Academic hospitals' discharge practices for patients with COVID-19 compared

Most U.S. hospitals provided patients with similar guidance on isolation, but their criteria for discharge varied, leading the study authors to call for more research in this area. An Italian study found high incidence of hospital-acquired infections among COVID-19 patients in ICUs.

Academic medical centers in the U.S. had mostly similar discharge practices for COVID-19 patients but varied in their specific clinical criteria for discharge, according to a recent review of 22 facilities. In the spring and summer of 2020, researchers looked at discharge documents and interviewed hospital leaders from facilities participating in the HOspital MEdicine Reengineering Network (HOMERuN) to identify and synthesize common practices for discharge protocols and procedures. Results were published by the Journal of General Internal Medicine on April 9.

The study found wide agreement on recommendations for isolation and transmission mitigation. However, hospital policies on clinical criteria for discharge varied considerably; for example, four sites gave little or no guidance to clinicians, while three gave very specific guidance with detailed algorithms. Most sites that had specific guidance addressed patients' symptom improvement, temperature, and oxygen requirement. The review also looked at approaches to ensuring social support and functional status, finding that most hospitals assessed these factors, but only 27% had specific policies on ensuring access to durable medical equipment, food, medication, or supplies for COVID-19 patients. Finally, 77% of the sites provided home monitoring or virtual follow-up care, which ranged from daily messaging via texting or patient portals and phone calls by a nurse to, less commonly, the use of home pulse oximeters and thermometers.

The study authors suggested the results could be used to identify some best practices. “As we await empirical data to build a broader evidence base, discharge practices with high consensus in key domains can provide useful guidance for hospitals to consider as they develop and refine protocols for a prolonged COVID-19 pandemic,” they said. “More research is needed to determine optimal clinical criteria for discharge.”

In other COVID-19 research, almost half of ICU patients with COVID-19 developed a hospital-acquired infection (HAI) in a recent Italian study, published by CHEST on April 12. The multicenter retrospective analysis included patients treated at eight Italian hospitals in February to May 2020. Of the 774 patients, 46% developed an HAI (a rate of 44.7 infections per 1,000 ICU patient-days), 35% of them from multidrug-resistant bacteria. Ventilator-associated pneumonia (50%), bloodstream infections (34%), and catheter-related bloodstream infections (10%) were the most frequent. HAIs complicated by septic shock were associated with significantly higher mortality, and HAIs generally prolonged mechanical ventilation and ICU and hospital stay. The authors noted that the studied ICUs were overwhelmed by the unexpected number of critically ill patients at the time and so the high incidence of drug-resistant infections might be due at least in part to suboptimal adherence to standard infection control measures. “Clinicians should make every effort to implement protocols for surveillance and prevention of infectious complications,” they concluded.