Preventability of 30-day hospital revisits following admission with COVID-19 at an academic medical center

Taupin, Daniel; Anderson, Timothy S.; Merchant, Elisabeth A.; Kapoor, Andrew; Sokol-Hessner, Lauge; Yang, Julius J.; Auerbach, Andrew D.; Stevens, Jennifer P.; Herzig, Shoshana J.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic may have affected the preventability of 30-day hospital revisits, including readmissions and emergency department (ED) visits without admission. This study was conducted to examine the preventability of 30-day revisits for patients admitted with COVID-19 in order to inform the design of interventions that may decrease preventable revisits in the future. METHODS: We retrospectively reviewed a cohort of adults admitted to our academic medical center with COVID-19 between March 21 and June 29, 2020 and discharged alive. Patients with a 30-day revisit following hospital discharge were identified. Two-physician review was used to determine revisit preventability, identify factors contributing to preventable revisits, assess potential preventive interventions, and establish the influence of pandemic-related conditions on the revisit. RESULTS: Seventy-six of 576 COVID-19 hospitalizations resulted in a 30-day revisit (13%), including 21 ED visits without admission (4%) and 55 readmissions (10%). Of these 76 revisits, 20 (26%) were potentially preventable. The most frequently identified factors contributing to preventable revisits were related to the choice of post-discharge location and to patient/caregiver understanding of the discharge medication regimen, each occurring in 25% of cases. The most frequently cited potentially preventive intervention was “improved self-management plan at discharge,” occurring in 65% of cases. Five of the 20 preventable revisits (25%) had contributing factors that were thought to be directly related to the COVID-19 pandemic. CONCLUSIONS: While only approximately one quarter of 30-day hospital revisits following admission with COVID-19 were potentially preventable, our results highlight opportunities for improvement to reduce revisits going forward.