tetano
Editor, Senior Moderator
J Gen Intern Med
. 2021 Jan 14.
doi: 10.1007/s11606-020-06340-w. Online ahead of print.
Hospital Readmissions After Implementation of a Discharge Care Program for Patients with COVID-19 Illness
Siqin Ye[SUP] 1 [/SUP], Grant Hiura[SUP] 2 [/SUP], Elaine Fleck[SUP] 3 [/SUP], Aury Garcia[SUP] 4 [/SUP], Joshua Geleris[SUP] 2 [/SUP], Paul Lee[SUP] 2 [/SUP], Nadia Liyanage-Don[SUP] 1 2 [/SUP], Nathalie Moise[SUP] 1 2 [/SUP], Neil Schluger[SUP] 5 [/SUP], Jessica Singer[SUP] 2 [/SUP], Magdalena Sobieszczyk[SUP] 6 [/SUP], Yifei Sun[SUP] 7 [/SUP], Harry West[SUP] 8 [/SUP], Ian M Kronish[SUP] 9 10 [/SUP]
Affiliations
Abstract
Background: The surge of coronavirus 2019 (COVID-19) hospitalizations in New York City required rapid discharges to maintain hospital capacity.
Objective: To determine whether lenient provisional discharge guidelines with remote monitoring after discharge resulted in safe discharges home for patients hospitalized with COVID-19 illness.
Design: Retrospective case series SETTING: Tertiary care medical center PATIENTS: Consecutive adult patients hospitalized with COVID-19 illness between March 26, 2020, and April 8, 2020, with a subset discharged home INTERVENTIONS: COVID-19 Discharge Care Program consisting of lenient provisional inpatient discharge criteria and option for daily telephone monitoring for up to 14 days after discharge MEASUREMENTS: Fourteen-day emergency department (ED) visits and hospital readmissions RESULTS: Among 812 patients with COVID-19 illness hospitalized during the study time period, 15.5% died prior to discharge, 24.1% remained hospitalized, 10.0% were discharged to another facility, and 50.4% were discharged home. Characteristics of the 409 patients discharged home were mean (SD) age 57.3 (16.6) years; 245 (59.9%) male; 27 (6.6%) with temperature ≥ 100.4 ?F; and 154 (37.7%) with oxygen saturation < 95% on day of discharge. Over 14 days of follow-up, 45 patients (11.0%) returned to the ED, of whom 31 patients (7.6%) were readmitted. Compared to patients not referred, patients referred for remote monitoring had fewer ED visits (8.3% vs 14.1%; OR 0.60, 95% CI 0.31-1.15, p = 0.12) and readmissions (6.9% vs 8.3%; OR 1.15, 95% CI 0.52-2.52, p = 0.73).
Limitations: Single-center study; assignment to remote monitoring was not randomized.
Conclusions: During the COVID-19 surge in New York City, lenient discharge criteria in conjunction with remote monitoring after discharge were associated with a rate of early readmissions after COVID-related hospitalizations that was comparable to the rate of readmissions after other reasons for hospitalization before the COVID pandemic.
. 2021 Jan 14.
doi: 10.1007/s11606-020-06340-w. Online ahead of print.
Hospital Readmissions After Implementation of a Discharge Care Program for Patients with COVID-19 Illness
Siqin Ye[SUP] 1 [/SUP], Grant Hiura[SUP] 2 [/SUP], Elaine Fleck[SUP] 3 [/SUP], Aury Garcia[SUP] 4 [/SUP], Joshua Geleris[SUP] 2 [/SUP], Paul Lee[SUP] 2 [/SUP], Nadia Liyanage-Don[SUP] 1 2 [/SUP], Nathalie Moise[SUP] 1 2 [/SUP], Neil Schluger[SUP] 5 [/SUP], Jessica Singer[SUP] 2 [/SUP], Magdalena Sobieszczyk[SUP] 6 [/SUP], Yifei Sun[SUP] 7 [/SUP], Harry West[SUP] 8 [/SUP], Ian M Kronish[SUP] 9 10 [/SUP]
Affiliations
- PMID: 33443699
- DOI: 10.1007/s11606-020-06340-w
Abstract
Background: The surge of coronavirus 2019 (COVID-19) hospitalizations in New York City required rapid discharges to maintain hospital capacity.
Objective: To determine whether lenient provisional discharge guidelines with remote monitoring after discharge resulted in safe discharges home for patients hospitalized with COVID-19 illness.
Design: Retrospective case series SETTING: Tertiary care medical center PATIENTS: Consecutive adult patients hospitalized with COVID-19 illness between March 26, 2020, and April 8, 2020, with a subset discharged home INTERVENTIONS: COVID-19 Discharge Care Program consisting of lenient provisional inpatient discharge criteria and option for daily telephone monitoring for up to 14 days after discharge MEASUREMENTS: Fourteen-day emergency department (ED) visits and hospital readmissions RESULTS: Among 812 patients with COVID-19 illness hospitalized during the study time period, 15.5% died prior to discharge, 24.1% remained hospitalized, 10.0% were discharged to another facility, and 50.4% were discharged home. Characteristics of the 409 patients discharged home were mean (SD) age 57.3 (16.6) years; 245 (59.9%) male; 27 (6.6%) with temperature ≥ 100.4 ?F; and 154 (37.7%) with oxygen saturation < 95% on day of discharge. Over 14 days of follow-up, 45 patients (11.0%) returned to the ED, of whom 31 patients (7.6%) were readmitted. Compared to patients not referred, patients referred for remote monitoring had fewer ED visits (8.3% vs 14.1%; OR 0.60, 95% CI 0.31-1.15, p = 0.12) and readmissions (6.9% vs 8.3%; OR 1.15, 95% CI 0.52-2.52, p = 0.73).
Limitations: Single-center study; assignment to remote monitoring was not randomized.
Conclusions: During the COVID-19 surge in New York City, lenient discharge criteria in conjunction with remote monitoring after discharge were associated with a rate of early readmissions after COVID-related hospitalizations that was comparable to the rate of readmissions after other reasons for hospitalization before the COVID pandemic.