Patients Who Leave The Hospital Against Medical Advice Suffer Worse Outcomes

Most patients admitted to the hospital know that they need to stay until they have been fully assessed and treated.  However, there are certain patient subgroups that leave the hospital before they should.  These patients who leave the hospital against the advice of medical professionals are more likely to be readmitted or die than patients who stay in the hospital until they have been discharged by a medical professional.

Researchers in Canada examined 1.9 million adult hospital admissions and discharges in the Manitoba area over a 20 year period.  In just over 1 percent of cases the patients left the hospital when they had been advised to stay for longer.

The patients who had left the hospital against medical advice were three times more likely to be readmitted within a month when compared to other patients.  In fact, 25 percent of these readmission occurred within a single day and the other 75 percent occurred within two weeks.  The groups of people who were more likely to be readmitted were older, male, poorer, and had, over the past five years, been hospitalized on multiple occasions.  Additionally, the patients who had left the hospital against the advice of medical professionals were two and a half times more likely to die within 90 days when compared to other patients.

The higher risk of readmission and death among patients who leave the hospital against the advice of medical professionals could be linked to both the illness for which the patient had been hospitalized for in the first place as well as the patient’s health behaviors (including ignoring the medical advice or medication orders of medical professionals).

Despite finding a link between leaving the hospital against medical advice and worse outcomes for patients, a cause and effect relationship was not established.  The researchers concluded that with strategies meant to convince patients not to leave the hospital prematurely, the effects of leaving against medical advice might diminish; however reducing the persistent elevated risk may require more changes outside of hospital admissions.

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