Ending Early Discharges: How Providers Can Keep Patients Engaged and Committed to Their Recovery Journey

A significant percentage of patients exit substance use disorder (SUD) treatment early. Whether you define this as attrition, unexpected discharge, or leaving “against medical advice”, this challenge is ubiquitous within recovery circles. While actual rates of early discharge vary widely depending on the treatment setting and specific circumstances, most facilities are seeking ways to improve in this area.

All Together Recovery is a treatment facility based in Danville, Kentucky. When the organization launched in December of 2024, Executive Director Nick Rhodus set bold targets for patient retention.

“Our goal from day one has been 20% early discharges, which is aggressive but also achievable, Rhodus said. “You can expect one out of every five patients to leave early no matter what you do. From there, much can be done to limit the number of patients who do not complete the recommended course of treatment.”

Currently, the facility is averaging an early discharge rate of 25%, well within reach of the ultimate target.

One of the ways Rhodus and the All Together Recovery team successfully keep patients engaged is by anticipating when and why most patients quit on recovery.

Specifically for their treatment facility, he found the three main exit ramps for patients – the first 2-3 days when withdrawal symptoms are acute; at two weeks, when withdrawal is in the rear view, and patients start to feel better; and the 28-day mark, which for many patients is viewed as the traditional completion of treatment.

“If you can anticipate the specific points in time when patients are most likely to leave, you can take action to mitigate those early discharges,” Rhodus said. “In the first few days, you know withdrawal symptoms are at their worst, and that patients are likely to feel isolated, so effectively using peer support and medication can get them through that phase. When it comes to the latter two stages, you can counter by creating an environment they don’t want to run away from and anchoring them with long-term goals that clearly show the value of sticking with the program.”

Two other strategies that work well for Rhodus and team are transparency and culture.

From the beginning, the All Together Recovery team is open and honest with patients about what to expect from treatment.

“Being transparent up front is really important,” Rhodus said. “You have to be honest with patients about the potential time commitment and what else will be happening. Share what you know, and what you don’t yet know. Transparency leads to trust, and without trust we can’t be successful.”

At the same time, there are clear expectations set for the culture the team is fostering within the facility.

“We are focused on creating a positive culture where patients feel supported, find value, and want to be a part of it,” Rhodus said. “We make it very clear what we expect of patients, what we expect of staff, and we hold each other accountable for creating the culture we all want. It’s really important to us that patients feel heard, seen, and connected.”

While Rhodus and team have done a lot on their own to ensure retention rates remain high, they also value support from Wayspring as a collaborative partner.

“Wayspring has been fantastic for us in terms of bringing people and resources to the table to help support our patients,” Rhodes said. “It’s an effective partnership because both sides put patient needs first and act in the best interest of the individual. With Wayspring, we can help prepare our patients for life after recovery and make sure they have what they need to be successful with aftercare. It gives them a clearer vision for their future and makes it less likely they terminate.”

Most providers understand that unexpected discharges are important to address, but often they don’t fully understand the underlying causes for patients prematurely disengaging from treatment, or the best next steps to take. This is another area where Wayspring can offer value, according to Dr. Michael Frost, Wayspring’s Chief Medical Officer.

“We can help providers identify what their true percentage of early discharges is, examine the most common reasons patients are leaving early, and help them build a plan to implement positive change,” Dr. Frost said. “The good news is that many of the adjustments we recommend are actually small shifts to the process. You can see improvement right away.”

Additionally, Dr. Frost suggests most of these changes will not require additional financial investment or staff resources. In fact, some facilities find that revenue increases and staff time is spent more efficiently when they reduce the percentage of unexpected discharges.

Dr. Frost also provided a short list of key considerations for providers who want to examine and improve their discharge metrics. These suggestions are based on Wayspring’s efforts and experience with providers across the country.

Know where you stand. You need data and insight to fully understand the opportunity and how to improve.
Approach your overall process with an open mind. Discover the trends, and listen to what the data tells you. Then commit to constructive problem-solving.
Make sure the treatment fits. The new edition of The ASAM Criteria can help ensure you consistently provide the right level of care for every patient.
Dial in your approach to withdrawal and make sure sleep, mood, and anxiety are attended to properly.
Strategically manage the milieu within your facility. Personalize how patients are assigned to peer groups based on demographics, personality fit, etc. This can go a long way to making specific patients feel more comfortable and, in turn, help them commit to the program.
Individualize care plans based on specific needs. The legacy construct of set blocks for treatment programs (i.e., 30 days) isn’t conducive for every patient. Adjusting the course of treatment based on individual needs will produce better outcomes.
Maintain a solid plan for conflict resolution and responding to potential crises. The ability to quickly diffuse friction helps minimize the impact of interpersonal conflicts.
Lean on available resources such as Wayspring to strengthen your approach and extend your impact.

Want to learn more about All Together Recovery’s approach to patient retention or how Wayspring can support your facility in this area? Contact us today to spark a conversation.

Dr. Frost also provided a short list of key considerations for providers who want to examine and improve their discharge metrics. These suggestions are based on Wayspring’s efforts and experience with providers across the country.

Are You a Wayspring Member?