Patients discharged from hospitals against medical advice face significant risks, including overdose and death. Research published in the Canadian Medical Association Journal highlights how risk prediction tools can identify those most vulnerable after a “before medically advised” (BMA) discharge. Findings indicate that individuals who leave the hospital against the advice of a physician are approximately twice as likely to die and about 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 initiate BMA discharges. According to Dr. Hiten Naik from the University of British Columbia, these risk assessment tools could facilitate informed discussions between clinicians and patients about the potential dangers of leaving the hospital prematurely. The aim is to evaluate the patient’s capacity to make such a decision and explore strategies to mitigate risks following a BMA discharge.
Understanding Risk Factors and Outcomes
The study introduces two distinct risk prediction models. The first estimates the likelihood of death from any cause within 30 days of a BMA discharge. The second focuses on patients with a history of substance use, assessing their risk of experiencing an illicit drug overdose. By analyzing data from British Columbia, researchers evaluated two cohorts: cohort A, comprising 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.
In cohort A, the findings revealed that deaths were less frequent than anticipated, with one death occurring within 30 days for every 63 BMA discharges. Strong predictors of mortality included multimorbidity, heart disease, and cancer. For cohort B, factors such as homelessness, reliance on income assistance, opioid use disorder, and a history of overdose significantly increased the likelihood of drug overdose following BMA discharge. Researchers noted that among this group, illicit drug overdoses were relatively common, with approximately one overdose occurring within 30 days for every 19 BMA discharges. This finding underscores the importance of this period as a critical opportunity for overdose prevention.
Implications for Healthcare Systems
The authors propose that hospitals and health systems could leverage these risk prediction models to enhance the management of higher-risk BMA discharges. By automating alerts and enrolling individuals in support programs, healthcare providers could better identify patients who might benefit from additional assistance.
Dr. Naik and his co-authors emphasize the potential of these models to alleviate clinician moral distress associated with BMA discharges by providing clearer risk assessments. They suggest that understanding a specific patient’s risks can foster more productive conversations about their care and decision-making processes.
The study concludes that while the tools developed represent a starting point, further exploration and integration into clinical practice could significantly enhance patient safety following hospital discharges. For more detailed information, refer to the article “Predicting drug overdose and death after ‘before medically advised’ hospital discharge” in the Canadian Medical Association Journal, published in 2025.
