Risk prediction tools are emerging as crucial instruments for identifying patients most vulnerable to overdose and death following a “before medically advised” (BMA) discharge from hospitals. Research published in the Canadian Medical Association Journal highlights that individuals who leave the hospital against medical advice face significantly heightened risks. Specifically, these patients are approximately twice as likely to die and ten times more likely to experience an illicit drug overdose within the first 30 days post-discharge.
Every year, around 500,000 individuals in the United States and 30,000 in Canada opt for BMA discharges, often without fully understanding the potential consequences. Dr. Hiten Naik from the University of British Columbia and his co-authors emphasize the importance of integrating risk assessment with clinical judgment. “Calculating a specific patient’s risk of death and drug overdose, combined with clinical judgment and other risk scores, might help clinicians and patients have a constructive, patient-centered discussion about the decision to initiate a BMA discharge,” the authors noted.
Understanding the Risks
The researchers developed two distinct risk prediction models. The first estimates the risk of death from any cause within 30 days of a BMA discharge. The second model specifically addresses patients with a history of substance use, estimating their risk of experiencing an illicit drug overdose. These models were informed by data from British Columbia, examining two cohorts: a general population group of 6,440 adults and a second group of 4,466 individuals with a history of substance use.
Findings show that while the overall incidence of death was lower than expected—one death for every 63 BMA discharges in the general population—certain factors like multimorbidity, heart disease, and cancer were significant predictors of mortality within the 30-day window. In the cohort with a history of substance use, various socioeconomic factors emerged as critical indicators for overdose risks. These included homelessness, reliance on income assistance, and previous incidents of drug overdose.
A Window for Intervention
The study reveals that for patients with a history of substance use, the likelihood of illicit drug overdose is alarmingly high, with about one overdose occurring for every 19 BMA discharges. This statistic suggests that the timeframe immediately following a BMA discharge is a vital opportunity for overdose prevention that has yet to be adequately explored.
To address these challenges, the authors propose that hospitals and health systems implement these risk prediction models as part of their discharge protocols. By automating the identification of higher-risk patients, healthcare providers could trigger alerts and facilitate automatic enrollment in support programs aimed at reducing overdose risks.
“These models offer a starting point for identifying patients who are at high risk and may benefit from greater support,” the authors concluded. The implications of this research could lead to more informed decision-making in healthcare settings, ultimately saving lives and enhancing patient care.
For more information, refer to the study titled “Predicting drug overdose and death after ‘before medically advised’ hospital discharge” in the Canadian Medical Association Journal, DOI: 10.1503/cmaj.250492.
