COVID-19 Readmissions: Main Patient Characteristics.

To the Editor:

With great interest, we read the article published by Dr Choi et al[1] “COVID-19–Related Circumstances for Hospital Readmissions: A Case Series From 2 New York City Hospitals,” and we emphasize the importance of knowing the risk factors that contribute to hospital readmission related to COVID-19 and to identifying possible preventable causes. In general, identifying patients at high risk of readmission is a cornerstone of health systems. In patients with COVID-19 infection, these publications become a guide to modify the design of our health systems and to provide safer medical care.

The Fundación Santa Fe de Bogotá, in Bogotá, Colombia, is a highly complex institution with a department specialized in the evaluation of clinical performance metrics. Between March 2020 and June 2021, a total of 19,611 coronavirus disease cases were confirmed by polymerase chain reaction tests in our emergency department with 6207 cases requiring hospitalization for at least 48 hours. Following the guidelines suggested by your publication, we sought to identify the specific causes for readmission and whether they were related to the health care received, a deterioration or worsening of the symptoms, and/or the patient’s own conditions such as personal history or sociocultural context. We also sought to determine the behavior of readmissions by comparing the emergency observation services (which in our case are considered as short hospitalizations being different from consultation events in the service) with the hospitalization service to learn about the dynamics between the 2 services and the flow of reconsulting patients.

During the process of replicating the methodology, we had several concerns, in particular the definition of patients to be considered as readmissions. For practical application, we wondered which cases should be taken into account:

Those who return to consult for a cause or complication related to the diagnosis made at the time of their last hospital discharge, and in this case, it would not be clear which patients to include or not in this category beyond dyspnea or ventilatory failure, because still there is a lack of knowledge about complications after discharge from COVID-19. Furthermore, the question arose as to whether patients once discharged and then readmitted only for a persistent positive test or reinfection without any complications or related progression should be considered as readmissions or as new independent care.

Patients readmitted for causes that are completely different from those of their previous illness should or should not be considered.

Therefore, we consider that the information provided by the article has been of great value, but a clarification of the items mentioned previously could help health institutions replicate their research and determine the real impact of readmission for COVID-19, to measure its effects on cost and installed capacity to implement preventive measures and prepare adequately for patient care, especially in Colombia, where vaccination rates are low and different highly contagious virus variants have recently appeared.