The Impact of COVID-19-related Visiting Restrictions on Effectiveness of Discharge Planning: A retrospective Hospital based cohort study

BACKGROUND AND AIM: Discharge planning is an individualized discharge preparation by an interdisciplinary team, with collaboration of the patient and family. However, visiting restrictions were implemented worldwide during COVID19 pandemic, and little is known about the impact on the effectiveness of discharge planning. Thus, we aim to explore the outcomes of discharge planning during the pandemic, by measure of 14-day unplanned hospital readmission after discharge. METHOD: This retrospective study is a single-center cohort of adult patients admitted to ordinary medical wards between April 1st and July 31 in 2019 and 2022. The strictest visiting restrictions were adopted in this interval in 2022. Those with medical/care needs were recruited for discharge planning. We analyzed the association between discharge planning and risk of 14-day unplanned hospital readmission by binary logistic regression. Additional sensitive analyses were performed among patients with cancers, aged over 65 and without COVID-19 at admission. We also compared the time from discharge to hopsital readmission by the Wilcoxon rank-sum test. RESULTS: In total, 4419 patients in 2019 and 6894 patients in 2022 were included. Patients in 2022 were older, with higher propotion of nursing home residents and cancers. When adjusted for all potential confounders, the adjusted odds ratio(aOR) for discharge planning and risk of 14-day unplanned hospital readmission increased from 2.31(1.61-3.30) in 2019 to 7.28(4.60-11.54) in 2022. Sensitivity analysis among patients with cancers, aged over 65 and without COVID-19 at admission showed similar results. There was no statistically significant difference in time from discharge to readmission (7.11(4.09-10.24) in 2019 and 6.94(4.24-10.55) in 2022, p=0.744), whether patients were recruited in discharge planning or not. CONCLUSIONS: Vsiting restrictions had negative impact on discharge planning, according to its association with higher risk of 14-day unplanned hospital readmission in 2022. Therefore, it's suggested that health care authorites make the necessary plans to revise discharge planning during the pandemic.