Background: For chronically ill patients admitted to Internal Medicine (IM) Units, intermediate care facilities such as rehabilitation and post-acute clinics are a bridge between hospitalization and returning home. Since 2020, the SARS-CoV2 pandemic forced a closure or repurposing of many such facilities, which in turn reduced the discharge options for IM patients. In this prospective study, we analyse the outcomes of discharges from IM before and after 2020 in a secondary hospital in Rome, Italy.Methods: All admissions to IM during 2014-2023 were prospectively recorded along with demographic data, hospital stay, outcome and type of discharge. Rates of discharge to home or to an intermediate care facility before and after 2020 were retrospectively compared.Results: 6932 admissions were included (48% males, median age 80 years, IQR 17); mean stay was 10.9±8.9 days, in-hospital mortality was 9.4%; overall 79.5% were discharged from IM either to home, rehabilitation, or hospice facilities. During 2014-2019, 11.8% of discharges were toward a residential care setting vs. only 6.4% in 2020-2023 (p<0.001). During 2014-2019 5.5% of discharges were to rehabilitation centres, vs. only 1.9% in 2020-2023 (p<0.001). In 2020-2023 mean hospital stay increased to 11.3±9.6 days vs. 10.7±8.5 days in 2014-2019 (p=0.01).Conclusions: Chronically ill patients who cannot be cared for at home often cannot be discharged for lack of an alternative to hospital care. Reduced availability of rehabilitation and post-acute beds after 2020 has contributed to longer hospital stay in our IM unit.
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