Current Medical Issues

Aim: The aim was to evaluate the discharge letters of patients who went “against medical advice” (AMA) from the emergency department (ED) before and after the introduction of a preformatted discharge letter in a tertiary care center in India. Methods: A prospective clinical audit of case sheets of 200 patients who presented to the ED and later went AMA were evaluated in two different time frames. The discharge letters of the first 100 case sheets were evaluated during September–October 2018 time period, and the second 100 case sheets were evaluated during February–March 2019 time period after the introduction of a preformatted discharge letter. Descriptive analysis was used to measure frequency and percentages. Results: The proportions of data recorded in the discharge letters of patients who went AMA before and after the use of a preformatted discharge letter are: cases where discharge letter was given, 74% versus 89%; cases where discharge letter was written by the concerned department, 67.5% versus 93.25%; cases where clinical details were mentioned completely, 86% versus 100%; cases where time of discharge was mentioned, 19% versus 89%; and the cases where name of the doctor who was discharging the patient was mentioned, 20% versus 86.5%. Conclusions: The audit highlighted the shortcomings in the “discharge against medical advice” letters which were rectified using preformatted discharge letters. This was evident from the data analyzed from the second audit cycle. Provision of a standard uniform preformatted discharge letter to every patient leaving the ED would be a step forward in ED current practices and quality improvement.