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Should Let Them Go? Study on the Emergency Department Discharge of Patients Who Attempted Suicide

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주제분류정신과학

초록

Objective The purpose of this study was to analyze the characteristics and factors of voluntary discharged patients after suicide attempt and analyze the effectiveness of follow-up measures. Methods Total 504 adult patients aged 14 years and over, who visited a local emergency medical center from September 1, 2013 to December 31, 2015 were enrolled and retrospectively reviewed. We analyzed the relationship with voluntary discharge group (VDG) among basic characteristics, suicidal attempt variables, outcome variables related to suicide attempts, and treatment related variables comparing with normal discharge group (NDG). Results Of the total 504 suicide attempts, three hundred eleven (61.7%) patients were VDG and 193 (38.2%) were NDG. The proportion of patients who completed the community service linkage were 18.7% (36/193) in NDG, compared with 7.7% (24/311) in VDG (p<0.05). In addition, the ratio of the patients who visited psychiatric outpatient department in NDG were 57.0% (110/193), more than four times as likely as 14.5% (45/311) in VDG (p<0.05). Conclusion Over sixty percent of suicide attempters discharged against medical advice. Further various aspects of national supportive measures including strengthening case management service should be considered.

Abstract

Objective The purpose of this study was to analyze the characteristics and factors of voluntary discharged patients after suicide attempt and analyze the effectiveness of follow-up measures. Methods Total 504 adult patients aged 14 years and over, who visited a local emergency medical center from September 1, 2013 to December 31, 2015 were enrolled and retrospectively reviewed. We analyzed the relationship with voluntary discharge group (VDG) among basic characteristics, suicidal attempt variables, outcome variables related to suicide attempts, and treatment related variables comparing with normal discharge group (NDG). Results Of the total 504 suicide attempts, three hundred eleven (61.7%) patients were VDG and 193 (38.2%) were NDG. The proportion of patients who completed the community service linkage were 18.7% (36/193) in NDG, compared with 7.7% (24/311) in VDG (p<0.05). In addition, the ratio of the patients who visited psychiatric outpatient department in NDG were 57.0% (110/193), more than four times as likely as 14.5% (45/311) in VDG (p<0.05). Conclusion Over sixty percent of suicide attempters discharged against medical advice. Further various aspects of national supportive measures including strengthening case management service should be considered.

참고문헌 (12)

  1. 2016 White Book, "Ministry of Health & Welfare", Korea Suidice Prevention Center, ~ (2016)
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  7. Brook M, "Discharge against medical advice from inpatient psychiatric treatment: a literature review", Psychiatr Serv, 57, pp.1192~1198 (2006)[DOI]
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  9. Targum SD, "An intervention to reduce the rate of hospital discharges against medical advice", Am J Psychiatry, 139, pp.657~659 (1982)[DOI]
  10. Passik SD, "Empathy and the failure to treat pain", Palliat Support Care, 5, pp.167~172 (2007)
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  12. Levy F, "The importance of a proper againstmedical-advice(AMA) discharge: how signing out AMA may create significant liability protection for providers", J Emerg Med, 43, pp.516~520 (2012)[DOI]

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