The Impact Of An Addiction Medicine Consult Service On “Against Medical Advice” Discharges


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Patients suffering from addiction and complications of substance use disorder (SUD) increase the cost of health care in multiple ways including longer lengths of stay and higher rates of readmissions (Englander et al, 2020). Additionally, patients with SUD are significantly more likely to leave the hospital against the advice of their care team compared to patients without SUD ((Simon, Snow and Wakeman, 2019; Ti and Ti, 2015). When a patient leaves the hospital against medical advice of their care team, this is termed a discharge against medical advice (AMA). It has been identified that in patients who have SUD and are discharged AMA there is an even higher rate of readmission, multiple readmissions and higher in-hospital mortality (Choi, 2011). At Grant Medical Center (GMC), we began an Addiction Medicine Consult Service in spring of 2019. Recognizing the high risk nature of our patients for AMA discharges, we reviewed data from two 6 month periods of time (one prior to initiation of consult team and one after) to evaluate the impact of our service on the rates of discharges AMA and 30 day readmissions. The results showed that for those patients who received an addiction medicine consult their AMA discharge rate was 17.7%, compared to the group that did not receive an addiction medicine consult at 5.5%. This paper will explore potential differences between groups receiving consults versus not receiving consults including payor mix, zip code of residence and other indicators of social determinants of health (SDoH). This is an opportunity for our team to use this information, among other experiences, to focus the next steps of our addiction medicine work including a focus on our patients’ multiple complex situations (medical and SDoH), expanded education for all hospital staff and engaging providers in prescribing medications for SUD.



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