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Leaving Hospital Against Medical Advice Linked to Readmission, Early Death

Update Date: Aug 26, 2013 02:04 PM EDT
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Leaving the hospital against doctors' orders may put patients at risk of readmission or early death.

A new study revealed that patients who leave hospital against medical advice are at greater risk of readmission and death for at least six months.

"Potential mechanisms for these associations directly related to the patients' acute illness include more severe illness or incomplete treatment of the illness," researchers wrote in the study.

The latest research involved 1,916,104 adult admissions and live discharges over almost 20 years (1990) in Manitoba, Canada. Researchers looked at the rates of unplanned admission to hospital within 30 days and death within 90 days after discharge. 

Overall, there were 21,417 cases of patients leaving hospital against medical advice.

The study revealed that people who left hospital against doctors' orders were three times more likely to be readmitted within 30 days and two and half times more likely to die within 90 days.

The findings revealed that one-quarter of the readmission occurred within 1 day and 75 percent within two weeks. Patients who were older, male, of lower socioeconomic status and who had multiple admissions to hospital in the preceding five years were more likely to be readmitted, according to researchers.

"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," researchers wrote.

Researchers say that the higher levels of risk may be associated to both the illness for which the patients were admitted to hospital or to their characteristics or health behaviors, like not following medical advice or adhering to their prescribed medications.

 "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," researchers concluded.

The findings are published in the CMAJ (Canadian Medical Association Journal).

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