Changes in Hospital Admissions for Urgent Conditions During COVID-19 Pandemic

Oseran, Andrew; Nash, Dina; Kim, Carolyn; Moisuk, Stacey; Lai, Po Yu; Pyhtila, John; Sequist, Thomas D.; Wasfy, Jason H.

doi:10.37765/ajmc.2020.43837

Cited by 72 publications

(54 citation statements)

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“…In agreement with previous studies [1][2][3][4][5][6][7], a substantial inpatient hospitalization deficit has been observed for cardiovascular, psychiatry, oncology and surgical cases in Germany during the Covid-19 pandemic. On the one hand, this can be explained by a reduction in emergency admissions that has been a consistent finding in Europe and the U.S. during the early phase of the pandemic.…”

Section: Discussionsupporting

confidence: 91%

“…During the early phase of the Covid-19 pandemic, reductions of hospital admissions have been observed for several medical and surgical conditions [1][2][3][4]. In contrast, there is only scarce data on trends during later stages of the pandemic [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, there is only scarce data on trends during later stages of the pandemic [5][6][7]. Moreover, the major focus of those studies was on inpatient care and emergency conditions [1][2][3][4][5][6][7]. This has prompted the German-wide Helios hospital network to refine a monitoring system that not only monitors hospitalization trends for several conditions, but also assesses the cumulative hospitalization deficit as the pandemic continues [5].…”

Section: Introductionmentioning

confidence: 99%

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Utilization of in- and outpatient hospital care in Germany during the Covid-19 pandemic insights from the German-wide Helios hospital network

et al. 2021

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Background During the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical and surgical conditions, while trend data during later stages of the pandemic are scarce. Consequently, this study aims to provide up-to-date hospitalization trends for several conditions including cardiovascular, psychiatry, oncology and surgery cases in both the in- and outpatient setting. Methods and findings Using claims data of 86 Helios hospitals in Germany, consecutive cases with an in- or outpatient hospital admission between March 13, 2020 (the begin of the “protection” stage of the German pandemic plan) and December 10, 2020 (end of study period) were analyzed and compared to a corresponding period covering the same weeks in 2019. Cause-specific hospitalizations were defined based on the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems (ICD-10) or German procedure classification codes for cardiovascular, oncology, psychiatry and surgery cases. Cumulative hospitalization deficit was computed as the difference between the expected and observed cumulative admission number for every week in the study period, expressed as a percentage of the cumulative expected number. The expected admission number was defined as the weekly average during the control period. A total of 1,493,915 hospital admissions (723,364 during the study and 770,551 during the control period) were included. At the end of the study period, total cumulative hospitalization deficit was -10% [95% confidence interval -10; -10] for cardiovascular and -9% [-10; -9] for surgical cases, higher than -4% [-4; -3] in psychiatry and 4% [4; 4] in oncology cases. The utilization of inpatient care and subsequent hospitalization deficit was similar in trend with some variation in magnitude between cardiovascular (-12% [-13; -12]), psychiatry (-18% [-19; -17]), oncology (-7% [-8; -7]) and surgery cases (-11% [-11; -11]). Similarly, cardiovascular and surgical outpatient cases had a deficit of -5% [-6; -5] and -3% [-4; -3], respectively. This was in contrast to psychiatry (2% [1; 2]) and oncology cases (21% [20; 21]) that had a surplus in the outpatient sector. While in-hospital mortality, was higher during the Covid-19 pandemic in cardiovascular (3.9 vs. 3.5%, OR 1.10 [95% CI 1.06–1.15], P<0.01) and in oncology cases (4.5 vs. 4.3%, OR 1.06 [95% CI 1.01–1.11], P<0.01), it was similar in surgical (0.9 vs. 0.8%, OR 1.06 [95% CI 1.00–1.13], P = 0.07) and in psychiatry cases (0.4 vs. 0.5%, OR 1.01 [95% CI 0.78–1.31], P<0.95). Conclusions There have been varying changes in care pathways and in-hospital mortality in different disciplines during the Covid-19 pandemic in Germany. Despite all the inherent and well-known limitations of claims data use, this data may be used for health care surveillance as the pandemic continues worldwide. While this study provides an up-to-date analysis of utilization of hospital care in the largest German hospital network, short- and long-term consequences are unknown and deserve further studies.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Utilization of in- and outpatient hospital care in Germany during the Covid-19 pandemic insights from the German-wide Helios hospital network

et al. 2021

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“…Nonetheless, inpatient bed-days decreased by more than one-third, consistent with the decrease in inpatient resource use reported for adult hospitals. 3 Remarkably, these trends were consistent across children's hospitals, despite variation in the content and installation of and adherence with social distancing policies in their surrounding local areas. These findings beg the question of how well children's hospitals are positioned to weather a recurrent surge in COVID-19.…”

Section: Discussionmentioning

confidence: 81%

Healthcare Encounter and Financial Impact of COVID‐19 on Children's Hospitals

Synhorst

Bettenhausen

Hall

et al. 2021

Journal of Hospital Medicine

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Children’s hospitals responded to COVID-19 by limiting nonurgent healthcare encounters, conserving personal protective equipment, and restructuring care processes to mitigate viral spread. We assessed year-over-year trends in healthcare encounters and hospital charges across US children’s hospitals before and during the COVID-19 pandemic. We performed a retrospective analysis, comparing healthcare encounters and inflation-adjusted charges from 26 tertiary children’s hospitals reporting to the PROSPECT database from February 1 to June 30 in 2019 (before the COVID-19 pandemic) and 2020 (during the COVID-19 pandemic). All children’s hospitals experienced similar trends in healthcare encounters and charges during the study period. Inpatient bed-days, emergency department visits, and surgeries were lower by a median 36%, 65%, and 77%, respectively, per hospital by the week of April 15 (the nadir) in 2020 compared with 2019. Across the study period in 2020, children’s hospitals experienced a median decrease of $276 million in charges.

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“…Public communication and information campaigns. It is important to keep the public informed about the measures and behaviors to adopt during the pandemic, but it is also important to ensure that they are aware of the safety of health care facilities, encouraging them to contact emergency networks in the event of acute neurological symptoms [40][41][42].…”

Section: Reflecting On Neurological Preparednessmentioning

confidence: 99%