Dangers of Leaving the Hospital Before Medically Advised

Highlights:

Before Medically Advised (BMA) discharge increases the overdose risk by 10 times
Younger males with psychiatric or substance use disorders are most affected
Urgent clinical and social support is vital to reduce overdose risk

Critical issue in healthcare: the increased risk of drug overdose among patients who leave the hospital before medically advised(BMA) highlighted by recent research published in the Canadian Medical Association Journal (CMAJ) ().

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‘Did You Know?
Leaving the hospital prematurely can increase the risk of overdose tenfold. #drugoverdose#BMAdischarge #medindia’

Increased Overdose Risk associated with Before Medically Advised(BMA) Discharge

The study reveals that patients who initiate a BMA discharge have a 10-fold increase in the risk of drug overdose within the first month after leaving the hospital. This stark statistic underscores the dangers associated with premature discharge, particularly for vulnerable populations.

Analysis of health data from 189,808 hospital admissions in British Columbia between 2015 and 2019 showed that 3.4% of these cases involved BMA discharges. The patients who opted for premature discharge were predominantly younger males with underlying conditions such as:

Psychiatric illness
Substance use disorder
History of illicit drug use

Comparison with Physician-Advised Discharge: The rate of fatal or nonfatal illicit drug overdose among those who left against medical advice was 10 times higher than among patients who underwent routine physician-advised discharge. This finding remained significant even after controlling for other overdose risk factors.

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Factors Leading to Premature Discharge

Patients leave hospitals prematurely for various reasons, including:

Improperly Treated Pain: Inadequate pain management may drive patients to seek relief outside the hospital.
Cravings: For patients with substance use disorders, cravings can lead to impulsive decisions to leave.
Psychiatric Stress: Emotional and psychological factors can exacerbate existing issues, prompting early discharge.
Conflict with Hospital Staff: Disagreements or conflicts may result in patients feeling compelled to leave.
Restrictions on Movement or Visitors: Limited access to loved ones or mobility can create feelings of isolation and lead to early discharge.

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Implications for Patient Care

Dr. John Staples, the study's senior author, emphasizes the need for heightened awareness among healthcare providers regarding the risks associated with BMA discharges. The interruption of treatment during hospitalization can lead to increased opioid tolerance and potential relapse into heavy drug use once patients return to their usual environments.

It is recommended that healthcare providers offer urgent clinical and social support to patients initiating BMA discharge, particularly those with a history of substance use disorder. These supports are crucial to mitigating the risk of overdose.

Healthcare systems should develop evidence-based protocols aimed at preventing BMA discharges when possible and; Establishing post-departure outreach initiatives to monitor and support patients after discharge.

The findings from this study call for a reevaluation of discharge practices in hospitals, particularly for at-risk populations. By addressing the underlying factors that lead to premature discharges and providing appropriate support, healthcare systems can significantly reduce the risk of drug overdose and improve overall patient outcomes.

Reference:

"Before medically advised" departure from hospital and subsequent drug overdose: a population-based cohort study - (https://www.cmaj.ca/content/196/31/E1066)

Source-Medindia

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