SHM Converge Scientific Abstract ePoster Gallery-Drivers of Self-Directed Discharge in Patients With Opioid Use Disorder

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This chart review examined why patients with opioid use disorder (OUD) leave the hospital by self-directed discharge (SDD, previously called “against medical advice”), a behavior linked to higher readmissions, costs, and worse outcomes. Using Duke University Hospital’s COMET program records from 2019–2022, the authors reviewed a convenience sample of 30 patients with OUD who SDD after receiving an addiction consult.<br /><br />The patients were mostly middle-aged, white, and female, with high rates of psychiatric illness, polysubstance use, and injection drug use. Many also had medical comorbidities, and the most common admission diagnoses were infections. Social challenges were frequent, including unemployment, lack of insurance, and some homelessness, though many had at least some family or partner support. Average hospital stay was about 8 days.<br /><br />Only about half of the patients were started on medications for opioid use disorder (MOUD) before discharge. Common patient-reported reasons for leaving included inadequate pain control or withdrawal management, responsibilities outside the hospital, not wanting to remain hospitalized, desire to smoke, conflicts with hospital policies or staff, and, in many cases, no reason was given.<br /><br />The authors conclude that improving treatment of pain and withdrawal symptoms, increasing access to nicotine replacement therapy, and using more structured narrative-based conversations about discharge decisions may help reduce SDD among patients with OUD.

Asset Subtitle

Anivarya Kumar

Meta Tag

Author List Anivarya Kumar, Dana Clifton, Lucy Cummins, Ryan Slauer

Category Research

Concept Self-directed Discharge

Concept Opioid Use Disorder

Concept Pain Management

Concept Withdrawal Management

Concept Medication for Opioid Use Disorder

Distinguished Non-Finalist

Presenter Organization Duke University School of Medicine

Presenting Author Anivarya Kumar

Track Quality Improvement

Keywords

opioid use disorder

self-directed discharge

hospital discharge

addiction consult

medications for opioid use disorder

withdrawal management

pain control

inpatient care

psychiatric comorbidity

social determinants of health

Self-directed Discharge

Opioid Use Disorder

Pain Management

Withdrawal Management

Medication for Opioid Use Disorder