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Hospital discharge during December holidays tied to more readmissions, deaths


(Reuters Health) – – Patients sent home from the hospital around Christmas time are more likely to have bad outcomes compared to those discharged at other times, a Canadian study suggests.

Researchers poring through data from Ontario hospitals found that patients discharged during the Christmas season were more likely to die or to be readmitted during the following 30 days compared to patients discharged in late November or late January.

The new findings, published in the BMJ, echo results of research on “the weekend effect,” in which patients admitted to the hospital on weekends are more likely to die than patients admitted on weekdays.

There are a couple of things patients can do to improve their odds of a better outcome, said Dr. Lauren Lapointe-Shaw, a general internist at Toronto General Hospital.

“The main thing is to inquire about whether a follow-up visit is recommended . . . and if so, how soon it should occur,” Lapointe-Shaw said. “We did see a big drop off in follow-up visits during this period of time and that could explain why the patients do worse.”

Patients can also ask what to expect over the next few weeks, Lapointe-Shaw said. “You want to be well-informed about self-care and any medication changes that need to be made,” she added. “You want to take ownership of your treatment plan and to reach out to healthcare providers early if things are going in the wrong direction.”

To see if the holidays presented problems for patients leaving the hospital, Lapointe-Shaw and her colleagues looked at data collected between 2002 and 2016 on 217,305 adults discharged during two weeks that included Christmas and New Year’s Day. They also studied 453,641 patients discharged during the last two weeks of November and the last two weeks of January.

Compared to patients discharged at other times, those discharged during the holidays had a higher risk of death or readmission to the hospital within the next seven, 14 and 30 days, with the greatest risk – 16 percent higher – within the first seven days.

Moreover, patients discharged during the holidays were 39 percent less likely than those sent home at other times to have a follow-up appointment within seven days, which was possibly due to understaffing or patients themselves wanting to wait until the holidays were over.

Overall, for every 100,000 patients discharged during the holidays, there were 26 more deaths, 188 more rehospitalizations, 483 more visits to emergency departments and 2,999 fewer follow-up appointments.

Part of the problem may be holiday-related staffing shortages, the researchers noted. Lapointe-Shaw suggests that healthcare providers need to take this into consideration. “They need to pay a bit of extra attention to people being discharged over the holidays,” she said. “Maybe providers need to do a little bit more to make sure follow-up appointments are made and coordination takes place.”

The new study points up “a small but significant effect of getting hospitalized during the December holidays on the risk of both readmission and death,” said Dr. Albert Wu, an internist and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

The findings might not just be a result of hospital practices and staffing, Wu said. “People may have been discharged earlier than they would be otherwise so they could be home for the holidays,” he explained. “So they could have been discharged both quicker and sicker, which could have led to their being readmitted or dying at a higher rate.”

SOURCE: BMJ, online December 10, 2018.

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