Although many emergency department patients with known or suspected COVID-19 require hospital admission, the majority are discharged home. Concern for surges in hospital occupancy compel emergency clinicians to preserve inpatient resources and discern which patients benefit most from admission. Some patients with COVID-19, however, experience delayed decompensation and may develop serious illness several days after initial symptoms. Many of these patients required respiratory support and had other complications such as venous thromboembolism, myocarditis, and acute kidney injury.

A study was published in the Wiley Online Library on August 27, 2020 that identified that approximately 5% of patients with COVID-19 discharged from the ED returned for an unscheduled hospital admission within 72 hours. Age, abnormal chest x-ray findings, and fever or hypoxia on presentation were independently associated with an increased rate of return admission.

The COVID-19 pandemic has challenged emergency providers to deliver time-sensitive interventions under difficult circumstances. An additional challenge is posed by patients who appear well enough to be discharged upon initial presentation but may require subsequent admission. This isn’t great news for anyone but for post-acute care providers it is another challenge; do we transfer to the ER or do we care for positive cases in-house? Whatever your decision, ensure that you are prepared to care for residents who are positive for COVID-19. Look at your staffing numbers, are you prepared if staff become ill and call off? Are you tracking your PPE supplies? Are you sure? Do you have an isolation unit with dedicated staff? These are just a few “needs” to consider.

As always, stay well, stay safe and stay tuned!