Reducing Covid-19 Health Inequities Through Identification of Health-Related Social Needs and Clinical Deterioration in Patients Discharged from the Emergency Department
Abstract
Introduction
The decision to discharge a patient from the hospital with confirmed or suspected COVID-19 is fraught with challenges. Patients who are discharged home must be both medically stable and able to safely isolate to prevent disease spread. Socioeconomically disadvantaged patient populations in particular may lack resources to safely quarantine and are at high risk for COVID-19 morbidity.
Methods
We developed a telehealth follow-up program for emergency department (ED) patients who received testing for COVID-19 from April 24 to June 29, 2020 and were discharged home. Patients who were discharged with a pending COVID-19 test received follow up calls on Days 1, 4 and 8. The objective of our program was to screen and provide referrals for health-related social needs (HRSNs); conduct clinical screening for worsening symptoms; and deliver risk-reduction strategies for vulnerable individuals. Retrospective chart review was conducted on all patients in this cohort to collect demographic information, testing results, and outcomes of clinical symptom and HRSN screening. Our primary outcome measurement was the need for clinical reassessment and referral for an unmet HRSN.
Results
From April 24th to June 29th, 2020, we made calls to 1,468 patients tested for COVID-19 and discharged home. On Day 4, we reached 67.0% of the 1,468 patients called. Of these, 15.9% were referred to a PA out of concern for clinical worsening and 12.4% were referred to an ED Patient Navigator for HRSNs. On Day 8, we reached 81.8% of the 122 patients called. Of these, 19.7% were referred to a PA for clinical reassessment and 14.0% of patients were referred to an ED Patient Navigator for HRSNs. Our intervention reached 1,069 patients, of which 12.6% required referral for HRSNs and 1.3% (n=14) were referred to the ED or Respiratory Illness Clinic due to concern for worsening clinical symptoms.
Conclusion
In this patient population, the demand for interventions to address social needs was as high as the need for clinical reassessment. Similar ED-based programs should be considered to help support patients’ interdependent social and health needs, beyond those related to COVID-19.