LAUSR

Study Objective: During the height of the COVID-19 pandemic in New York City (NYC), emergency departments (EDs) faced unprecedented numbers of patients seeking care for COVID-19-like illness (CLI). Testing for COVID-19 was not widespread, the most appropriate management and disposition of patients with respiratory disease was unknown and ED, ward and ICU beds were becoming scarce. We have reported previously on short-term (7-day) outcomes using a clinical pathway for discharging CLI patients with mild to moderate hypoxia based on exertional oxygen saturation (eSpO2) after one minute of walking in place. Eligible CLI patients with an eSpO2 of at least 90% were discharged with a pulse oximeter, oxygen concentrator if needed, and remote follow-up. We report long-term outcomes for CLI patients discharged using this pathway. Methods: Between 07/2020 and 09/2020, follow-up phone calls were attempted for CLI patients with mild to moderate hypoxia discharged between 03/2020 and 05/2020 during the height of the COVID-19 pandemic at two NYC EDs. Patients were contacted by phone using a standardized script. Information on subsequent COVID testing, health care and outcomes was collected. Demographic and clinical data was obtained from the electronic health record (EHR). If patients could not be contacted after three attempts, review of the EHR for evidence of life (EOL) such as a follow-up clinic visit was performed. Patients were considered lost to follow-up (LTF) if not contacted and no EOL identified. Results: 492 patients discharged with moderate CLI were included. The mean age was 51 [range: 17-92], 62% were male and 61% were discharged from the community ED site. The average duration of CLI symptoms was 7.1 days with non-specific influenza-like symptoms being the most common (80%) and few patients having a primary respiratory complaint (13%). The mean triage SpO2 was 95% [IQR: 93-97] and discharge eSpO2 was 94% [92-96]. A chest x-ray was performed in 350 patients;70% had findings consistent with viral pneumonia. A pulse oximeter and/or oxygen concentrator was documented as given to 73% and 18%, respectively. We contacted 337/492 (69%) by phone and EOL was available for an additional 141 (28%) patients;3% were considered LTF. The mean follow-up time was 85 days [95% CI: 81-89]. 228 patients reported COVID testing;179 (80%) tested positive. At the time of follow-up, nine patients (1.8%, 95% CI: 0.9 -3.4] were deceased, 17% [14-21] had a subsequent ED visit, 11% [9-14] were admitted with 16 and 8 patients requiring ICU level care and intubation respectively. Conclusions: Long-term follow-up of CLI patients discharged with mild to moderate hypoxia demonstrates low subsequent admission and mortality rates. This clinical pathway relying on exertional oxygen saturation after a one-minute walk test offers a simple method for identifying patients suitable for discharge with remote monitoring during pandemic conditions in resource-limited settings.