Barriers to acute care discharge from an urban center before and during the COVID-19 pandemic.

Background: Timely discharge of medically ready acute care patients reduces strain on hospital resources and limits patient exposure to iatrogenic harm. The increased need for acute care beds during various stages of the COVID-19 pandemic has made addressing barriers to timely discharge even more critical. The aim of this study was to analyze discharge barriers and hospital length of stay (LOS) before vs. during COVID-19 for a subset of acute care patients with identified barriers at an urban medical center. Methods: A cross-sectional analysis was conducted with 64 patients in the baseline period before COVID-19 and 68 patients in the period during COVID-19. The Department of Care Coordination at the Johns Hopkins Hospital collected barrier and disposition data for the two six-week periods. A multivariable linear regression model was used to analyze the association between LOS and predictor variables including age, discharge barriers, discharge dispositions, and time period. Results: Acute care patients with three identified barriers experienced a significant increase in average LOS during the COVID-19 time period (43.5 vs. 70.3 days, p<0.001), while the average LOS for all patients in this dataset decreased (35.0 vs. 28.1 days). For both periods, "High Cost/Complex Care Needs" (28% before vs. 34% during) was the most common barrier, followed by "Insurance Company" (13% for both periods). Conclusions: Acute patients with three barriers experienced an increase in average LOS during the COVID-19 time period, while the average LOS of all patients in this dataset decreased during the pandemic. Further assessment of barriers and the impact of care pattern policies during the COVID-19 pandemic could inform discharge strategies.