Overwhelming Majority of COVID-19 Patients Sent Home from ED Do Very Well

As pharmacists well know, COVID-19 patients sent home from the emergency department to recover can go through some bad patches. Based on a new study in Los Angeles, however, most tend to do very well. In the Cedars-Sinai study, more than 85% had no need to return to the ED. Here is more information.

LOS ANGELES – While hospital pharmacists are integral parts of teams treating seriously ill COVID-19 inpatients, community pharmacists likely have more involvement with those recovering at home, often through telephone calls.

A new study provides information on how patients sent home from emergency departments fared with novel coronavirus.

The report in JACEP Open points out that the overwhelming majority of patients who visited the Cedars‐Sinai Medical Center ED with , suspected COVID-19 (novel coronavirus) symptoms, and who were treated and sent home to recuperate, recovered within a week.

In fact, Cedars-Sinai-led researchers advise that none of those patients died from the virus and fewer than 1% required intensive care.

"When the pandemic began there was minimal evidence to guide us as to who should be hospitalized and who could be sent home," said Sam Torbati, MD, co-chair and medical director of the Ruth and Harry Roman Emergency Department at Cedars-Sinai. "In real time, we began developing our criteria for who needed hospitalization for monitoring, intensive care, and who could recover at home. And this study shows our patients received the appropriate level of care."

The authors explain that, with minimal evidence describing outcomes for ED patients with suspected COVID‐19 infection who are not hospitalized, they sought to . assess 30‐day outcomes (ED revisit, admission, ICU admission, and death) for low‐risk patients discharged after ED evaluation for those patients.

The retrospective cohort study focused on patients triaged to a COVID‐19 surge area within an urban ED and discharged between March 12 and April 6. Researchers explain that physicians were urged to discharge patients if they appeared well with few comorbidities. The study team collected data from review of medical records and phone follow‐up, and the analysis was descriptive.

Included in the review were 452 patients, with median age of 38, and a majority, 61.7%, having no comorbidities. Chest radiographs were performed for 50.4% of patients and showed infiltrates in 14% of those tested. Polymerase chain reaction testing was performed for 28.3% of patients during the index ED visit and was positive in 35.9% of those tested.

With follow‐up achieved for 75.4% of patients. ED revisits occurred for 13.7% of patients, according to the results. Researchers report that the inpatient admission rate at 30 days was 4.6%, with 0.7% requiring intensive care. Median number of days between index ED evaluation and return for admission was 5 (interquartile range 3–7, range 1–17), and no known deaths occurred.

“A minority of low‐risk patients with suspected COVID‐19 will require hospitalization after being discharged home from the ED,” the authors conclude, suggesting that more researcher is necessary to develop and validate ED disposition guidelines.

"What we learned from the study is that outpatient management is safe for most COVID-19 patients who have normal vital signs and no comorbidities," added first author Carl Berdahl, MD. "However, patients should be instructed to return to the Emergency Department for worsening symptoms, including labored breathing."

"The takeaway for the public is that emergency clinicians can safely and readily identify patients with COVID-19 who are safe for outpatient monitoring," Torbati noted. "Those who meet criteria for discharge are at very low risk of getting worse and requiring hospitalization."