Discharge to post–acute care and other predictors of prolonged length of stay during the initial COVID-19 surge: a single site analysis

• Published in: International journal for quality in health care Vol. 35; no. 4
• Main Authors: O’neil, Jessica C, Geisler, Benjamin P, Rusinak, Donna, Bassett, Ingrid V, Triant, Virginia A, Mckenzie, Rachael, Mattison, Melissa L, Baughman, Amy W
• Format: Journal Article
• Language: English
• Published: UK Oxford University Press 02.01.2023
• Subjects: COVID-19 - epidemiology; Humans; Length of Stay; Original; Patient Discharge; Patient Readmission; Retrospective Studies; Risk Factors; Subacute Care; COVID-19; length of stay; readmissions; post–acute care; bed capacity
• ISSN: 1353-4505; 1464-3677
• DOI: 10.1093/intqhc/mzac098

Abstract Background During the initial surge of coronavirus disease 2019 (COVID-19), health-care utilization fluctuated dramatically, straining acute hospital capacity across the USA and potentially contributing to excess mortality. Methods This was an observational retrospective study of patients with COVID-19 admitted to a large US urban academic medical center during a 12-week COVID-19 surge in the Spring of 2020. We describe patterns in length of stay (LOS) over time. Our outcome of interest was prolonged LOS (PLOS), which we defined as 7 or more days. We performed univariate analyses of patient characteristics, clinical outcomes and discharge disposition to evaluate the association of each variable with PLOS and developed a final multivariate model via backward elimination, wherein all variables with a P-value above 0.05 were eliminated in a stepwise fashion. Results The cohort included 1366 patients, of whom 13% died and 29% were readmitted within 30 days. The LOS (mean: 12.6) fell over time (P < 0.0001). Predictors of PLOS included discharge to a post–acute care (PAC) facility (odds ratio [OR]: 11.9, 95% confidence interval [CI] 2.6–54.0), uninsured status (OR 3.2, CI 1.1–9.1) and requiring intensive care and intubation (OR 18.4, CI 11.5–29.6). Patients had a higher readmission rate if discharged to PAC facilities (40%) or home with home health agency (HHA) services (38%) as compared to patients discharged home without HHA services (26%) (P < 0.0001). Conclusion Patients hospitalized with COVID-19 during a US COVID-19 surge had a PLOS and high readmission rate. Lack of insurance, an intensive care unit stay and a decision to discharge to a PAC facility were associated with a PLOS. Efforts to decrease LOS and optimize hospital capacity during COVID-19 surges may benefit from focusing on increasing PAC and HHA capacity and resources.