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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.

Minnesota Coronavirus Cases

Data is updated nightly.

Cases: 445047

Reported Deaths: 5955
CountyCasesDeaths
Hennepin924911470
Ramsey39703735
Dakota32788331
Anoka30811360
Washington20004225
Stearns17775185
St. Louis13546240
Scott1189996
Wright11548102
Olmsted1035775
Sherburne815765
Carver691436
Clay648478
Rice600166
Kandiyohi552871
Blue Earth538033
Crow Wing479673
Otter Tail453464
Chisago449732
Benton416785
Winona386246
Douglas372466
Nobles366746
Mower362328
Goodhue343657
Polk327756
McLeod323144
Morrison310043
Beltrami308746
Lyon299835
Itasca282643
Becker281738
Isanti281141
Carlton278143
Steele27119
Pine265113
Freeborn241320
Todd230929
Nicollet223336
Brown213734
Mille Lacs212845
Le Sueur208515
Cass206123
Meeker198533
Waseca188816
Martin169126
Wabasha16883
Roseau165316
Hubbard148338
Redwood139227
Renville136539
Houston135313
Dodge13304
Chippewa130832
Cottonwood126518
Fillmore12215
Wadena119416
Rock109512
Sibley10797
Aitkin107133
Watonwan10618
Faribault104615
Pennington97715
Kanabec97218
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Yellow Medicine93314
Murray8655
Jackson85010
Swift83018
Pope7355
Marshall70115
Stevens6978
Clearwater68514
Lac qui Parle65616
Lake62915
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Lincoln4821
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Unassigned43468
Grant4257
Norman4228
Mahnomen4087
Kittson37019
Red Lake3164
Traverse2473
Lake of the Woods1801
Cook1130

Iowa Coronavirus Cases

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Cases: 303065

Reported Deaths: 4267
CountyCasesDeaths
Polk45335447
Linn17673274
Scott15356163
Black Hawk13648236
Woodbury12945175
Johnson1202149
Dubuque11300149
Pottawattamie8934112
Dallas881171
Story863434
Webster467471
Cerro Gordo462968
Sioux453356
Clinton448361
Warren437538
Marshall425561
Buena Vista391529
Muscatine386177
Des Moines380641
Plymouth348868
Wapello340898
Jasper319658
Lee313530
Marion301752
Jones269649
Henry263230
Carroll253034
Bremer242048
Crawford228122
Boone216217
Washington214231
Benton208544
Jackson190831
Mahaska190736
Tama185657
Dickinson184226
Delaware172236
Kossuth170543
Clay166019
Wright162724
Fayette159522
Buchanan158023
Hamilton157829
Winneshiek154819
Harrison154462
Hardin153929
Cedar151419
Clayton150748
Butler146424
Page143715
Cherokee138127
Floyd137936
Mills136016
Lyon133632
Poweshiek132324
Hancock128824
Allamakee126827
Iowa122822
Calhoun12209
Grundy120026
Jefferson119524
Madison11869
Winnebago118229
Mitchell115634
Louisa114130
Cass112541
Chickasaw110512
Emmet110231
Sac110215
Appanoose109638
Union108122
Humboldt104219
Guthrie102224
Shelby101326
Franklin101218
Unassigned9210
Palo Alto9019
Keokuk84325
Montgomery84022
Howard82519
Monroe80518
Clarke7817
Pocahontas77211
Ida73830
Greene6887
Davis68721
Adair68620
Lucas6468
Osceola6349
Monona63316
Worth5983
Taylor5919
Fremont5036
Van Buren49412
Decatur4784
Ringgold4269
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