Publication: Journal of General Internal Medicine
Authors: Girish Nadkarni, MD, Co-Chair; Anuradha Lala, MD, Member; Benjamin Glicksberg, PhD, Member; and other coauthors of the Mount Sinai COVID Informatics Center at the Icahn School of Medicine at Mount Sinai.
Bottom Line: This study describes characteristics of patients with COVID-19 who returned to the ER or required readmission to the hospital within 14 days of being discharged. Understanding what conditions impact these patient outcomes can help improve care during the hospital stay and after discharge.
Researchers found the most common cause for a patient's early hospital readmission after discharge was for respiratory distress. These patients were also more likely to have other ailments including chronic obstructive pulmonary disease and hypertension.
Results: Of the nearly 2,900 discharged patients, more than 100 (3.6%) returned for emergency care after about 4.5 days; 56 of those returning patients required readmittance into the hospital. Half the patients returned for respiratory complications. Compared to patients who did not return, those returning had higher rates of chronic obstructive pulmonary disease and hypertension.
Patients who returned also had a shorter length hospital stay during treatment, lower rates of anticoagulation treatment, and were less likely to require intensive care. Age, sex, and race/ethnicity were no different among readmitted patients compared to those who did not return.
Why the Research Is Interesting: The findings provide insight that can potentially lead to improved care for patients hospitalized with COVID-19 to reduce both complications after discharge and hospital readmissions.
Who: 2,864 patients with COVID who were treated and discharged from five hospitals in the Mount Sinai Health System, and later readmitted.
When: COVID patients hospitalized between February 27 to April 12, 2020.
What: The study describes clinical characteristics of patients with COVID-19 who were most likely to return to the ER or require hospital readmission within two weeks of being discharged.
How: Researchers examined data collected from electronic health records including time spent in the emergency department and within an outpatient lab visit. They also considered more than 100 variables including demographics, key vitals, disease diagnoses, comorbid conditions, procedures during hospitalization, ICU-level care, and outcomes.
Study Conclusions: A return to the hospital after admission for COVID-19 within 14 days of discharge was relatively low for the majority of patients. However, the most common cause for a patient's return to the hospital was for respiratory distress. Patients who returned were more likely to have chronic obstructive pulmonary disease and hypertension.
Said Mount Sinai's Girish Nadkarni of the research:"This study shows that many patients have lingering effects from hospitalization for COVID-19 and thus, there is opportunity for longitudinal studies that could further assess the long-term effects of COVID on patient outcomes when they are discharged."
Said Mount Sinai's Dr. Anuradha Lala of the research:"COVID-19 has diminished and then resurged in many places, and as such, it is crucial for us to understand the post-hospitalization course and risk factors for coming back into the hospital. 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. 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."
Said Mount Sinai's Dr. Benjamin Glicksberg of the research:"We found that individuals with certain comorbid conditions, specifically COPD and hypertension, were more likely to return to the hospital. 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."
About the Mount Sinai Health SystemThe Mount Sinai Health System is New York City's largest academic medical system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai is a national and international source of unrivaled education, translational research and discovery, and collaborative clinical leadership ensuring that we deliver the highest quality care--from prevention to treatment of the most serious and complex human diseases. The Health System includes more than 7,200 physicians and features a robust and continually expanding network of multispecialty services, including more than 400 ambulatory practice locations throughout the five boroughs of New York City, Westchester, and Long Island. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of the Top 20 Best Hospitals in the country and the Icahn School of Medicine as one of the Top 20 Best Medical Schools in the country. Mount Sinai Health System hospitals are consistently ranked regionally by specialty by U.S. News & World Report.
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Journal of General Internal Medicine