Hospital Discharge During Holiday Season Considered Novel Risk for Readmission, Death
The “Christmas Effect” has been linked to increased risks in patients discharged from the hospital during the December holiday season.
Compared with patients discharged during November and January, patients discharged from the hospital during the month of December were at higher risk for reduced follow-up and increased death or hospital readmission, according to study results published in BMJ.
Lauren Lapointe-Shaw, MDCM, of the Toronto General Hospital in Ontario, Canada, and colleagues, conducted a population-based, retrospective cohort study in patients at acute care hospitals in Ontario to determine whether patients who are discharged from hospital care during the holidays have higher rates of death or readmission than patients discharged during 2 control periods: 1 in late November and 1 in January.
Researchers identified 670,946 eligible participants (13.9% children, 45.3% adults younger than 65, and 40.9% older adults; 50% female). In total, 32.4% of patients were discharged during the holiday period; 67.6% were discharged during one of the two control periods.
Overall, the most common diagnoses were circulatory (16.8%), digestive (15.7%), and respiratory conditions (13.4%). Median length of hospitals stay was 3 days.
Dr Lapointe-Shaw and colleagues found that patients discharged during the holiday period had an increased risk for death or hospital readmission within 30 days (25.9% vs 24.7%), with an increased risk for return to the emergency department, rehospitalization, and death compared with the non-holiday discharge group (24.3% vs 23%, 11.8% vs 11.4%, and 1.5% vs 1.5%, respectively). These increased risks were “further accentuated” within 7 and 14 days following discharge.
The researchers also analyzed the role the “Christmas Effect” played in readmission rates and death. Patients who were discharged the week before or after the holiday were less likely to have a 7-day follow-up (33.6% vs 47.6%; odds ratio (OR), 0.56; 95% CI, 0.55-0.56) and a higher risk for death or readmission within 7 days (14.2% vs 12.4%) compared with patients discharged before or after the holiday period.
“Although acute hospital-based services are usually available during the holiday period, this might not be the case for outpatient care,” the researchers wrote, noting that early outpatient follow-up allowed physicians and patients the opportunity for education, drug review, discussion, and detection of clinical deterioration — all of which have been linked to reduced hospital readmission.
They concluded, “Further study of the potential role of follow-up in mediating this relation is now justified. Rather than rushing to get patients home, hospital clinicians should pay attention to discharge planning…ensuring optimal…follow-up care. Discharged patients, unlike unwanted gifts, should not be returned after the holidays.”
Lapointe-Shaw L, Austin PC, Ivers NM, Redelmeier DA, Bell CM. Death and readmissions after hospital discharge during the December holiday period: cohort study [published online December 10, 2018]. BMJ. doi:10.1136/bmj.k4481