Analysis of Clinical Criteria to Determine Stability for Discharge among Patients Hospitalized with COVID-19
Patients hospitalized with COVID-19 can clinically deteriorate in the second week of illness after a period of initial stability. Thus, an important clinical question is determining when it is safe to discharge these patients from the hospital without overwhelming hospitals’ capacities. Unfortunately, discharge criteria for COVID-19 patients are often based on expert opinion, with little evidence to inform them. The goal of this study is to determine risks for post-discharge adverse outcomes, including readmission and death, among a large population of patients hospitalized with COVID-19. Using data from the HCA CHARGE database, we have assembled a cohort of over 75,000 adults admitted for care of COVID-19 respiratory disease. The primary outcome is readmission to any HCA hospital or death known to HCA Healthcare within 30 days of discharge. Predictors of interest include encounter data (e.g., discharge destination), demographics, vital signs, laboratory values, chronic medical conditions, inpatient COVID-19 treatment, days since first positive test for COVID-19, a previously validated readmission risk score, and hospital size. The results of this study will hopefully lead to development of a risk score that can be used to guide discharge decisions (e.g., when to discharge, when to delay discharge, when to provide additional post-discharge monitoring).
Jeffrey L. Schnipper, MD, MPH