ABSTRACT
Study Objectives: During the pandemic, emergency clinicians balanced the growing crisis of limited hospital bed availability with the risks of sending sick patients home. We sought to measure the rates of return visits during the pandemic and assess patient characteristics associated with higher rates of return. Methods: Cohort study of patients evaluated at 9 EDs within an integrated health system between March 13 and May 20, 2020 with clinical suspicion for Covid-19. We excluded patients who neither had testing for SARS-CoV-2 nor were designated with isolation precautions for Covid-19. We identified and collected data through a central dashboard that was established within the EHR. We defined confirmed Covid-19 cases as those with a positive PCR for SARS-CoV-2 infection. All patients had a minimum follow-up period of 14 days. The primary outcome was a return visit over the first 14 days. The analysis consisted of descriptive statistics and a multivariable proportional hazards model that was limited to patients discharged home on their index visit to assess the association between confirmed Covid-19 and bounceback. Results: There were 13,367 ED patients with clinical suspicion of Covid-19, of whom 7289 (54.5%) were female, 5225 (39.1%) black, non-Hispanic, and the mean age was 55.7 ±19.9 years. There were 12859 (96.2%) patients tested with PCR for SARS-CoV-2, 508 (3.8%) isolated for Covid-19 but never tested, and 3760 (28.1%) with confirmed Covid-19. The number of patients hospitalized was 7724 (57.8%). Return visits among those that were not hospitalized occurred 436 (7.7%) times within 14 days from the initial encounter and 546 (9.7%) times within 30 days. The median time to a return visit was 7 [IQR 3, 17] days. Of patients with a return visit in 14-days, 207 (46.1%) were hospitalized on their second visit. Patients who were discharged home that had confirmed Covid-19 had a return rate of 20.0% vs. 3.7% among patients without confirmed Covid-19 (see Figure 1). In multivariable analysis, factors not associated with the primary outcome were race, pulse oximetry, and sex. Factors significantly associated with 14-day returns were age >60 years (HR 1.34, 95% CI 1.03 - 1.67), each 1-point increase in the Charlson comorbidity index (HR 1.13, 95% CI 1.03 - 1.17), and confirmed Covid-19 (HR 5.25, 95% CI 4.29 - 6.42). Conclusions: Admission rates were high in patients with suspected Covid-19, and return rates over 14 days were 7.7%. Patients with confirmed Covid-19 had a 5-fold greater hazard of a 14-day return compared to those without confirmed Covid-19. [Formula presented]