Staff must communicate mortality risk to patients leaving against medical advice

Hospital staff should communicate the risks in patients' leaving against medical advice. A study in American Journal of Medicine revealed that, not only are those patients more likely to bounce back, but they are twice as likely to die.

Until now, it was only assumption that patients leaving against medical advice didn't fare as well, but "now we know" that it is specifically associated with a higher risk of death, William N. Southern, hospital medicine chief of Albert Einstein College of Medicine and Montefiore Medical Center, told Reuters Health.

Researchers at the New York hospital found that 1.3 percent of patients who left before advised died within 30 days, compared to 0.7 percent of patients who stayed until a planned discharge--a rate twice as high. Refusing treatment is a patient's right, but Southern noted that patients also leave for other reasons, such as work or family obligations.

Study authors also stated that patients who signed out early were more likely to abuse substances, have psychiatric conditions or have Medicaid coverage, but researchers accounted for those differences and still came to the same conclusion.

"Our findings suggest that whatever your baseline (death) risk is--whether it's high or low--it would be twice as high if you leave the hospital against medical advice," Southern said.

Southern added, "So it may be that they aren't staying long enough to complete a course of treatment, [b]ut it may also be that they are not getting the follow-up care they may need."

With 500,000 patients signing themselves out of hospitals each year, the associated risks could signal the need for improved follow-up care.  

For more information:
- read the Reuters Health article
- see the study

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