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07-06-2012 | Legal medicine | Article

Discharge against medical advice increases death risk

Abstract

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MedWire News: Discharge from hospital against medical advice is approximately twice as likely to result in death within 30 days, and significantly more likely to result in readmission, than planned discharge, report US researchers.

Furthermore, "discharges against medical advice have shorter lengths of stay than planned discharges, suggesting that the increased risk associated with discharge against medical advice may be attributable to premature discharge," writes the team in the American Journal of Medicine.

Indeed, early discharge may equate to incomplete medical treatment, which may result in worsening of the patient's condition, and possibly death, say William Southern, from Montefiore Medical Center in New York, and colleagues.

The findings have implications for physicians when discharge against medical advice cannot be avoided; for instance, patients considering leaving hospital despite being advised not to can be told of the increased risks associated with his or her actions, suggest the study authors.

Southern et al reviewed data for 148,810 discharges from a US health system between 2002 and 2008, of which 3544 were against medical advice and 80,536 were planned.

They assessed numbers of discharges, rather than patients, to account for patients who discharged multiple times during the study period.

The team found significantly higher 30-day mortality rates among discharges against medical advice than among planned discharges, at 1.3% versus 0.7%. After adjustment for propensity score (which included factors likely to be associated with discharge against medical advice such as gender, race/ethnicity, insurance type) and sociodemographic and clinical characteristics, the association remained significant.

In an analysis of discharges of propensity-score matched patients, 45 discharges against medical advice resulted in death compared with 23 of planned discharges.

The authors note a similar trend for readmission rates: 30-day readmission was significantly higher among discharges against medical advice than among planned discharges, at 24.7% versus 11.3%.

Furthermore, the matched analysis revealed that significantly more discharges against medical advice led to readmission within 30 days than planned discharges, at 876 versus 586.

Finally, the average length of stay was significantly shorter among discharges against medical advice, at 3.37 days, compared with 4.16 days among planned discharges.

By Sarah Guy

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