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 becaus...

Posted: Dec 11, 2018 8:24 AM
Updated: Dec 11, 2018 8:24 AM

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.

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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.

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 481397

Reported Deaths: 9395
CountyCasesDeaths
Harrison32996486
Hinds30973586
DeSoto30491353
Jackson23650348
Rankin21267368
Lee14867220
Madison14145271
Jones13365226
Forrest13125238
Lauderdale11538305
Lowndes10418176
Lamar10184130
Pearl River9055219
Lafayette8218137
Hancock7501112
Washington7033150
Oktibbeha6937124
Monroe6491161
Neshoba6463201
Warren6439163
Pontotoc626593
Panola6219126
Bolivar6105144
Marshall6102121
Union573086
Pike5590136
Alcorn536090
Lincoln5297131
George470072
Scott456096
Leflore4468140
Prentiss445277
Tippah443680
Itawamba4430100
Adams4403116
Tate4351101
Simpson4324112
Wayne431566
Copiah431087
Yazoo423086
Covington414792
Sunflower4137104
Marion4087104
Leake397186
Coahoma394298
Newton368775
Grenada3553104
Stone350659
Tishomingo334689
Attala324886
Jasper313762
Winston303591
Clay295273
Chickasaw286665
Clarke280290
Calhoun265140
Holmes261887
Smith249549
Yalobusha220547
Tallahatchie218850
Walthall210558
Greene207845
Lawrence206033
Perry199353
Amite198152
Webster195942
Noxubee178239
Montgomery172054
Jefferson Davis167642
Carroll161937
Tunica152734
Benton142035
Kemper138440
Claiborne126634
Choctaw126326
Humphreys126337
Franklin116628
Quitman103626
Wilkinson101536
Jefferson88833
Sharkey62820
Issaquena1926
Unassigned00

Alabama Coronavirus Cases

Cases: 781915

Reported Deaths: 13798
CountyCasesDeaths
Jefferson1109621748
Mobile706071213
Madison49359617
Baldwin36054485
Shelby35933311
Tuscaloosa33540540
Montgomery32996673
Lee22337218
Calhoun20935400
Morgan19666329
Etowah18890454
Marshall17575274
Houston16598377
St. Clair15287298
Limestone14442184
Cullman14441252
Elmore14299259
Lauderdale13395278
Talladega12781234
DeKalb12102233
Walker10495328
Autauga9611135
Blount9595154
Jackson9293152
Coffee8764174
Dale8485171
Colbert8448180
Tallapoosa6557177
Escambia6541117
Covington6409165
Chilton6314142
Russell600655
Franklin5744101
Chambers5350133
Marion4748116
Dallas4672185
Clarke459177
Pike458895
Geneva4333116
Winston420292
Lawrence4099108
Bibb405680
Barbour342969
Marengo324783
Monroe316652
Butler316088
Randolph302855
Pickens300673
Henry299657
Hale290483
Cherokee286752
Fayette276473
Washington245048
Crenshaw236768
Clay226264
Cleburne225750
Macon218057
Lamar192541
Conecuh180146
Lowndes170758
Coosa167533
Wilcox159636
Bullock148642
Perry136336
Sumter124136
Greene120542
Choctaw73326
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Fall has started off exactly as you would have anticipated and it looks like we should have a number of dry days still ahead, but this isn’t a permanent switch, because heat is pegged to return.
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