IMPORTANCE There has been a significant increase in the implementation and dissemination of geriatric emergency department (GED) programs. Understanding the costs associated with patient care would yield insight into the direct financial value for patients, hospitals, health systems, and payers. OBJECTIVE To evaluate the association of GED programs with Medicare costs per beneficiary.
The coronavirus disease 2019 (COVID-19) pandemic has strained healthcare systems through increased care complexity, need for staff and patient safety, and surges in patients suspected or known to be infected with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2). Previous infectious disease outbreaks and natural disasters have altered clinical operations and ED performance in different manners depending on the disaster type and duration. During the 2009 H1N1 Influenza pandemic, total ED patient visits increased [1], and measures of ED performance such as patient length of stay (LOS), waiting time, left without being seen (LWBS) and boarding time were negatively affected [2,3]. Following a severe wildfire in San Diego, ED volumes decreased while rates of admission and LWBS increased [4]. Immediately following Hurricane Harvey, visits to free-standing EDs in Houston increased [5]. Conversely, after Hurricane Sandy, ED visits in New York plummeted but quickly returned to pre-disaster rates [6]. This retrospective review examines ED volumes and operational metrics of a health system in the Chicagoland area from January 1, 2020 to April 22, 2020. The seven hospitals analyzed were categorized by annual ED volumes and include: one very-high volume urban academic ED, one high-volume suburban community ED, and five average to low-volume community sites (Table 1). The following operational metrics were collected: median daily visits, COVID-19 specific visits, patients LWBS, door to diagnostic evaluation by a qualified medical professional ("door-to-doc" time), hospitalization rate, decision to admit to ED departure (boarding time), and median ED LOS. The study described three time periods determined by public health messaging and initial local cases: pre-COVID
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