Dear President Lamm: The enclosed is from our “mayven,” Professor Herbert Lukashok, to whom I addressed the question about hospitalization that you had put to me. I believe his reply is responsive to the point of your inquiry (as I understood it). If, however, there are further questions, please contact either one of us again. Sincerely, Dominic Purpura. Enclosure. Memorandum, Albert Einstein College of Medicine, Department of Epidemiology and Social Medicine, July 6, 1987, To: Dr. Kligler, From: H. Lukashok, Re: Last Day of Hospitalization. That hospitals can be dangerous places is not disputed; nosocomial (hospital-acquired) infections are a common peril, causing over six million excess hospital days annually, with 1–1.5% of infected patients dying as a result and an additional 3–4% with deaths contributed to by such infections. In 1976 the nosocomial infection rate was estimated at 5–7 per 100 admissions. Data from the Boston Collaborative Drug Surveillance Program suggest that almost one-third of hospitalized patients experience at least one adverse drug reaction. It is estimated that about 30,000 deaths occur each year as a result of anesthesia. A study of teaching hospitals found that nearly half of patients were exposed to one or more potentially dangerous procedures, with 14% of those experiencing complications. On this brief review of the literature, one could argue that even one extra day in the hospital could expose a patient to additional life-threatening hazards, but I have seen no evidence specifically demonstrating that the last day is more dangerous than any other. Current policy emphasizes keeping patients out of the hospital whenever possible and discharging them as soon as possible, driven by utilization review, DRG reimbursement for Medicare patients, and an increase in ambulatory surgery. Patient days of care in general hospitals have dropped over 20% since 1980, average length of stay is down about 1½ days, and discharge rates fell 11% betwee…