Changes in emergency department utilisation in Germany before and during different phases of the COVID-19 pandemic, using data from a national surveillance system up to June 2021

Abstract

Background During the COVID-19 pandemic and associated public health and social measures, decreasing patient numbers have been described in various healthcare settings in Germany, including emergency care. This could be explained by changes in disease burden, e.g. due to contact restrictions, but could also be a result of changes in utilisation behaviour of the population. To better understand those dynamics, we analysed routine data from emergency departments to quantify changes in consultation numbers, age distribution, disease acuity and day and hour of the day during different phases of the COVID-19 pandemic. Methods We used interrupted time series analyses to estimate relative changes for consultation numbers of 20 emergency departments spread throughout Germany. For the pandemic period (16-03-2020 – 13-06-2021) four different phases of the COVID-19 pandemic were defined as interruption points, the pre-pandemic period (06-03-2017 – 09-03-2020) was used as the reference. Results The most pronounced decreases were visible in the first and second wave of the pandemic, with changes of − 30.0% (95%CI: − 32.2%; − 27.7%) and − 25.7% (95%CI: − 27.4%; − 23.9%) for overall consultations, respectively. The decrease was even stronger for the age group of 0–19 years, with − 39.4% in the first and − 35.0% in the second wave. Regarding acuity levels, consultations assessed as urgent, standard, and non-urgent showed the largest decrease, while the most severe cases showed the smallest decrease. Conclusions The number of emergency department consultations decreased rapidly during the COVID-19 pandemic, without extensive variation in the distribution of patient characteristics. Smallest changes were observed for the most severe consultations and older age groups, which is especially reassuring regarding concerns of possible long-term complications due to patients avoiding urgent emergency care during the pandemic.

The impact of the early COVID-19 pandemic on healthcare system resource use and costs in two provinces in Canada: An interrupted time series analysis

“…The long-term impacts of cancer care delays and deferrals leading to more severe presentations are yet to be revealed [16,78]. Similar to other studies [26,27], we found that the rates of ED visits significantly declined at the start of the pandemic compared to the last prepandemic week, by 41% in Ontario and 24% in BC, and never returned to pre-pandemic levels in 2020. This is consistent with ED avoidance by people with milder conditions, diversion of human and diagnostic resources away from urgent care, as well as significant decreases in infections associated with lockdown measures.…”

“…The initial ramp-down started in March 2020 when Canadian healthcare systems began reducing elective procedures and non-emergency care [5,6,8], and reconfiguring facilities in preparation for COVID-19 patients [14,15]. In Canada and internationally, there were reports of major reductions in cancer screening [16][17][18][19], diagnosis [20], and treatment [21,22] in 2020 compared to previous years, as well as lower numbers of hospital admissions [23,24] and emergency department (ED) visits [10,11,[25][26][27]. While some non-COVID-19 care was transitioned from in-person to virtual [28][29][30][31][32] and from inpatient to outpatient [33], concerns about delivering ideal care under COVID-19 circumstances were identified [34][35][36].…”

Effects of COVID-19-targeted non-pharmaceutical interventions on pediatric hospital admissions in North Italian hospitals, 2017 to 2022: a quasi-experimental study interrupted time-series analysis

“…In particular, to estimate the effectiveness of population-level health interventions that have been implemented at a clearly defined point in time, Interrupted Time Series (ITS) regression analysis is the recommended method ( 15 ). However, the majority of research on this topic is monocentric ( 16–19 ), is restricted to specific pediatric age classes or considers all ages including adults ( 17 , 19–26 ), focuses on specific diagnoses ( 9 , 16 , 17 , 19 , 21 , 25 , 27 ), only looks at Emergency Department (ED) visits ( 16 , 17 , 19 , 21 , 23 , 26 , 28 , 29 ), or addresses the time period immediately following the pandemic onset without evaluating ongoing effects ( 18 , 25 , 30 ).…”

Pre-Hospital Emergency Medical Services Utilization Amid COVID-19 in 2020: Descriptive Study Based on Routinely Collected Dispatch Data in Bavaria, Germany

“…The comparison of the use of pre-hospital EMS to the use of emergency departments during the early pandemic periods show some parallels: The most pronounced decreases occurred during the first and second wave [28]. Also, the decrease was stronger in young age groups [28,29] and in patients affected by trauma [6,30]. Other results were not on the same line: Studies looking at emergency department use report declines in patients with neurological symptoms [6,31,32] and cardiovascular disease [32].…”

“…The comparison of the use of pre-hospital EMS to the use of emergency departments during the early pandemic periods show some parallels: The most pronounced decreases occurred during the first and second wave [28]. Also, the decrease was stronger in young age groups [28,29] and in patients affected by trauma [6,30].…”