A Rapid Guidance Summary from the
Penn Medicine Center for Evidence-based Practice
Last updated March 26, 2020 6:00 pm All links rechecked March 26 unless otherwise noted.
Key questions answered in this summary
- How should COVID-19 patients be cared for after hospital discharge?
Criteria for discontinuing isolation precautions and COVID-19 related care are outside the scope of this report.
Summary of major recommendations
Guidelines for patients with mild disease who do not need to be hospitalized also apply to discharged patients.
Patients should remain in isolation at home until free of disease.
Provide patients with symptomatic treatment. Guidelines do not call for definitive treatment, and protocols from other hospitals call for symptomatic treatment only..
Patients should immediately contact the hospital if they develop symptoms of complicated disease
Key: A–consistently recommended in multiple guidelines, B–recommended in a single guideline, recommended only in hospital policy documents, or recommended weakly, C–guidelines or recommendations lacking or inconsistent.
Definition of terms
Guideline: Guidance developed by a professional society or government agency, intended for use at multiple hospitals.
Policy: Guidance developed at a hospital for use at that hospital. It may be based on guidelines or on expert opinion.
Guidelines for discharge to home care
Provide patient with mild COVID-19 with symptomatic treatment such as antipyretics for fever.
No relevant guidance.
Patients can be discharged from the healthcare facility whenever clinically indicated.
Acute and community hospitals must discharge all patients as soon as they are clinically safe to do so. 50% of discharged patients are expected to be cared for at home without support from a health or social care provider; 45% are expected to need health or social care support. 4% will need to be discharged to a rehabilitative care setting. 1% have had a life-changing event.
Details of isolation guidelines
Place the patient in a well-ventilated single room (i.e. with open windows and an open door). Limit the movement of the patient in the house and minimize shared space. Ensure that shared spaces (e.g. kitchen, bathroom) are well ventilated (keep windows open). Limit the number of caregivers. Ideally, assign one person who is in good health and has no underlying chronic or immunocompromising conditions. Caregivers should wear a medical mask that covers their mouth and nose when in the same room as the patient.
Considerations for care at home include:
NHS guidance for isolation of patients and family members applies. Use of facemasks is not recommended. Please see linked document for details.
Hospital policies on discharge of patients to home
Please see Appendix A for detailed instructions.
Please see Appendix B for detailed instructions
Hospital policies on management of discharged patients
No specific guidance for hospital patients discharged to home. We assume that outpatient treatment protocols apply.
Provide supportive care rather than definitive treatment to patients not requiring hospital care.
About this report
A Rapid Guidance Summary is a focused synopsis of recommendations from selected guideline issuers and health care systems, intended to provide guidance to Penn Medicine providers and administrators during times when latest guidance is urgently needed. It is not based on a complete systematic review of the evidence. Please see the CEP web site for further details on the methods for developing these reports.
Lead analyst: Matthew D. Mitchell, PhD (CEP)
Evidence team: Emilia J. Flores, PhD, RN (CEP), Kirstin A. Manges, PhD, RN (NCS); Shazia M. Siddique, MD (CEP)
Reviewer: Nikhil K. Mull, MD (CEP)
©2020 Trustees of the University of Pennsylvania
Appendix A. Washington discharge checklist
Appendix B. Zhejiang University Hospital discharge plan
- Body temperature remains normal for at least 3 days (ear temperature is lower than 37.5 ℃);
- Respiratory symptoms are significantly improved;
- The nucleic acid is tested negative for respiratory tract pathogen twice consecutively (sampling interval more than 24 hours); the nucleic acid test of stool samples can be performed at the same time if possible;
- Lung imaging shows obvious improvement in lesions;
- There is no comorbidities or complications which require hospitalization;
- SpO2 > 93% without assisted oxygen inhalation;
- Discharge approved by multi-disciplinary medical team.
Medication after discharge
Generally, antiviral drugs are not necessary after discharge. Treatments for symptoms can be applied if patients have mild cough, poor appetite, thick tongue coating, etc. Antiviral drugs can be used after discharge for patients with multiple lung lesions in the first 3 days after their nucleic acid are tested negative.
- Patients must continue two weeks of isolation after discharge. Recommended home isolation conditions are:
- Independent living area with frequent ventilation and disinfection;
- Avoid contacting with infants, the elderly and people with weak immune functions at home;
- Patients and their family members must wear masks and wash hands frequently;
- Body temperature are taken twice a day (in the morning and evening) and pay close attention to any changes in the patient's condition.
A specialized doctor should be arranged for each discharged patient's follow-ups. The first follow-up call should be made within 48 hours after discharge. The outpatient follow-up will be carried out 1 week, 2 weeks, and 1 month after discharge. Examinations include liver and kidney functions, blood test, nucleic acid test of sputum and stool samples, and pulmonary function test or lung CT scan should be reviewed according to the patient's condition. Follow-up phone calls should be made 3 and 6 months after discharge.
Management of patients tested positive again after discharge
Strict discharge standards have been implemented in our hospital. There is no discharged case in our hospital whose sputum and stool samples are tested positive again in our follow-ups. However, there are some reported cases that patients are tested positive again, after being discharged based on the standards of national guidelines (negative results from at least 2 consecutive throat swabs collected at an interval of 24 hours; body temperature remaining normal for 3 days, symptoms significantly improved; obvious absorption of inflammation on lung images). It is mainly due to sample collection errors and false negative testing results. For these patients, the following strategies are recommended:
- Isolation according to the standards for COVID-19 patients.
- Continuing to provide antiviral treatment which has been proved to be effective during prior hospitalization.
- Discharge only when improvement is observed on lung imaging and the sputum and stool are tested negative for 3 consecutive times (with an interval of 24 hours).
- Home isolation and follow-up visits after discharge in accordance with the requirements mentioned above.