Reducing rates of discharge against medical advice in the neonatal intensive care unit in a tertiary care hospital in South India: a mixed‐methods study

Abstract Objective To elucidate characteristics among neonates and their mothers who were discharged against medical advice (DAMA), providers’ perspectives on DAMA the effect of an intervention to reduce in a tertiary care hospital South India. Methods We conducted mixed‐methods study identify at risk DAMA. reviewed charts logit regression analysis calculate adjusted odds ratios (aOR) 95% confidence intervals (CI) determine associations with focus group discussions nurses doctors. developed that included family counselling, supplemental funds for bills involving members Results Of 10 834 neonates, 179 (1.7%) over period. Maternal associated higher previous parity (aOR 1.9, CI 1.1–2.3, P = 0.001). Mothers received antenatal had lower 0.2, 0.1–0.7, 0.039). Neonates birth weight 2.1, 1.7–9.4, 0.002) congenital malformations 3.3, 1.1–5.3, 0.005) also The most commonly cited reasons financial constraints, inadequate counselling perceived poor prognosis. average monthly number decreased from 3.6 (1.6%) 1.5 (0.6%) after our multi‐pronged intervention. Conclusions severe illness prognosis A demonstrated reductions rates This may be trialled similar settings