title: Identifying and Addressing the Hidden Reasons Why Patients Refuse Discharge From the Hospital.
abstract: BACKGROUND
  Consultation-liaison psychiatrists are often asked to evaluate patients who refuse discharge from a medical facility. Literature to guide clinicians on the management of these patients is very limited.
  
  
  OBJECTIVE
  This article seeks to explain this phenomenon through a case series, provide a differential diagnosis of patients who request to stay in the hospital, as well as provide clinicians with direction in the management of these difficult situations.
  
  
  METHODS
  We discuss a case series of 3 patients treated at a large academic medical center, who refused discharge, discuss potential differential diagnoses, and provide management recommendations to guide clinicians.
  
  
  CONCLUSIONS
  Providing care for a patient who refuses discharge can present several dilemmas for the treatment provider. Additionally, patients who refuse discharge may face emotional, physical, and financial costs secondary to continued unnecessary medical hospitalization. A variety of psychiatric conditions may contribute to a patient׳s desire to stay in the hospital.
  
  
  CONCLUSIONS
  Patients who refuse medical discharge can present unique challenges for hospital-based medical providers as well as consultation psychiatrists who care for these patients. Careful consideration of diagnostic etiologies as well as coordination of care across the treatment team may be required to manage these unique and challenging cases.
authors.affiliation: Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN. Electronic address: jo.e.wilson@vanderbilt.edu.
authors.forename: Jo Ellen
authors.initials: JE
authors.lastname: Wilson
authors.affiliation: Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: John
authors.initials: J
authors.lastname: Shuster
authors.affiliation: Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Ama A
authors.initials: AA
authors.lastname: Rowe
authors.affiliation: Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Sheryl B
authors.initials: SB
authors.lastname: Fleisch
authors.affiliation: Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Amanda
authors.initials: A
authors.lastname: Wilson
authors.affiliation: Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Nicolson
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications; D003937:Diagnosis, Differential; D058999:Drug-Seeking Behavior; D005162:Factitious Disorders / Q000150:complications / Q000175:diagnosis*; D001068:Feeding and Eating Disorders / Q000150:complications; D005260:Female; D015658:HIV Infections / Q000150:complications; D006760:Hospitalization; D006798:Housing; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications; D009293:Opioid-Related Disorders / Q000150:complications / Q000175:diagnosis; D010349:Patient Compliance; D010351:Patient Discharge; D011570:Psychiatry; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012017:Referral and Consultation; D019966:Substance-Related Disorders / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult