Shorter Hospital Stay, More Complications?

Early discharge against medical advice led to an increased risk of returning within the next month

(RxWiki News) When patients are checked into a hospital, they are assigned to a team of medical professionals who help them receive the best possible care. But sometimes patients don't complete the recommended treatment plan.

A recent report shows that a significant number of hospital patients check out of the hospital before they are medically advised to do so.

The report found that there are certain groups that were more likely to check out early, like young men, and that early discharge was strongly linked to medical complications.

The report emphasized the importance of doctor-patient communication about treatment plans and staying in the hospital until discharged by a medical professional.

"Stay for the full course of treatment when hospitalized."

The Canadian Institute for Health Information conducted the study to see how common self-discharge was and what the consequences were for patients who did so.

Previous research has shown that early self-discharge increases patients' risk of death and negative health outcomes. The same patients are also more likely to return to the hospital than patients who wait for their doctor to give the OK for their discharge.

The Canadian Institute for Health Information used their administrative data to look at patients who discharged themselves against medical advice and also reviewed their later health outcomes. They analyzed data for 2011-2012.

The Canadian researchers found that, during the study period, 25,137 patients, or about 1.3 percent of all patients who left the hospital discharged themselves against medical advice.

The report noted that previous studies on American populations estimated that about 2.7 percent of American patients left hospitals early.

Several factors made certain patients more likely to leave before their care team recommended them for discharge.

Young people and males were significantly more likely than older adults and females to self-discharge. People who were homeless or lived in low-income neighborhoods were also more likely to leave the hospital early than people with homes and higher incomes.

The data also showed that certain diagnoses were more likely to be associated with early self-discharge. Patients who were diagnosed with a mental illness or substance abuse disorders made up 27 percent of all the patients who left the hospital against medical advice.

Other less common but still notable diagnoses that were linked to early discharge were circulatory, respiratory and digestive issues. The authors suggested that patients with chronic diseases may believe that their health issues are under control after they have received initial treatment, when they actually need more care.

The report also found that 27 percent of self-discharges occurred between 7 pm and 7 am, although only 7 percent of routine, medically advised discharges happen during that time.

Early self-discharge from the hospital was linked to an increased risk of returning to the hospital soon after. Patients who self-discharged were over 3 times more likely to return to an emergency room within the next seven days compared to patients who were discharged by a doctor.

The authors of the report also identified possible solutions for keeping patients in the hospital until they are discharged by a medical care team. For example, clearer communication about the necessity of treatment may encourage patients to stay in the hospital for their full course of treatment.

The report was published by the Canadian Institute for Health Information on October 1.

No funding sources or conflicts of interest were disclosed.


Review Date: 
October 3, 2013