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COVID-19-Related Circumstances for Hospital Readmissions: A Case Series From 2 New York City Hospitals
Justin J Choi1, Jigar H Contractor1, Amy L Shaw1
1From the Department of Medicine.
Insights
Most COVID-19 hospital readmissions were not preventable, often due to disease progression. However, 17% were potentially preventable, linked to discharge issues during the pandemic.
Area of Science:
- Public Health
- Infectious Diseases
- Healthcare Management
Background:
- Hospital readmissions are a significant concern in healthcare.
- Understanding readmission drivers is crucial for improving patient outcomes.
- The COVID-19 pandemic presented unique challenges to patient care and discharge.
Purpose of the Study:
- To identify factors contributing to hospital readmissions after COVID-19.
- To assess the preventability of these readmissions.
- To inform strategies for reducing future readmissions.
Main Methods:
- Retrospective case review of COVID-19 patients readmitted within 30 days.
- Utilized the Hospital Medicine Reengineering Network framework.
- Analyzed readmissions at two New York City hospitals.
Main Results:
- Out of 53 readmissions, 83% were not preventable, primarily due to COVID-19 progression.
- 17% of readmissions were potentially preventable.
- Key factors for preventable readmissions included disposition issues (56%) and premature discharge (33%).
Conclusions:
- Most COVID-19 readmissions are unavoidable consequences of disease progression.
- Pandemic-related disposition challenges contributed to some preventable readmissions.
- Clinicians must address disposition challenges during public health crises.
Objective:
The aim of the study was to determine the main factors contributing to hospital readmissions and their potential preventability after a coronavirus disease 2019 (COVID-19) hospitalization at 2 New York City hospitals.
Methods:
This was a retrospective study at 2 affiliated New York City hospitals located in the Upper East Side and Lower Manhattan neighborhoods. We performed case reviews using the Hospital Medicine Reengineering Network framework to determine potentially preventable readmissions among patients hospitalized for COVID-19 between March 3, 2020 (date of first case) and April 27, 2020, and readmitted to either of the 2 hospitals within 30 days of discharge.
Results:
Among 53 readmissions after hospitalization for COVID-19, 44 (83%) were deemed not preventable and 9 (17%) were potentially preventable. Nonpreventable readmissions were mostly due to disease progression or complications of COVID-19 (37/44, 84%). Main factors contributing to potentially preventable readmissions were issues with initial disposition (5/9, 56%), premature discharge (3/9, 33%), and inappropriate readmission (1/9, 11%) for someone who likely did not require rehospitalization.
Conclusions:
Most readmissions after a COVID-19 hospitalization were not preventable and a consequence of the natural progression of the disease, specifically worsening dyspnea or hypoxemia. Some readmissions were potentially preventable, mostly because of issues with disposition that were directly related to challenges posed by the ongoing COVID-19 pandemic. Clinicians should be aware of challenges with disposition related to circumstances of the COVID-19 pandemic.
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