COVID-19: Breathing problems are the most common reason for returning to the hospital
A recent study shows that it is relatively rare for COVID-19 patients to return to the hospital within 2 weeks of discharge. Individuals with high blood pressure or chronic obstructive pulmonary disease (COPD) were the most likely to require readmission.
As the COVID-19 pandemic continues, many hospitals remain under severe pressure.
To identify ways to relieve some of this pressure and improve patient care, researchers at the Icahn School of Medicine at Mount Sinai, New York, NY, compared COVID-19 patients who returned to the hospital with those who did not.
All those included in the study were patients at one of five hospitals in New York City between February 27 to April 12, 2020.
The researchers searched electronic health records for return visits to hospital emergency departments and outpatient clinics within 14 days of discharge.
Out of 2,864 discharged patients, 103 (3.6%) returned for emergency care. In total, the hospitals readmitted 56 patients.
Half of all the patients who returned to the hospital did so because they were experiencing breathing difficulties, which was the most common complication. Other complications included chest pain (6%), other pain (6%), altered mental status (5%), falls (5%), and skin or soft-tissue infections (5%).
Patients who returned to the hospital were significantly more likely to have hypertension (36% vs. 22.1%) and COPD (6.8% vs. 2.9%) than those who did not go back.
Surprisingly, say the researchers, there was no apparent association between the patients’ age and their likelihood of readmission.
Differences in original care
The original length of stay of people who went back to the hospital was significantly shorter than patients who did not return. Patients who returned had initially been in the hospital for a median of 4.5 days. Patients who did not return had been in the hospital for a median of 6.7 days.
Individuals who went back to the hospital were also less likely to have received anticoagulant drugs to help prevent dangerous blood clotting. However, this result was not statistically significant.
Of the 56 patients who went back to the hospital, 51 (91.1%) went home, three died, and two remained in the hospital at the time of the analysis.
The study features in the latest issue of the Journal of General Internal Medicine.
The authors conclude:
“Many healthcare facilities remain stretched beyond capacity. Readmissions following hospitalization for COVID-19 have the potential to exacerbate this burden and may represent a missed opportunity to provide optimal care. As the evolution of COVID-19 remains uncertain, characterization of the clinical course of patients who re-present after discharge is important with potential to inform discharge planning and post-discharge care.”
Keeping patients well
The peak of the COVID-19 outbreak in New York City (NYC) may have passed, says co-author Dr. Anuradha Lala, but several areas are now seeing a second wave of cases.
“While caring for patients during the peak of the pandemic in NYC, our focus was on safe and efficient discharge to make room for new patients and prevent additional exposure,” she says.
“As we move into a phase where COVID-19 is no longer a novel disease, we must transition our attention to the post-acute phase to understand how to keep patients well and out of the hospital.”
Dr. Benjamin Glicksberg, another of the study’s authors, adds: “These findings may help clinical practitioners optimize discharge strategies in the short-term, and suggest the need for future studies on tailored monitoring to decrease the risk of hospital returns.”
The authors acknowledge that their study’s relatively small sample size limited its statistical power and prevented them from controlling for other variables that could have affected the results.
Also, they were unable to collect data on possible readmissions to hospitals outside the Mount Sinai Health System or account for patients who may have died at home following discharge.
