Holiday hospitalization carries higher risks, study says

Research has shown that going to the hospital in July or over the weekend can be riskier for patients because of factors such as medical errors, understaffing or staff fatigue. The holiday period can also be added to the list, according to a new study.

“In taking care of patients who are admitted over the December holiday period, I had noticed, along with my colleagues — we all kind of had this anecdotal experience, or maybe just more of a myth — that discharging patients over the holidays was a little riskier,” said Dr. Lauren Lapointe-Shaw, one of the authors of the study, published Monday in the BMJ.

Lapointe-Shaw is also a Ph.D. student at the University of Toronto and a general internist physician at Toronto General Hospital.

She and her co-authors looked at the records of 670,946 patients discharged from acute-care hospitals in Ontario between April 1, 2002, and January 31, 2016. They compared discharges in three periods: the Christmas period, which included Christmas and New Year’s, and two control periods, two-week stretches four weeks before and after the holidays.

The researchers also looked at the scheduling of follow-up appointments within seven and 14 days and the risk of death or readmission to the hospital within seven, 14 and 30 days.

Roughly a third of the patients — 217,305 — were discharged during the holiday period. “They had a small increased risk, and they were considerably less likely to have the follow-up with the physician,” Lapointe-Shaw said.

Patients who were discharged in the holiday period had a 36.3% chance of a physician follow-up in seven days and a 59.5% chance of a physician follow-up in 14 days. For those in the control groups, the rates were 47.8% and 68.7%, respectively.

When it came to death or readmission, the patients discharged during the Christmas period were 13.3% more likely to be readmitted or to die within seven days, 18.6% in 14 days and 25.9% in 30 days. For the control groups, the risk rates were 11.7%, 17% and 24.7%, respectively.

The study found that “per 100,000 patients, 26 excess deaths, 188 excess rehospitalizations, 483 excess visits to an emergency department, and 2,999 fewer follow up appointments could be attributed to being discharged from hospital during the December holidays.”

“Something is happening differently for these patients,” Lapointe-Shaw said. “They are at higher risk, and despite that, they are not getting as much of the optimal transitional care that we would like them to get.”

Dr. Seth Goldstein, an associate professor of surgery at Northwestern University Feinberg School of Medicine, noted that “over the past few years, there’s been a bit of a spotlight on hospital systems and how to maintain quality of care 24/7.

“I think what this study does is points out that it’s not unique to nights and weekends,” he said. He believes that reduced hospital staffing, and a time when patients are less likely to want to be in the hospital, could have this effect.

Goldstein, who was not involved in the study, is also a pediatric general and thoracic surgeon at the Ann & Robert H. Lurie Children’s Hospital of Chicago.

“I think the effect is probably real, and there are potential patient factors and hospital factors that can play a role” in these increased risks, Goldstein said.

Patient factors include an unwillingness to be in the hospital during the holidays and a change in routine, including eating and drinking habits, he said. Hospital factors could include lower numbers of staff and quicker discharges of patients so they can be home for the holidays.

Goldstein says solutions for hospitals include ensuring that safety and quality mechanisms are in place and, for patients, “seek urgent, emergency care when the condition arises, and you shouldn’t try to wait it out at home because it’s Christmas.”

The fact that researchers are looking into the issue is also important to him.

“It’s a good study, because awareness is the first step of anything you’d ever do to try to tackle the problem a little more head-on,” he said.

 

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