Research published in the Canadian Medical Association Journal reveals that risk prediction tools can effectively identify patients at high risk of overdose and death following a discharge from hospital against medical advice. The study emphasizes that patients who leave the hospital “before medically advised” (BMA) are significantly more likely to experience fatal outcomes or drug overdoses shortly after their discharge.
Understanding the Risks of Early Discharge
Every year, approximately 500,000 individuals in the United States and 30,000 in Canada opt for BMA discharges. The findings indicate that these patients are about twice as likely to die and around ten times more likely to suffer an illicit drug overdose within the first 30 days post-discharge. This alarming statistic highlights the urgent need for healthcare systems to address the vulnerabilities of these patients.
Dr. Hiten Naik from the University of British Columbia, along with co-authors, notes that by calculating a patient’s specific risk for overdose and death, clinicians can engage in more informed discussions with patients regarding BMA discharge decisions. The combination of risk estimates and clinical judgment can lead to better assessments of a patient’s capacity to make such decisions, ultimately aiming to mitigate potential risks associated with early discharge.
Research Methodology and Findings
The researchers developed two distinct risk prediction models. One model estimates the overall risk of death from any cause during the 30 days following a BMA discharge, while the other focuses on patients with a history of substance use, evaluating the risk of illicit drug overdose. The study utilized data from British Columbia, analyzing two cohorts: cohort A comprised 6,440 adults from the general population who initiated BMA discharges, and cohort B included 4,466 individuals with a history of substance use.
In cohort A, the findings revealed that while the overall risk of death was lower than anticipated, with one death occurring for every 63 BMA discharges, certain factors were strong predictors of mortality. These included multimorbidity, heart disease, and cancer. Conversely, cohort B highlighted that factors such as homelessness, income assistance, opioid use disorder, and a history of drug overdose were strong indicators of the risk for overdose following BMA discharge.
The authors point out that for individuals in cohort B, illicit drug overdose was a frequent outcome soon after leaving the hospital. Specifically, there was approximately one illicit drug overdose within 30 days for every 19 BMA discharges. This finding underscores the critical window for potential overdose prevention interventions that may currently be overlooked.
Recommendations for Healthcare Systems
To address these risks, the authors propose that hospitals and health systems utilize the newly developed risk prediction models. By automating the assessment of high-risk BMA discharges, health systems can implement alerts and facilitate automatic enrollment in support programs for at-risk patients. Dr. Naik and his team believe that these models can serve as a foundational step towards identifying patients who may greatly benefit from enhanced support during this vulnerable period.
The study concludes that integrating risk prediction into clinical practice not only aids in patient care but may also alleviate the moral distress healthcare providers experience when faced with BMA discharges. These insights could foster a more patient-centered approach to hospital discharges, ultimately saving lives and improving patient outcomes.
For further details, refer to “Predicting drug overdose and death after ‘before medically advised’ hospital discharge,” published in the Canadian Medical Association Journal.
