Wednesday , January 20 2021

Patients discharged from hospital during holidays at higher risk, study says

Patients who have been discharged from Ontario during the December holiday period have a high risk of death or readmission, according to a new study.

The Institute for Clinical Evaluative Sciences looked at patients leaving hospital during the two-week winter break outlined in school calendars over a 14-year period. It found that they had a higher chance of mortality or returning to the emergency department with one week, two weeks or a month being discharged.

A study by the Institute for Clinical Evaluative Sciences found a higher chance of mortality or returning to hospital for patients who were discharged during the December holiday period.
A study by the Institute for Clinical Evaluative Sciences found a higher chance of mortality or returning to hospital for patients who were discharged during the December holiday period. (Richard Lautens / Toronto Star photo photo)

The same goes for patients discharged during off-hours on Fridays or over weekends.

"We actually found that there was a small increased risk of patients having a readmission or dying within three days and that they were actually less likely to have a follow-up doctor within two weeks of hospital discharge." Lauren Lapointe-Shaw, and PhD student at ICES and lead researcher on the study.

The study found that holiday discharges are also less likely to follow up with physicians after they have left the hospital. For every 100,000 patients, there were 2,999 fewer two-week followup appointments, 26 excess deaths, 188 extra hospitalizations, and 483 excess emergency visits during the holiday period.

Lapointe-Shaw said this could be due to busy schedules and festivities during the holidays, when an increase in activity may cause discharged patients to push themselves too hard while recovering.

"There are more risk behaviors that go on," Lapointe-Shaw said. "More eating, drinking, more, involvement in activities, which can certainly increase the risk. A medical condition would be destabilized. "

Yet patient behavior is not the sole culprit. Understaffed hospitals may have difficulty transitioning patients out of hospitals as they try and stay on demand with fewer hands.

"So how do we plan for people to go home during the holiday period when hospitals tend to be relatively shorter staffed?" She said. "There is often a large wave of patients with an annual flu season and resources could be in shorter supply."

Lapointe-Shaw said she had noticed the issue throughout her experience working in health care during the holidays and during discussions with clinicians.

"If you are discharging someone home over the holidays, are you kind of sending them off the cliff? Are they going to have the follow up that's necessary? "She said.

Maryanne D'Arpino, senior director of the Canadian Patient Safety Institute, directly referred to the impact of the flu season during holidays.

"Given the fact that the ramping up of the cases has been ramping up, this may be a potential increase in more people trying to access the emergency departments and potentially lead to an increased number of admissions to hospitals," D'Arpino told Star.

"We know that during discharges and transitions of care, there are higher risks for patients to make safety incidents, which can lead to readmissions."

D'Arpino also said that there were a number of readmission cases that could have been avoided, citing patient safety incidents, which "are based on preventable, unintended outcomes of care, rather than underlying disease itself", and could result in prolonged care, disability and possibly death.

With files from Bianca Bharti and Ilya Banares

Stefanie Marotta is a news reporter, working out of the Star's radio room in Toronto. Follow her on Twitter: @StefanieMarotta

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