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Why do patients leave against medical advice?

ncbi.nlm.nih.gov

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Re: Why do patients leave against medical advice?

#51

Post by malfist »

thenerdhead wrote: post #2

This paragraph caught my eye: > The financial burden is not imposed on the patient only; the healthcare system is also affected by the consequence of leaving against medical advice. Reports have shown that the cost of an average stay was USD 3716.00 for those patients who left as planned. However, patients who left against medical advice and were readmitted had an average bill of USD 10,761.56 for staying 4.7 days in…

I don't think that's what they're proposing. The penalty would be to the hospital for having a high rate of AMA discharges.

Which is exactly what Medicare does to improve outcomes. They apply penalties to the payouts in bad outcomes

Re: Why do patients leave against medical advice?

#52

Post by malfist »

kenjackson wrote: post #40
thenerdhead wrote: post #2

This paragraph caught my eye: > The financial burden is not imposed on the patient only; the healthcare system is also affected by the consequence of leaving against medical advice. Reports have shown that the cost of an average stay was USD 3716.00 for those patients who left as planned. However, patients who left against medical advice and were readmitted had an average bill of USD 10,761.56 for staying 4.7 days in…

> This makes me laugh. As if medical care in the USA isn't already ridiculously inflated. Honestly this is an area where I'd invite Elon Musk to come in and disrupt. In the same way that he disrupted space travel and electric vehicles in part by asking, "do we need to do everything in the expected high cost manner"? Question if you need certain things to be at certain medical grade for everything. I get that staff is…

I think neurolink is a good example of why we don't need Elon disrupting health care

Re: Why do patients leave against medical advice?

#53

Post by Waterluvian »

John23832 wrote: post #43
Waterluvian wrote: post #35

Earlier quoted context omitted.

Bankruptcy may very well do greater collective harm. Pretty horrifying to even have to weigh that variable.

As much as bankruptcy is horrible, it’s does not compare to the immediate harm of a disseminated MRSA infection. Let’s not be hyperbolic.

I think you’re very fortunate to not have known anyone who has had to make that calculation.

Re: Why do patients leave against medical advice?

#54

Post by adastra22 »

kajecounterhack wrote: post #34

My dad had a heart-related scare, but we left the hospital after waiting 10 hours and not being seen (we were checked in an triaged, but that was it). Thank goodness I had prepared multiple meals + brought water but we did not expect that long of a wait, especially for something heart related. After all that time, it just felt less risky to go home and get some baby aspirin. They made us sign a waiver as we left.

> They made us sign a waiver as we left.

Could you have refused?

Re: Why do patients leave against medical advice?

#55

Post by adastra22 »

zabzonk wrote: post #13

people want to be back in their own homes. i was in hospital a year ago (nhs, fractured ankle) and the guys in the whole ward i was on were literally desperate to get out of the place (which wasn't horrible, and i think the nhs is brilliant). it took me probably an extra week to get discharged that it needn't have done. but there is a lot of arse-covering going on.

Why didn’t they just leave? They’re not prisoners.

Re: Why do patients leave against medical advice?

#56

Post by zabzonk »

hondo77 wrote: post #48
jeffbee wrote: post #20

Earlier quoted context omitted.

> people want to be back in their own homes Seriously why are "bad food" and "noisy nurses" not on the list of reasons? People want to eat and sleep and if they feel like their acute medical problem is manageable I can see why they'd want to leave.

This. I was hospitalized for 12 days a couple months ago. At the end, I was going to leave if I wasn't discharged by a certain day because I couldn't take the food anymore. Fortunately, it didn't come to that but, my god, the food was horrible. And I'm not a fussy eater. I did my best to work with what I had, and had friends bring in food from the outside (I wasn't on any restrictions) but I finally reached the end o…

ah, you should have spent 5 years at a british boarding school - after that, you will be able to eat and enjoy almost anything! the only things i really draw the line at are whelks and tripe. neither of which are normal hospital food.

Re: Why do patients leave against medical advice?

#57

Post by petsfed »

kajecounterhack wrote: post #36
petsfed wrote: post #33

Earlier quoted context omitted.

Seriously! When my first child was born, we stayed as long as possible, basically until the nurses more or less kicked us out. There was tons of support, and it was as pleasant an environment as I can easily imagine. For baby #2, the focus was 100% on getting the nurse and doctor through their appointed tasks. 14 hour old baby is actively nursing? Too bad, hand her over, its time to do the measurements. We got so fed…

They let you leave without checking out? Our hospital was very tight on security because baby identity verification is a whole thing.

Instead of continuing to wait for the nurse doing their rounds, we went up to the nurse's station, stated our intent to leave, waived off all the "we really think you should stay", then they matched up the ID tags, cut them off, and away we went.

Re: Why do patients leave against medical advice?

#58

Post by zabzonk »

adastra22 wrote: post #55
zabzonk wrote: post #13

people want to be back in their own homes. i was in hospital a year ago (nhs, fractured ankle) and the guys in the whole ward i was on were literally desperate to get out of the place (which wasn't horrible, and i think the nhs is brilliant). it took me probably an extra week to get discharged that it needn't have done. but there is a lot of arse-covering going on.

Why didn’t they just leave? They’re not prisoners.

no, they are not. but if you want to get continuing support, you need to go along with what the medics and ancillary staff are saying. for example, physiotherapy.

Re: Why do patients leave against medical advice?

#59

Post by 0xDEFACED »

My ~18 month old son is medically complex, and his pediatricians send him to the ER basically every other week. ER docs run a bunch of tests, shrug and say LGTM and send us home. The hospital is an hour away, and they never get any closer to figuring out what the problem is (just follow up with X specialist in Y months). My wife and I are sick of it, but we’re worried that if we don’t take him in when they tell us to that CPS might get involved. So off we go, wash rinse repeat.

All of that to say, if someone wants to leave early, I get it.

Re: Why do patients leave against medical advice?

#60

Post by apwheele »

_a_a_a_ wrote: post #27
apwheele wrote: post #5

Earlier quoted context omitted.

Part of my job I build predictive models to identify individuals at high risk of 'readmission' (it impacts billing, hence why healthcare systems are interested). Conditional on an individual's history (e.g. do you have diabetes, other comorbidities, etc.), I haven't found much evidence that leaving against Dr advisement matters all that much for predicting readmission.

> I haven't found much evidence that leaving against Dr advisement matters all that much for predicting readmission maybe cos they're dead

So although tongue-in-cheek, it is an interesting question when dealing with medical records data (in particular I deal with insurance claims data in the US).

So to be clear, I know the person is alive when discharged (there is a code for death, as well as to hospice for example, in which you don't want to look at readmission either).

So a scenario in which someone is discharged, has a follow up heart attack, goes to ER and dies I would observe. The case the person dies and does not go to the hospital though I would not observe (no follow up insurance claim).

The latter scenario certainly happens -- how often it happens and how much it would bias my estimate in this case I am not sure.

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