New Risk Tools Aim to Reduce Overdose Deaths After Hospital Discharge

Recent research published in the Canadian Medical Association Journal highlights the potential of risk prediction tools to identify patients most vulnerable to overdose and death following a hospital discharge against medical advice. Patients who leave the hospital before receiving physician approval are at a significantly higher risk of adverse outcomes, including a doubling of mortality rates and a tenfold increase in the likelihood of experiencing an illicit drug overdose within the first 30 days after discharge.

In the United States, approximately 500,000 individuals and around 30,000 people in Canada initiate such discharges annually. The study, led by Dr. Hiten Naik from the University of British Columbia, emphasizes the importance of integrating risk assessment with clinical judgment to facilitate informed discussions between healthcare providers and patients regarding the implications of leaving the hospital early.

Understanding the Risk Factors

The research team developed two risk prediction models aimed at assessing the likelihood of death from any cause and the risk of drug overdose specifically for those with a history of substance use. Utilizing data from British Columbia, they analyzed two cohorts: one comprising 6,440 adults who had discharged themselves and another with 4,466 individuals with substance use history.

Findings showed that in cohort A, the overall death rate was lower than anticipated, with one death occurring for every 63 discharges. Key indicators of mortality included multimorbidity, heart disease, and cancer. Conversely, cohort B revealed alarming trends among individuals with substance use disorders. Factors such as homelessness, receipt of income assistance, and recent drug overdose experiences were strong predictors of overdose following discharge. Researchers noted that approximately one illicit drug overdose occurred within 30 days for every 19 BMA discharges.

Implications for Healthcare Systems

The authors argue that the immediate period following a BMA discharge represents a critical, yet inadequately addressed, opportunity for overdose prevention. They propose that hospitals and health systems adopt these risk prediction models to streamline the management of high-risk cases. This could involve automated alerts and enrollment in support programs that provide necessary resources to vulnerable patients.

“These models offer a starting point for identifying patients who are high risk and may benefit from greater support,” the authors wrote. By quantifying risk, clinicians can engage in more constructive, patient-centered conversations about the decision to discharge against medical advice, thereby potentially mitigating the associated risks.

As healthcare systems continue to grapple with the complexities of early discharges, the study serves as a call to action for the integration of risk assessment tools in clinical practice. The full study is set to be published in 2025 and is expected to inform future policies aimed at reducing overdose rates and improving patient outcomes following hospital discharge.