New Risk Models Identify Patients at Overdose Risk Post-Hospital Discharge

Risk prediction tools have emerged as a promising method to identify patients at heightened risk of overdose or death following a “before medically advised” (BMA) hospital discharge. Research published in the Canadian Medical Association Journal indicates that individuals who leave the hospital against medical advice face significantly increased dangers. Specifically, such patients are approximately twice as likely to die and ten times more likely to experience an illicit drug overdose within the first 30 days after discharge.

BMA discharges occur for around 500,000 individuals in the United States and 30,000 in Canada annually. The findings suggest that a combination of risk assessment and clinical judgment could facilitate more informed discussions between healthcare providers and patients regarding the implications of choosing a BMA discharge.

Understanding the Risks

Dr. Hiten Naik from the University of British Columbia, along with his co-authors, emphasizes the importance of calculating an individual patient’s risk of death and overdose. This approach could foster constructive dialogues about the decision to discharge patients early, including evaluating their capacity to make such decisions and exploring strategies to mitigate associated risks.

The research team developed two distinct risk prediction models. The first model estimates the overall risk of death from any cause within 30 days after a BMA discharge, while the second focuses on patients with a history of substance use, specifically estimating the risk of illicit drug overdose.

Using data from British Columbia, the researchers analyzed two cohorts: cohort A, consisting of 6,440 adults from the general population who initiated a BMA discharge, and cohort B, which included 4,466 individuals with a history of substance use.

Key Findings and Implications

In cohort A, the study revealed that deaths were less frequent than anticipated, with one death occurring for every 63 BMA discharges within the 30-day window. Key predictors of death included multimorbidity, heart disease, and cancer.

Conversely, cohort B highlighted that homelessness, reliance on income assistance, opioid use disorder, non-alcohol substance use disorder, prior drug overdose incidents, and discharges from surgical services were significant indicators of the risk of drug overdose post-BMA discharge.

The authors noted that among patients with a history of substance use, illicit drug overdose occurred at a concerning rate, with approximately one incident for every 19 BMA discharges within the same 30-day period. They assert that this timeframe represents a critical opportunity for overdose prevention, which warrants further exploration.

The research team recommends that hospitals and health systems consider employing these risk prediction models to streamline the management of higher-risk BMA discharges. By integrating alerts and automatic enrollment in support programs, healthcare providers could better assist vulnerable patients.

In conclusion, the findings from this research provide a foundational starting point for identifying high-risk patients who may require additional support following a BMA discharge. The ongoing development and application of these risk prediction models could significantly improve patient outcomes and reduce the likelihood of adverse events.

More information can be found in the Canadian Medical Association Journal study titled “Predicting drug overdose and death after ‘before medically advised’ hospital discharge,” set to be published in 2025.