PLoS ONE (Jan 2020)

Clinical complexity and hospital admissions in the December holiday period.

  • Marco Vincenzo Lenti,
  • Catherine Klersy,
  • Alice Silvia Brera,
  • Valeria Musella,
  • Irene Benedetti,
  • Lucia Padovini,
  • Mariella Ciola,
  • Gabriele Croce,
  • Alessia Ballesio,
  • Maria Fortunata Gorgone,
  • Giampiera Bertolino,
  • Antonio Di Sabatino,
  • Gino Roberto Corazza

DOI
https://doi.org/10.1371/journal.pone.0234112
Journal volume & issue
Vol. 15, no. 6
p. e0234112

Abstract

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BackgroundChristmas and New Year's holidays are risk factors for hospitalization, but the causes of this "holiday effect" are uncertain. In particular, clinical complexity (CC) has never been assessed in this setting. We therefore sought to determine whether patients admitted to the hospital during the December holiday period had greater CC compared to those admitted during a contiguous non-holiday period.MethodsThis is a prospective, longitudinal study conducted in an academic ward of internal medicine in 2017-2019. Overall, 227 consecutive adult patients were enrolled, including 106 cases (mean age 79.4±12.8 years, 55 females; 15 December-15 January) and 121 controls (mean age 74.3±16.6 years, 56 females; 16 January-16 February). Demographic characteristics, CC, length of stay, and early mortality rate were assessed. Logistic regression analyses for the evaluation of independent correlates of being a holiday case were computed.ResultsCases displayed greater CC (17.7±5.5 vs 15.2±5.9; p = 0.001), with greater impact of socioeconomic (3.51±1.7 vs 2.9±1.7; p = 0.012) and behavioral (2.36±1.6 vs 1.9±1.8; p = 0.01) CC components. Cases were also significantly frailer according to the Edmonton Frail Scale (8.0±2.8 vs 6.4±3.1; pConclusionsPatients hospitalized during the December holiday period had worse health outcomes, and this could be attributable to the grater CC, especially related to socioeconomic (social deprivation, low income) and behavioral factors (inappropriate diet). The evaluation of all CC components could potentially represent a useful tool for a more rational resource allocation over this time of the year.