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Rate of readmission and mortality risks of schizophrenia patients who were discharged against medical advice

Published online by Cambridge University Press:  15 April 2020

A. Valevski ,
G. Zalsman ,
S. Tsafrir ,
R. Lipschitz-Elhawi ,
A. Weizman  and
T. Shohat
A. Valevski*
Affiliation:
Geha Mental Health Center, 1, Helsinki Street, PO Box 103, 49100Petach Tikva, Israel The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
G. Zalsman
Affiliation:
Geha Mental Health Center, 1, Helsinki Street, PO Box 103, 49100Petach Tikva, Israel The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
S. Tsafrir
Affiliation:
Geha Mental Health Center, 1, Helsinki Street, PO Box 103, 49100Petach Tikva, Israel
R. Lipschitz-Elhawi
Affiliation:
Geha Mental Health Center, 1, Helsinki Street, PO Box 103, 49100Petach Tikva, Israel School of Social Work, Bar-Ilan University, Ramat Gan, Israel
A. Weizman
Affiliation:
Geha Mental Health Center, 1, Helsinki Street, PO Box 103, 49100Petach Tikva, Israel The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Felzenstein Medical Research Center, Petach Tikva, Israel
T. Shohat
Affiliation:
Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
*
*Corresponding author. Tel.: +972 3 9258283; fax: +972 3 9259287. E-mail address:[email protected]
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Abstract

Purpose

To compare the readmission and the mortality rates of schizophrenia patients who were discharged against medical advice (AMA) and patients who were discharged by physician recommendation.

Methods

The records (1984–2005) of all consecutive admissions (n = 12,937) of schizophrenia patients (n = 8,052) were reviewed. Out of this group, 673 (8.3%) refused to remain in the hospital and signed a hospital form for discharge AMA. Their records were analyzed for rates of re-hospitalization and mortality at study closure. The records of AMA patients were compared to those of patients with regular discharge (n = 1345).

Results

AMA patients were younger at admission (P<0.001), comprised more males (P<0.01), more were single (P<0.0001), and had a shorter duration of illness than the controls (P<0.05). A total of 49.9% of AMA events occurred within the first 2weeks of hospitalization. The readmission rate was significantly higher for AMA patients than for the controls (P<0.001). The mortality rate as a result of suicide (P<0.0001) and accidents (P<0.05) was higher for AMA patients compared to controls.

Conclusion

The schizophrenia patients discharged AMA have a higher readmission rate and a higher mortality rate due to suicide and accidents compared to non-AMA discharged patients. Patients with AMA discharge warrant special community surveillance to improve outcome.

Keywords

SchizophreniaAgainst medical adviceMortalitySuicide rate
Type
Original articles
Information
European Psychiatry , Volume 27 , Issue 7 , October 2012 , pp. 496 - 499
Copyright
Copyright © European Psychiatric Association 2012

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