PROVIDENCE, R.I. (WPRI) – Rhode Island emergency departments are seeing COVID-19 patients readmitted at high rates, spurring one hospital group to try and improve at-home monitoring and care.
The R.I. Department of Health reports the statewide hospital readmission rate is nearly 8% for COVID-19 patients, and some emergency care doctors working in the state’s busiest hospitals said they are seeing rates at about 10%.
That roughly matches other critical health conditions known to have the highest readmission rates, such as congestive heart failure and pneumonia. But hospital workers report seeing patients battling COVID-19 returning as quickly as a few days after being discharged, which is significantly faster than those other health conditions.
The monthly readmission rate fell after an initial spike in the early months of the pandemic, but it’s shot up again halfway through December, as overall COVID-19 hospitalizations have reached record levels this month.
“We’re seeing this phenomenon where patients will get admitted, they will get treated in the hospital and improve,” said Dr. Otis Warren, Rhode Island president of the American College of Emergency Physicians. “Many patients will be discharged from the hospital and then [two to 10] days later they need to come back for a multitude of reasons.”
One reason is the nature of the disease. COVID-19 will often hit a person with somewhat mild symptoms that at first allow a patient to recover safely at home. But the disease can take a sharp turn for the worse after only a few days, making it difficult to predict who’s truly getting better.
A second reason is that treatment in the hospital is far better than what’s available to people at home. Most of the drugs used to treat coronavirus patients are only available in hospital settings or most effective while patients are on oxygen, meaning options are limited for people after they are discharged.
There’s also heightened concern among some patients about moving from the hospital into skilled-nursing facilities – a common step down from emergency and in-patient care – because of the serious outbreaks that have been seen at assisted-living and long-term care facilities.
Warren said patients’ decisions to go directly home, especially if they have other ailments, can negatively affect their wellbeing if they don’t properly take care of themselves.
“While they’re in the hospital, they’re being monitored, they’re getting daily blood tests, they’re getting continuous oxygen monitoring,” Warren said. “When they go home … those things that are very delicate balances, we’re seeing, oftentimes falls off the side or one way or the other.”
R.I. Health Department Director Dr. Nicole Alexander-Scott, who tested positive for the coronavirus over the weekend, recently touted a new monoclonal antibody treatment made available to the state as one tool to help people with milder symptoms get better at home. The treatment could help deter some people with the coronavirus from needing the hospitals, she explained during a recent news conference.
“There are now better treatments for people in the hospital, and now also for people who have milder illnesses at home,” said Alexander-Scott, who was asymptomatic and working from home as of Monday.
But Warren said the antibody treatment supply is limited and has only been given to a few patients under specific settings, meaning it’s not a widespread option. In a Wall Street Journal op-ed published Sunday, former FDA commissioner Dr. Scott Gottlieb raised concerns about the lackluster supply of antibody treatments and called for increased production and improved access.
“Some states are not distributing their available supply and access to the drugs can be hit or miss, varying widely from state to state,” Gottlieb tweeted Sunday.
The elevated rate of readmission is particularly challenging at a time when hospital beds are increasingly scarce. As of Tuesday, Rhode Island reported 455 people with the virus were in the hospital – far exceeding levels seen during the spring.
As overcrowding has already resulted in the opening of two field hospitals in Cranston and Providence, figuring out ways to try and help people with COVID-19 better take care of themselves at home has become increasingly necessary.
Dr. Anthony Napoli has come up with one idea that’s taking on life this week.
On Wednesday, Napoli’s employer Lifespan is expected to roll out a new initiative called the “COVID Home Companion Kit,” a take-home set of equipment and instructions for patients who are at a higher risk of being readmitted.
“We want to know their oxygen level and their respiratory symptoms,” Napoli said.
The kits will include pulse oximeters, which patients can use to track oxygen levels. Any reading below 95 could indicate something is wrong; anything less than 90 is reason for concern, Napoli explained. The information is helpful to health care providers because oxygen levels will often drop before a patient’s conditions worsen.
“You see people with this disease showing up with levels lower than 90, but you wouldn’t predict it just looking at the patients,” Napoli said.
The tools will come with instructions on how to report symptoms through the hospital network’s online system, which will be regularly reviewed by quality assurance nurses. If there are any red flags, Lifespan may tell patients to return to the hospital or to schedule a telehealth visit with a medical professional.
Catching early warning signs could help save lives, Napoli said, and providing telemedicine to others who don’t necessarily need emergency care could help alleviate pressure on the hospitals.
If successful, Napoli hopes the idea could be helpful to the health care system beyond COVID-19.
“If we demonstrate that this works, we could generalize it to other illnesses and more closely monitor people who are at higher risk,” he said.