Wednesday , January 20 2021

Discharging from hospital in December is associated with more readmission, death

Patients sent home from the hospital around Christmas are more likely to have poor results than those who are relieved from another time, a Canadian study suggests.

Researchers tracking data from Ontario hospitals found that patients reported during the Christmas season were more likely to die or be re-adopted within the next 30 days compared to patients released at the end of November or the end of January .

The new findings, published in the BMJ, reflect the results of weekend effect research, in which patients admitted to the hospital over the weekends are more likely to die than patients on weekdays.

There are a number of things patients can do to improve their chances for a better outcome, said Dr. Lauren Laoin-Shaw, general practitioner at the Toronto Hospital.

"The main thing is to ask if a follow-up visit is recommended, and, if so, how soon should it happen," said Lapon-Shaw. "We have seen a significant decline in follow-up visits over this period of time, and this may explain why patients are getting worse."

Patients may also ask what to expect in the next few weeks, said Lapon-Shaw. "You want to be well informed about self-assessment and any drug changes that need to be made," she added. "You want to take ownership of your treatment plan and contact healthcare providers early if things are going in the wrong direction."

To see if the holidays are a problem for patients leaving the hospital, Lapon-Shaw and her colleagues looked at the data collected between 2002 and 2016 of 217,305 adults released in two weeks, including Christmas and New Year. They also studied 453,641 patients discharged during the last two weeks of November and the last two weeks of January.

Compared to the patients released during the holidays, the risk of death or readmission increased by the highest risk – 16% higher – during the next seven days, 14 and 30 days in the first seven days.

In addition, patients released during the holidays are 39% less likely than those sent home at another time to have a follow-up meeting within seven days, probably due to inadequate staff or the patients themselves who want to wait until the end of the holidays.

Overall, for every 100,000 patients released during the holidays, there were 26 more deaths, 188 other rehabilitations, 483 more visits to the emergency services, and 2999 less post appointments.

Part of the problem may be the shortage of staff related to holidays, researchers note. Lapointe-Shaw suggests that healthcare providers should take this into account. "They have to pay a little more attention to the people who are released during the holidays," she said. "Maybe vendors have to do a little more to make sure that subsequent appointments are made and coordination is taking place."

The new study points to "a small but significant effect of hospitalization during December's holidays because of the risk of readmission and death," said Dr. Albert Wu, an intern and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

The findings may not only be a result of hospital practice and staffing, Wu said. "People may have been released earlier than they would have been otherwise to be home to the holidays," he explained. "So they could be released both faster and more painfully, which could lead to re-acceptance or death with a higher percentage."

SOURCE: BMJ, online 10 December 2018

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