NAPLES — Going into the hospital doesn’t rank high on anybody’s list, but the number of patients who leave the hospital against doctors’ orders is on the rise.
An increase in patients leaving hospital beds within the Lee Memorial Health System may prompt officials to look at new measures to help prevent it, said Dr. Charles Krivenko, chief medical officer for the Lee Memorial system.
“It’s an interesting trend,” he said “We have to start thinking more about prevention strategies.”
The Agency for Healthcare Research and Quality has released a new report that the incidence of patients leaving hospital beds “against medical advice” has risen 39 percent from 1997 to 2007.
Patients who self-discharge accounted for 1.2 percent of all hospital discharges in 2007, according to the federal agency that works on health-care quality improvement initiatives.
The reasons cited are finances and stress, family emergencies, self-assessment of their condition, alcohol or substance abuse, and mental illness. The findings were derived from hospitalization data reported by states for a national cost and utilization project.
Nationwide, 368,000 hospital patients left against medical advice in 2007 compared to 264,000 patients in 1997, according to the report.
Uninsured patients and those on Medicaid accounted for nearly half of the patients who self-discharge. It is more common among men than women.
The five principal diagnoses among these patients are nonspecific chest pains, alcohol-related disorders, substance-related disorders, mood problems and diabetes with complications.
In general, more lower-income patients are likely to leave hospitals early and incidence is higher in urban areas than rural communities.
The agency says understanding the characteristics of hospital stays that result in patients leaving against medical advice “is critical to designing strategies to prevent premature hospital departures that could result in adverse health outcomes.”
Typically the agency doesn’t interpret the data, but would hope hospitals take a look at what’s going on, said Roxanne Andrews, a senior researcher who wasn’t involved in the study.
“Patients who leave the hospital against medical advice are placing themselves at risk and other studies show they are placing themselves at risk,” she said.
These patients are more likely to cause their health to worsen and are more likely to be readmitted within 30 days, according to the report.
The Lee Memorial system, which operates four hospitals in Lee County, said its rate for patients leaving against medical advice has gone up and is about the same as the national rate, said Krivenko, the chief medical officer.
In 2004, Lee Memorial records show, 456 patients left against doctors’ orders out of 67,000 discharges, for a rate of 0.68 patients leaving against doctors’ orders, he said. The data is for all four hospitals in the Lee Memorial system.
But in 2009 through July, the rate so far is 1.08 percent, he said.
Each year since 2004, the rate of self-discharging has inched upward, he said.
Lee Memorial Hospital near downtown Fort Myers has the highest rate -- 1.96 percent of discharges so far this year were self-made by the patient, he said.
That’s probably due to a combination of factors, including the trauma center being there, more drug and alcohol problems in the city of Fort Myers, and more patients being detained under the state’s Baker Act law for mental evaluations who are admitted to that hospital campus.
The hospital system is focused on watching out for patients who may be a suicide risk but hasn’t focused as much on patients who leave against medical advice, he said.
Patients may not be satisfied with their care or may not be able to cope mentally with their illness, he said.
“Sometimes you just can’t assure patients,” he said. “They are in denial and want out and there’s nothing you can do. People who are dealing with an illness and want to get out don’t care or have anxiety and they say ‘I’m leaving.’ It’s probably an emotional behavior. A lot of the cases they may be overwhelmed by their illness or may have phobias about being in the hospital.”
Mark Milner, director of clinical outcomes management for the NCH Healthcare System in Collier County, said NCH’s Downtown Naples or North Naples hospitals have few incidences of patients leaving before they should.
There’s been no more than five cases of that in the past year, he said.
“It’s very rare,” Miller said, but added it is a patient’s right issue. “Our goal is to make them fully aware of what that choice means.”
In some circumstances, the patient may be elderly and is the caretaker for an elderly spouse at home and the patient is more concerned about the person at home than their own well-being, he said. That’s when a case manager will be brought in to find respite care for the person at home.
Not having insurance doesn’t appear to be the reason patients leave the hospital early, but not being from the area and deciding to not follow a course of treatment do appear to play roles, he said.
“We are really on top of it and stay on top of it but it doesn’t seem to be an issue now,” he said.