Hospitals vary in postdischarge info, care for patients with COVID-19

Hospitals vary in their handling of recommendations and follow-up care for patients with COVID-19, a recent survey found.

The survey was sent to 51 hospitals participating in the National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network in July 2021. Over eight weeks, 47 of the hospitals responded to the survey, which had 13 questions, mostly closed-ended, about the structure of outpatient follow-up for patients discharged after hospitalization for COVID-19. Results were published by CHEST on Jan. 30.

Thirty-seven of the hospitals (79%) provided discharge information specific to COVID-19; 70% counseled patients on reasons to return to the hospital, 66% on isolation precautions, and 64% on reasons to call primary care. About a quarter (26%) included potential symptoms or impairments of post-acute sequelae of COVID-19 (PASC) in their discharge info. Postdischarge contact was part of care at 63% of hospitals, with the most common methods being clinic visits, either in-person or virtual (43%), and phone calls (38%).

Thirty-three hospitals had a postdischarge outpatient clinic specific to COVID-19, 20 of which had opened prior to August 2020. Hospitals with PASC clinics tended to be larger and in higher-income areas than those without. A referral was required for all but one of the clinics: 70% relied on physician discretion or patient/family requests for referrals, while 39% used specific criteria, and 21% referred all patients who had been hospitalized with COVID-19. Patients received a range of testing, such as pulmonary function testing, six-minute walk tests, chest X-rays, and assessments of cognition, mental health, physical function, and quality of life. Of the 14 hospitals that did not have a PASC clinic, two had plans to create one.

The authors described this as the “first large-scale, multicenter evaluation of care delivery following hospitalization for COVID-19.” They noted that the effectiveness of PASC clinics remains unknown. “While multidisciplinary PASC clinics could reduce care fragmentation, they could also promote low-value care through unnecessary testing or divert resources away from clinics with established benefit,” the authors wrote. “Future studies should aim to understand the effectiveness and equity of dedicated, multidisciplinary care on improving longer-term, patient-centered outcomes for COVID survivors.”