Discharging in December? How holiday discharges put patients at risk

By Anastasia Climan, RDN, CD-N | Fact-checked by Barbara Bekiesz
Published December 20, 2023

Key Takeaways

  • Patients discharged during the end-of-the-year holidays face a higher risk of readmission and death.

  • Physicians must be mindful of this “holiday effect,” particularly in seemingly low-risk patients.

  • Encouraging timely follow-ups during the holidays can help combat a critical underlying cause of preventable complications.

Reduced medical staffing and a higher risk of injury and illness can become the perfect storm for poor patient outcomes during the holidays. Multiple studies have noted disparities in follow-up care, readmission rates, and survival for patients discharged in December vs other times of the year. 

Here’s some data on which patients are most at risk for this dangerous “holiday effect” and how you, as a physician, can help promote better outcomes.

How the “holiday effect” impacts different patients

Research shows that certain conditions are especially vulnerable to this holiday effect. Specifically, studies have identified worsened affects regarding sepsis, pulmonary embolism, and acute aortic dissection during the holiday season.[] 

However, this effect doesn’t seem to be as strong for trauma patients, as studies show no variability in mortality or adverse clinical outcomes for traumatic injuries during the holiday season.

One study from Taiwan noted how cancer patients undergoing major surgery faced higher rates of unplanned readmission within 30 days when discharged during the holidays.[] The researchers analyzed data from 1,433 hospitalized patients with colon cancer, head and neck cancer, lung cancer, liver cancer, and prostate cancer. They calculated a “holiday ratio” by dividing the number of holiday days by the number of total hospitalization days, then used multivariate logistic regression to uncover contributing variables to potentially avoidable readmission (PAR) within 30 days. 

“The holiday ratio >0.3 was a negative independent predictor of 30-day PAR in patients with colon cancer,” the investigators observed. In addition, patients who were readmitted within 30 days had statistically higher mortality rates. Of note, researchers didn’t propose a theory as to why colon cancer seemed to be a disorder disproportionately impacted by the holidays.

Prioritizing patients when resources are limited

The Taiwan researchers suggested that reduced communication among medical staff and patients may contribute to the holiday effect. 

More team transitions and lax compliance with handoff protocols may mean that crucial information is lost, leading to poor judgment in discharge planning and medical decisions.

Another study, looking at acute care patients in Ontario, had similar findings.[] Hospital discharges during the 2-week December holiday period were associated with less timely follow-up and higher readmission and death rates than discharges in the preceding November and following January.

The investigators proposed that delayed follow-up impairs the likelihood of identifying complications or signs of early deterioration that would benefit from medical attention.

They noted that, in this study, the most significant risk was observed for those with a genitourinary condition, neoplasm, pregnancy-related condition, or injury. 

Patients with chronic obstructive pulmonary disease did not appear to be as impacted by the discharge timing, suggesting the holiday effect may be more significant for patients with a lower baseline risk compared with generally higher risk patients. 

Researchers proposed that when faced with limited resources, clinicians may prioritize high-risk patients with more thorough discharge planning, effectively protecting against the holiday effect.

Patient factors

While reduced hospital resources are a common scapegoat for substandard outcomes during the holidays, it’s also possible that patient-centered factors are at play. During major holidays, patients may experience higher stress levels, poor quality sleep, and a greater intake of alcohol, sodium, and sugar, as suggested by the Canadian researchers. 

In addition, higher readmission rates may partially result from visiting family members who encourage a relative to seek urgent medical treatment if complications arise during holidays.

Patients may postpone follow-up visits due to their travel commitments and celebrations. If their usual physician is on vacation, they may prefer to wait until the provider is available rather than see an alternative provider within the recommended timeframe. In doing so, they lose the opportunity for the follow-up visit to identify potential complications or deterioration in a timely manner. 

What this means for you

Physicians must be aware that patients, particularly lower risk patients, are especially vulnerable during the holiday season. The holidays present some logistical challenges, so paying extra attention to documentation, communication, and discharge planning is essential during this time. You can encourage your patients to prioritize their health and follow-up appointments despite celebratory distractions that could delay critical care.

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