People who leave hospital against their doctors' orders are more likely to be readmitted to hospital or die, according to a new study in CMAJ (Canadian Medical Association Journal).
"Leaving the hospital against medical advice was associated with increased risks of readmission to hospital and death that persisted for at least 6 months," writes Dr. Allan Garland, Faculty of Medicine, University of Manitoba, Winnipeg, with coauthors. "Potential mechanisms for these associations directly related to the patients' acute illness include more severe illness or incomplete treatment of the illness."
Researchers looked at 1 916 104 adult admissions and live discharges over almost 20 years (1990) in Manitoba to determine rates of unplanned admission to hospital within 30 days and death within 90 days after discharge. There were 21 417 (1.1%) instances of patients leaving hospital against medical advice. People who left hospital against medical advice had 3 times the rate of readmission in the month following. Of readmissions within 30 days among patients who left hospital against medical advice, one-quarter occurred within 1 day and 75% within 2 weeks. People who were older, male, of lower socioeconomic status and who had multiple admissions to hospital in the preceding 5 years were more likely to be readmitted. The odds of death within 90 days were two and a half times higher for people who left hospital against medical advice.