, Jiangsu, China
| | - Xubei Guo
- Department of Intensive Care Unit, Children's Hospital of Soochow University, No.92, Zhongnan street, Suzhou Industrial Park, Suzhou, Jiangsu, China
| | - Yunhong Dai
- Department of Intensive Care Unit, Children's Hospital of Soochow University, No.92, Zhongnan street, Suzhou Industrial Park, Suzhou, Jiangsu, China
| | - Xingqiang Dong
- Department of Intensive Care Unit, Children's Hospital of Soochow University, No.92, Zhongnan street, Suzhou Industrial Park, Suzhou, Jiangsu, China
| | - Qiujiao Zhu
- Department of Intensive Care Unit, Children's Hospital of Soochow University, No.92, Zhongnan street, Suzhou Industrial Park, Suzhou, Jiangsu, China
| | - Zhenjiang Bai
- Department of Intensive Care Unit, Children's Hospital of Soochow University, No.92, Zhongnan street, Suzhou Industrial Park, Suzhou, Jiangsu, China
| | - Ying Li
- Department of Intensive Care Unit, Children's Hospital of Soochow University, No.92, Zhongnan street, Suzhou Industrial Park, Suzhou, Jiangsu, China
| | - Shuiyan Wu
- Department of Intensive Care Unit, Children's Hospital of Soochow University, No.92, Zhongnan street, Suzhou Industrial Park, Suzhou, Jiangsu, China.
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10
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Guo XY, Woolfenden S, McDonald G, Saavedra A, Lingam R. Discharge against medical advice in culturally and linguistically diverse Australian children. Arch Dis Child 2019; 104:1150-1154. [PMID: 31229953 DOI: 10.1136/archdischild-2019-317063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/23/2019] [Accepted: 05/26/2019] [Indexed: 01/30/2023]
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.
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Affiliation(s)
- Xin Yue Guo
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Woolfenden
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Community Child Health, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Gordon McDonald
- Sydney Informatics Hub, University of Sydney, Sydney, New South Wales, Australia
| | - Aldo Saavedra
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,Centre for Translational Data Science, University of Sydney, Sydney, New South Wales, Australia
| | - Raghu Lingam
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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Predictors of In-Hospital Mortality in Aboriginal Children Admitted to a Tertiary Paediatric Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111893. [PMID: 31146338 PMCID: PMC6603740 DOI: 10.3390/ijerph16111893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/25/2019] [Accepted: 05/26/2019] [Indexed: 01/03/2023]
Abstract
Background: Aboriginal Australian children have higher rates of mortality at younger ages than non-Aboriginal Australian children. We aimed to (i) calculate the case fatality rate (CFR) for Aboriginal and non-Aboriginal children admitted to children's hospitals in New South Wales (NSW) and (ii) identify predictors of CFR. Methods: We used a retrospective cross-sectional analysis of data from electronic medical records for in-patient admissions to the Sydney Children's Hospitals Network (SCHN) over five years (2011-2015). Logistic regression analysis was used to identify predictors of mortality and excess deaths in Aboriginal children were calculated. Results: There were 241,823 presentations over the 5-year period. The CFR for Aboriginal children was double that of non-Aboriginal children (0.4% vs. 0.2%, p = 0.002), with Aboriginal children under 2 years and from remote and regional Australia at highest risk of excess mortality. Predictors of death for all children in order of significance were: Circulatory disorders (Odds Ratio (OR) 17.16, p < 0.001), neoplasm/blood/immune disorders (OR 2.77, p < 0.001), emergency admissions (OR 1.94, p < 0.001), aboriginality (OR 1.73, p = 0.005) and longer length of stay (OR 1.012; p < 0.001). Conclusions: Our data show that Aboriginal children are almost twice as likely to die than non-Aboriginal children. In particular, excess deaths in Aboriginal children are most commonly from outer regional and remote areas and children aged under 2 years with perinatal or circulatory conditions.
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