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Research Christmas 2018: Heart of the Matter

Death and readmissions after hospital discharge during the December holiday period: cohort study

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4481 (Published 10 December 2018) Cite this as: BMJ 2018;363:k4481

Rapid Response:

Quality of follow-up of patients after hospital discharge Re: Death and readmissions after hospital discharge during the December holiday period: cohort study

Lapointe-Shaw et al. (1) reported that patients discharged from hospital during the December holiday period are at higher risk of death or readmission within 30 days. They explain this increased risk by reduced access to care and to physicians.

What’s the solution? To increase the duration of hospitalisation until the end of holidays? No holidays for health professionals in December?

Complications occur more frequently in holidays but also in the second part of the night and at weekends. However, if a complication occurs and there is a complaint, the judges will not take into account the holiday factors.

I think that in our practice in developed countries, there are other factors. Indeed, when the patient is discharged from hospital, follow-up by nurses and GPs is usually performed.

For me the real problem is that in some cases, even in patients who are followed up outside hospital, complications and sometimes death occur without any medical alert. For example, after a hysterectomy or a caesarean section, patients have a daily injection of anticoagulants by nurses. Despite the daily presence of a health professional, we deplore in rare cases serious complications like thromboembolism, severe pelvic infection or death without any alarm or diagnosis of a complication before the event. There was no diagnosis outside the hospital of any clinical signs that could evolve into a dramatic situation and jeopardize the patient’s life. The lack of recognising symptoms led to underestimation of the situation and patents were not addressed to the hospital. In such a situation the patient could die. It is due not only to a problem of reduced access to health care but also a lack of knowledge (3) and training of some nurses and health professionals to detect serious situations, like pain, hemorrhage infections and other signs leading to complications or death (3).

Finally, the reduced access to care during holidays is a reality. However, the health professional that follows up patients after hospital discharge should be trained to recognize emergency situations that must be readdressed to the hospital.

References

1. Lapointe-ShawL., Austin P., M Ivers N., Luo J., A Redelmeier D, M Bell C.
Death and readmissions after hospital discharge during the December holiday period: cohort study. BMJ 2018;363:k4481

2. Buckley T, Gordon C. The effectiveness of high fidelity simulation on medical-surgical registered nurses' ability to recognise and respond to clinical emergencies.
Nurse Educ Today. 2011 ;31:716-21.

3. Geiselmann B, Kornhuber HH. Decentralised treatment of multiple sclerosis by the general practitioner, district nurse and relatives. Dtsch Med Wochenschr. 1981 ;106:15-8.

Competing interests: No competing interests

11 December 2018
Souhail ALOUINI
Obstetrician and Gynaecologist Surgeon
Regional Hospital Center of Orleans
14 avenue de l'hôpital, 45100, Orleans