Discharge to Post-Acute Care and Other Predictors of Prolonged Length of Stay During the Initial COVID-19 Surge: A Single Site Analysis


 
 
 During the initial surge of coronavirus disease 2019 (COVID-19), healthcare utilization fluctuated dramatically, straining acute hospital capacity across the United States (US), and potentially contributing to excess mortality.
 
 
 
 This was an observational retrospective study of patients with COVID-19 admitted to a large US urban academic medical center during a twelve-week COVID-19 surge in the Spring of 2020. We describe patterns in length of stay (LOS) over time. Our outcome of interest was prolonged length of stay (PLOS) which we defined as seven or more days. We performed univariate analyses of patient characteristics, clinical outcomes, and discharge disposition to evaluate the association of each variable with PLOS and developed a final multivariate model via backward elimination wherein all variables with a p-value above 0.05 were eliminated in a stepwise fashion.
 
 
 
 The cohort included 1,366 patients, of whom 13% died and 29% were readmitted within 30 days. LOS (mean: 12.6) fell over time (p<0.0001). Predictors of PLOS included discharge to a post-acute care (PAC) facility (odds ratio [OR]: 11.9, 95% confidence interval [CI] 2.6-54.0), uninsured status (OR 3.2, CI 1.1-9.1), and requiring intensive care and intubation (OR 18.4, CI 11.5-29.6). Patients had a higher readmission rate if discharged to PAC facilities (40%) or home with home health agency (HHA) (38%) services as compared to patients discharged home without HHA (26%) (p<0.0001).
 
 
 
 Patients hospitalized with COVID-19 during a US COVID-19 surge had a prolonged LOS and high readmission rate. Lack of insurance, an ICU stay, and a decision to discharge to a PAC facility were associated with a PLOS. Efforts to decrease LOS and optimize hospital capacity during COVID-19 surges may benefit from focusing on increasing PAC and HHA capacity and resources.
