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Worse Outcomes Seen When Patients Leave Hospital Against Medical Advice

Posted August 28, 2013

 Patients who leave the hospital against medical advice are more likely to be readmitted or die than other patients, a new long-term study finds.

Canadian researchers examined 1.9 million adult hospital admissions and discharges over nearly 20 years in the province of Manitoba. In 1.1 percent of those cases, patients left the hospital against medical advice.

People who left the hospital against medical advice were three times more likely than other patients to be readmitted within 30 days, according to the study, which appears Aug. 26 in the CMAJ (Canadian Medical Association Journal).

One-quarter of those readmissions occurred within a single day and 75 percent within two weeks. Those most likely to be readmitted were older, male, poorer and had been hospitalized multiple times in the previous five years.

Patients who left the hospital against medical advice were two and a half times more likely to die within 90 days than other patients, according to a journal news release.

“For both hospital readmission and death, the elevated rates among patients who left against medical advice started out high and then declined, but remained elevated to at least 180 days,” wrote Dr. Allan Garland, of the faculty of medicine at the University of Manitoba, and colleagues.

The increased risk of readmission and death among patients who leave the hospital against medical advice may be linked to both the illness for which patients were hospitalized and their health behaviors, such as ignoring medical advice or medication orders, the researchers said.

Although the study found a link between leaving against medical advice and worse outcomes for hospital patients, it did not establish a cause-and-effect relationship.

“Although strategies targeted at trying to convince patients not to leave prematurely might diminish the early effects of leaving against medical advice, reducing the persistently elevated risk will likely require longitudinal interventions extending beyond hospital admission,” the researchers concluded.

SOURCE: CMAJ (Canadian Medical Association Journal), news release

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