Leave the hospital early can double the chances of returning

Patients who come out of the hospital against the advice of a doctor are twice as likely to return within 30 days as those who leave when doctors say they are ready, reveals a large US study .
"Discharges against medical advice are common among hospitalized patients in the United States, affecting 1-2% of rejections," said Dr. Nilay Kumar, author of the study, of the School of Medicine and Public Health. University of Wisconsin Madison.
Patients released against the advice of a doctor tend to be young men with low socioeconomic status, addiction, mental health disorders and no health insurance coverage, a- he added.
"They tend to leave several times against the advice of a doctor and to be readmitted to different hospitals during this 30-day period," Kumar told Reuters Health.
Kumar badyzed data relating to 23 million hospitalizations of patients over 18 years old.
The 2014 data covered 22 states and more than 2,000 hospitals, notes he in the American Journal of Medicine.
Kumar found that 2.4 million hospitalizations, or about 10%, had had at least one unplanned readmission within 30 days.
In addition, about 290,000 people, or 1.3 per cent, have been on leave against medical advice. About 20% of patients discharged from the hospital against the advice of a physician had a readmission within 30 days, compared with 10% of patients who had received their routine discharge.
Those who left a hospital against the advice of a doctor were also 2.3 times more likely to be readmitted to another hospital and more than 18 times more likely to be released for the opinion of a doctor.
The most common cause of hospitalization in patients who were released later against the advice of a physician was alcohol-related disorders, accounting for 9%, followed by addiction , skin infections, sepsis and complications of diabetes.
"These patients tend to receive fragmented care in the form of readmission to different hospitals," Kumar said.
"Discontinuity of care is badociated with higher rates of hospital mortality and longer stays at the hospital."
Overall, discharge rates for patients against medical advice varied considerably between hospitals, ranging from zero to 12.5%, with an average of about 1%.
About one-third of hospitals were behind two-thirds of outpatients versus medical advice, and these hospitals were more likely to have higher numbers of patients, to be located in larger metropolitan areas of a million inhabitants and to be private hospitals owned by investors.
This could be explained by a higher proportion of patients admitted for addiction, mental illness and homelessness in these hospitals, Kumar said.
"It's important to look at patients' stories as to why they are leaving the hospital, because if we can understand, we may be able to help," said Dr. Jeffrey Berger of NYU Winthrop Hospital in Mineola. , in the state of New York.
Berger, who wrote about the ethical and professional obligations badociated with rejection of medical advice, cited a case, for example, in which an elderly male patient wanted to leave earlier in order to return home to feed his dog.
In another case, an elderly man had to take care of his wife with mental health problems.
"It's important to recognize that behavioral health is often not promoted in communities across the country," said Berger.