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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: 297321

Reported Deaths: 6805
CountyCasesDeaths
DeSoto19814231
Hinds18949395
Harrison16886282
Rankin12842265
Jackson12750234
Lee9720163
Madison9516204
Jones8035148
Forrest7289138
Lauderdale6872228
Lowndes6061140
Lamar593381
Lafayette5767114
Washington5232130
Bolivar4630124
Oktibbeha443095
Panola433698
Pearl River4212132
Warren4144115
Pontotoc411071
Marshall405995
Monroe3996129
Union397174
Neshoba3848171
Lincoln3624104
Hancock352978
Leflore3400121
Sunflower320986
Tate303974
Pike302697
Scott296171
Alcorn292763
Yazoo292066
Itawamba290675
Coahoma283069
Tippah280065
Copiah279959
Simpson277581
Prentiss271258
Marion258878
Wayne255641
Leake254172
Covington250280
Grenada248878
Adams235778
George232745
Newton232753
Winston222179
Jasper214145
Tishomingo213266
Attala206971
Chickasaw201954
Holmes182870
Clay179452
Stone173429
Tallahatchie171739
Clarke170773
Calhoun158628
Smith153833
Yalobusha145736
Greene128133
Walthall125441
Montgomery123540
Noxubee123431
Perry123235
Lawrence121421
Carroll119425
Amite112435
Webster111132
Jefferson Davis102731
Tunica99824
Claiborne99030
Benton94024
Humphreys93128
Kemper91423
Quitman77514
Franklin76420
Choctaw70117
Jefferson62827
Wilkinson62727
Sharkey49217
Issaquena1676
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Alabama Coronavirus Cases

Cases: 499411

Reported Deaths: 10149
CountyCasesDeaths
Jefferson719951403
Mobile36396741
Madison32674469
Tuscaloosa24391423
Montgomery22789523
Shelby22250219
Baldwin19915289
Lee15070161
Calhoun13961296
Morgan13785255
Etowah13413327
Marshall11458215
Houston10121264
Elmore9509190
Limestone9435139
St. Clair9050228
Cullman8993183
Lauderdale8628214
DeKalb8507175
Talladega7643165
Walker6600260
Jackson6551104
Autauga634492
Blount6252128
Colbert6007121
Coffee5261104
Dale4680107
Russell407534
Franklin400779
Covington3996107
Chilton3911104
Escambia379473
Tallapoosa3637143
Clarke344553
Chambers3432111
Dallas3428142
Pike292973
Marion288796
Lawrence285787
Winston258568
Bibb246058
Marengo244657
Geneva240270
Pickens225757
Barbour213851
Hale212569
Fayette202657
Butler201466
Henry183541
Cherokee178140
Monroe166739
Randolph165141
Washington157036
Macon147845
Crenshaw146755
Clay146254
Cleburne140141
Lamar133933
Lowndes133151
Wilcox123225
Bullock117736
Conecuh107224
Perry106427
Sumter100832
Coosa90324
Greene88732
Choctaw55723
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