COVID-19 emergency department discharges: an outcome study

Abstract

Pressure on acute medical services in the pandemic mandated an assertive emergency department (ED) discharge policy. Given the potential for subsequent deterioration and growing appreciation of complications relating to COVID-19 infection, this follow up study was instigated to provide clinical reassurance that discharged patients had followed a safe clinical course. 199 patients discharged from the ED of our central London hospital were identified over a 20-day period at the height of the pandemic in April 2020. 44 had already reattended ED and 12 had been admitted. At 2-week telephone follow-up, 14 patients were identified who required urgent recall for assessment. At 4-week telephone follow-up, 87 patients were identified with persistent symptoms requiring face to face review. A COVID-19 follow-up clinic was therefore established to provide multi-professional review and diagnostics. 65 patients attended for this assessment. This is the first report on outcomes in COVID-19 infected patients discharged from an ED. It highlights the importance of safety-netting after discharge, the difficulty in predicting which patients might deteriorate and the need for appropriate follow up services.

Keywords: COVID-19; ED discharge policy; outcomes; safety-net.

Fig 1.

Numbers of patients contacted and reviewed.

Fig 2.

Chest X-ray changes at initial presentation to the emergency department.

Fig 3.

6-week follow-up graphs. a) Percentage subjective recovery at 6 weeks. b) Breathlessness scores during peak illness and at 6 weeks.

Fig 4.

Comparing C-reactive protein and D-dimer in single attendances vs representing to emergency department and subsequently discharged and representing and being admitted.