Key result
Discharge during holiday periods was associated with higher odds of 30-day all-cause readmission (OR 2.56; 95% CI 2.01-3.25), whereas discharge on an intern switch day had lower odds (OR 0.33).
Why the study?
Academic medical centers face challenges training residents in discharge practices amidst high workloads and frequent rotations, prompting investigation into whether daily service census, service turnover, time of discharge, and day of discharge increase 30-day readmissions.
Does discharge during holiday periods or intern switch days affect 30-day readmission rates in general internal medicine patients?
Observational (n=1,935)
No
Does discharge during holiday periods or intern switch days affect 30-day readmission rates in general internal medicine patients?
Odds Ratio: 2.56 (95% CI 2.01–3.25)
Discharging general internal medicine patients during holiday periods is associated with a significantly increased risk of 30-day readmission, highlighting a vulnerable period for transitions of care.
OBJECTIVE: Academic medical centers face unique challenges in educating physician trainees in effective discharge practices to prevent readmissions. Meanwhile, residents must handle high workloads coupled with frequent rotations to different services. This study aimed to determine whether daily service census, service turnover, time of discharge, and day of discharge increase the risk of 30-day readmission. METHODS: All of the discharges from two academic general internal medicine teaching services between October 1, 2013 and September 30, 2014 were included in this observational data analysis. Variables were fit to a 30-day, all-cause readmission outcome using multiple logistic regression with inverse probability of treatment weighting and multiple imputations with chained equations. The following potential confounding variables were included in the model: health system utilization, demographics, laboratory values, and comorbidities. RESULTS: Among 1935 total discharges, 258 patients (13.3%) were readmitted within 30 days of the index discharge. Turnover, service census, weekend discharge, and time of discharge were not significantly associated with the risk of readmission. Patients discharged during holiday periods had higher odds of readmission (odds ratio 2.56, 95% confidence interval 2.01-3.25), whereas patients discharged on an intern switch day had lower odds of readmission (odds ratio 0.33, 95% confidence interval 0.27-0.41). CONCLUSIONS: Patients who are discharged during holiday periods are at a higher risk of readmission after adjusting for potential confounders. These results also suggest that discharge on an intern switch day had a protective effect on readmission. Further work is needed to examine whether these findings can be replicated, and, if confirmed, to determine to what extent these associations are causal.
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Dharod et al. (2019) conducted an observational in General Internal Medicine Hospital Discharges (n=1,935). Discharge during holiday periods vs. Discharge during non-holiday periods was evaluated on 30-day, all-cause readmission (OR 2.56, 95% CI 2.01-3.25). Discharge during holiday periods was associated with higher odds of 30-day all-cause readmission (OR 2.56; 95% CI 2.01-3.25), whereas discharge on an intern switch day had lower odds (OR 0.33).
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