Are Some COVID-19 Readmissions Preventable? A Case Series from Two New York City Hospitals
Hospital readmissions are frequent, costly, and potentially harmful, and some are considered preventable. Factors that affect readmissions after hospitalization for COVID-19 and their preventability are unknown. We examined hospital readmissions among COVID-19 patients in two New York City hospitals to describe the characteristics of patients who had COVID-19 hospital readmissions at these two hospitals, identify contributing factors for readmissions, and determine which readmissions were potentially-preventable. We performed detailed case reviews using the Hospital Medicine Reengineering Network (HOMERuN) 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 two hospitals within 30 days of discharge. Among 53 readmissions following hospitalization for COVID-19, 38 (72%) were deemed not preventable and 15 (28%) were potentially-preventable. Non-preventable readmissions were mostly due to disease progression or complications of COVID-19 (31/38, 82%). Main factors contributing to potentially-preventable readmissions were premature discharge (9/15, 60%) and issues with initial disposition (5/15, 33%), including ability to obtain home care and willingness to go to a skilled nursing facility in the context of the pandemic. Although most readmissions following a COVID-19 hospitalization were deemed not preventable and were a consequence of the natural progression of the disease, over one-fourth of readmissions were potentially-preventable. Factors that contributed to potentially-preventable readmissions were premature discharge and issues relating to disposition that were directly related to challenges posed by the ongoing COVID-19 pandemic. Clinicians should be cautious about discharging COVID-19 patients prematurely.