Discharge Practices for COVID-19 Patients: Rapid Review of Published Guidance and Synthesis of Documents and Practices at 22 US Academic Medical Centers

doi:10.1007/s11606-021-06711-x

. 2021 Jun;36(6):1715-1721.

doi: 10.1007/s11606-021-06711-x. Epub 2021 Apr 9.

Discharge Practices for COVID-19 Patients: Rapid Review of Published Guidance and Synthesis of Documents and Practices at 22 US Academic Medical Centers

Affiliations

¹ Penn Medicine Center for Evidence-based Practice, Section of Hospital Medicine, Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. [email protected].
² Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, USA. [email protected].
³ Division of Hospital Medicine, University of California San Francisco, San Francisco, USA.
⁴ Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, USA.
⁵ Christiana Care, Wilmington, DE, USA.
⁶ University of Virginia, Charlottesville, VA, USA.
⁷ Johns Hopkins University, Baltimore, MD, USA.
⁸ University of Miami, Miami, FL, USA.
⁹ Division of General Internal Medicine, University of Washington, Seattle, WA, USA.
¹⁰ Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

PMID: 33835314
PMCID: PMC8034037
DOI: 10.1007/s11606-021-06711-x

Discharge Practices for COVID-19 Patients: Rapid Review of Published Guidance and Synthesis of Documents and Practices at 22 US Academic Medical Centers

S Ryan Greysen et al. J Gen Intern Med. 2021 Jun.

. 2021 Jun;36(6):1715-1721.

doi: 10.1007/s11606-021-06711-x. Epub 2021 Apr 9.

Authors

Affiliations

¹ Penn Medicine Center for Evidence-based Practice, Section of Hospital Medicine, Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. [email protected].
² Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, USA. [email protected].
³ Division of Hospital Medicine, University of California San Francisco, San Francisco, USA.
⁴ Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, USA.
⁵ Christiana Care, Wilmington, DE, USA.
⁶ University of Virginia, Charlottesville, VA, USA.
⁷ Johns Hopkins University, Baltimore, MD, USA.
⁸ University of Miami, Miami, FL, USA.
⁹ Division of General Internal Medicine, University of Washington, Seattle, WA, USA.
¹⁰ Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

PMID: 33835314
PMCID: PMC8034037
DOI: 10.1007/s11606-021-06711-x

Abstract

Background: There are currently no evidence-based guidelines that provide standardized criteria for the discharge of COVID-19 patients from the hospital.

Objective: To address this gap in practice guidance, we reviewed published guidance and collected discharge protocols and procedures to identify and synthesize common practices.

Design: Rapid review of existing guidance from US and non-US public health organizations and professional societies and qualitative review using content analysis of discharge documents collected from a national sample of US academic medical centers with follow-up survey of hospital leaders SETTING AND PARTICIPANTS: We reviewed 65 websites for major professional societies and public health organizations and collected documents from 22 Academic Medical Centers (AMCs) in the US participating in the HOspital MEdicine Reengineering Network (HOMERuN).

Results: We synthesized data regarding common practices around 5 major domains: (1) isolation and transmission mitigation; (2) criteria for discharge to non-home settings including skilled nursing, assisted living, or homeless; (3) clinical criteria for discharge including oxygenation levels, fever, and symptom improvement; (4) social support and ability to perform activities of daily living; (5) post-discharge instructions, monitoring, and follow-up.

Limitations: We used streamlined methods for rapid review of published guidance and collected discharge documents only in a focused sample of US academic medical centers.

Conclusion: AMCs studied showed strong consensus on discharge practices for COVID-19 patients related to post-discharge isolation and transmission mitigation for home and non-home settings. There was high concordance among AMCs that discharge practices should address COVID-19-specific factors in clinical, functional, and post-discharge monitoring domains although definitions and details varied.

Keywords: COVID-19; discharge practices; practice guidelines; transitions of care.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

**Figure 1**
Concordance on COVID-19 discharge practices.

See this image and copyright information in PMC

Cited by

Post-Hospitalization Home Monitoring Programs During the COVID-19 Pandemic: Survey Results from the Hospital Medicine Re-engineering Network (HOMERuN).
Bann M, Manjarrez E, Kellner CP, Greysen R, Davis C, Lee T, Soleimanpour N, Tambe N, Auerbach A, Schnipper JL. Bann M, et al. J Gen Intern Med. 2024 Jun;39(8):1288-1293. doi: 10.1007/s11606-023-08581-x. Epub 2023 Dec 27. J Gen Intern Med. 2024. PMID: 38151604 Free PMC article.
Post-Anesthesia Recovery: A Comprehensive Review of Sampe, Modified Aldrete, and White Scoring Systems.
Deshmukh PP, Chakole V. Deshmukh PP, et al. Cureus. 2024 Oct 6;16(10):e70935. doi: 10.7759/cureus.70935. eCollection 2024 Oct. Cureus. 2024. PMID: 39502982 Free PMC article. Review.
Discharge to post-acute care and other predictors of prolonged length of stay during the initial COVID-19 surge: a single site analysis.
O'neil JC, Geisler BP, Rusinak D, Bassett IV, Triant VA, Mckenzie R, Mattison ML, Baughman AW. O'neil JC, et al. Int J Qual Health Care. 2023 Jan 2;35(1):mzac098. doi: 10.1093/intqhc/mzac098. Int J Qual Health Care. 2023. PMID: 36477564 Free PMC article.
Relatives' experiences of visiting restrictions during the COVID-19 pandemic's first wave: a PREMs study in Valais Hospital, Switzerland.
Tacchini-Jacquier N, Monnay S, Bonvin E, Dubuis J, Verloo H. Tacchini-Jacquier N, et al. BMC Health Serv Res. 2023 Sep 19;23(1):1008. doi: 10.1186/s12913-023-10013-9. BMC Health Serv Res. 2023. PMID: 37726727 Free PMC article.
Incidence of symptomatic COVID-19 in close contacts of patients after discharge from hospital.
Ahmadi A, Poopak A, Nazemi S, Mohammadi N, Eslami B, Seyyedsalehi MS, Doshmangir L, Allameh SF, Zendehdel K. Ahmadi A, et al. BMC Infect Dis. 2022 Mar 26;22(1):293. doi: 10.1186/s12879-022-07300-x. BMC Infect Dis. 2022. PMID: 35346079 Free PMC article.

See all "Cited by" articles

References

1. Jenke AT, Mei H, Rothenberg C, et al. press. 2020. Analysis of hospital resource availability and COVID-19 mortality across the United States. J Hosp Med. - PMC - PubMed
1. Auerbach A, O'Leary KJ, Greysen SR, et al. for the HOMERuN COVID-19 Collaborative Group. Hospital Ward Adaptation During the COVID-19 Pandemic: a National Survey of Academic Medical Centers. J Hosp Med. 2020;15(8):483–488. doi: 10.12788/jhm.3476. - DOI - PMC - PubMed
1. Fraher EP, Pittman P, Frogner BK, et al. Ensuring and Sustaining a Pandemic Workforce. N Engl J Med. 2020;382(23):2181–2183. doi: 10.1056/NEJMp2006376. - DOI - PubMed
1. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323:1061–9. doi: 10.1001/jama.2020.1585. - DOI - PMC - PubMed
1. Richardson, S. et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized with COVID-19 in the New York City Area. JAMA (2020) doi:10.1001/jama.2020.6775. - PMC - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

none/Gordon and Betty Moore Foundation

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

[1] Jenke AT, Mei H, Rothenberg C, et al. press. 2020. Analysis of hospital resource availability and COVID-19 mortality across the United States. J Hosp Med. - PMC - PubMed

[2] Jenke AT, Mei H, Rothenberg C, et al. press. 2020. Analysis of hospital resource availability and COVID-19 mortality across the United States. J Hosp Med. - PMC - PubMed

[3] Auerbach A, O'Leary KJ, Greysen SR, et al. for the HOMERuN COVID-19 Collaborative Group. Hospital Ward Adaptation During the COVID-19 Pandemic: a National Survey of Academic Medical Centers. J Hosp Med. 2020;15(8):483–488. doi: 10.12788/jhm.3476. - DOI - PMC - PubMed

[4] Auerbach A, O'Leary KJ, Greysen SR, et al. for the HOMERuN COVID-19 Collaborative Group. Hospital Ward Adaptation During the COVID-19 Pandemic: a National Survey of Academic Medical Centers. J Hosp Med. 2020;15(8):483–488. doi: 10.12788/jhm.3476. - DOI - PMC - PubMed

[5] Fraher EP, Pittman P, Frogner BK, et al. Ensuring and Sustaining a Pandemic Workforce. N Engl J Med. 2020;382(23):2181–2183. doi: 10.1056/NEJMp2006376. - DOI - PubMed

[6] Fraher EP, Pittman P, Frogner BK, et al. Ensuring and Sustaining a Pandemic Workforce. N Engl J Med. 2020;382(23):2181–2183. doi: 10.1056/NEJMp2006376. - DOI - PubMed

[7] Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323:1061–9. doi: 10.1001/jama.2020.1585. - DOI - PMC - PubMed

[8] Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323:1061–9. doi: 10.1001/jama.2020.1585. - DOI - PMC - PubMed

[9] Richardson, S. et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized with COVID-19 in the New York City Area. JAMA (2020) doi:10.1001/jama.2020.6775. - PMC - PubMed

[10] Richardson, S. et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized with COVID-19 in the New York City Area. JAMA (2020) doi:10.1001/jama.2020.6775. - PMC - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Discharge Practices for COVID-19 Patients: Rapid Review of Published Guidance and Synthesis of Documents and Practices at 22 US Academic Medical Centers

Affiliations

Discharge Practices for COVID-19 Patients: Rapid Review of Published Guidance and Synthesis of Documents and Practices at 22 US Academic Medical Centers

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Miscellaneous