COVID–19 driven decline in emergency visits: Has it continued, is it permanent, and what does it mean for emergency physicians?

Melnick, Glenn; O'Leary, June F.; Zaniello, Ben A.; Abrishamian, Luis

doi:10.1016/j.ajem.2022.08.031

Cited by 16 publications

(14 citation statements)

References 5 publications

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“…Patient Encounters and Emergency Department Capacity in California, 2011-2021 visits observed in 2020 and 2021 may be largely associated with the COVID-19 pandemic and closely resembles changes in health care use observed in other states over this same period. 24 While the total number of ED visits increased, there were also significant changes in visit type.…”

Section: Jama Network Open | Emergency Medicinesupporting

confidence: 93%

Patterns in Patient Encounters and Emergency Department Capacity in California, 2011-2021

Hsia,

Zagorov,

Sarkar

et al. 2023

JAMA Netw Open

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ImportanceThe health care system has undergone major changes in the past decade, and emergency department (ED) crowding has worsened over time; however, the most recent patterns in ED capacity and use in California have yet to be studied.ObjectiveTo analyze patterns in ED capacity and utilization in California hospitals from 2011 to 2021.Design, Setting, and ParticipantsThis retrospective cohort study used data from the California Department of Health Care Access and Information and the US Census Bureau to analyze ED facility characteristics from more than 400 general acute care hospitals with more than 320 EDs in California as well as patients who presented to those EDs between January 1, 2011, and December 31, 2021.Main Outcomes and MeasuresLinear patterns (measured by percentage change) in total annual ED capacity (volume of hospital beds, EDs, ED treatment stations, and trauma centers) and ED use (ED visits by disposition and acuity) were assessed as primary outcomes. Patterns in ambulance diversion hours and the number of patients who left the ED without being seen were also examined as secondary outcomes. Visit acuity was categorized into 5 levels by increasing severity (minor, low to moderate, moderate, severe without threat, and severe with threat) based on California Department of Health Care Access and Information descriptions corresponding to Current Procedural Terminology codes.ResultsIn the prepandemic period (2011-2019), the total population of California increased from 37 638 369 to 39 512 223 (5.0%; 95% CI, 4.1%-5.8%), then decreased to 39 237 836 in 2021 (0.7%; 95% CI, −3.9% to 2.5%). Over the entire study period (2011-2021), the total California population increased by 4.2% (95% CI, 3.3%-5.2%). From 2011 to 2019, the annual number of ED visits increased from 12 054 885 to 14 876 653 (23.4%; 95% CI, 20.0%-26.8%) before decreasing to 12 944 692 in 2021 (−13.0%; 95% CI, −33.1% to 7.1%); from 2011 to 2021, total ED visits increased by 7.4% (95% CI, 5.6%-9.1%). From 2011 to 2021, the total number of EDs decreased from 339 to 326 (−3.8%; 95% CI, −4.4% to −3.2%) and the total number of hospital beds decreased from 75 940 to 74 052 (−2.5%; 95% CI, −3.3% to −1.6%), while the number of ED treatment stations in these fewer EDs increased from 7159 to 8667 (21.1%; 95% CI, 19.7%-22.4%). The number of visits rated as severe with threat also increased, from 2 011 637 in 2011 to 3 375 539 in 2021 (67.8%; 95% CI, 59.7%-75.9%), while visits rated as minor decreased from 913 712 to 336 071 (−63.2%; 95% CI, −75.2% to −51.2%) over the same period.Conclusions and RelevanceIn this cohort study, multiple measures of ED capacity did not proportionally increase with the increasing demand for services; however, the COVID-19 pandemic appears to have substantially affected some of these patterns. These findings may be helpful to policy makers and health care stakeholders when planning resource allocation of limited health care resources.

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Section: Jama Network Open | Emergency Medicinesupporting

confidence: 93%

Patterns in Patient Encounters and Emergency Department Capacity in California, 2011-2021

Hsia,

Zagorov,

Sarkar

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

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“…The COVID‐19 pandemic may have led to delayed outpatient care and increased morbidity leading to higher likelihood of ED visits 50 . Emerging research suggests ED visits have rebounded but have not returned to pre‐pandemic levels, and those that frequently receive their care at the ED may not return to the ED until they feel it is safe to do so 51 . Understanding the role of the factors examined in our study may be integral with increased populations that would shift to primary and alternative care settings for their care.…”

Section: Discussionmentioning

confidence: 99%

“…50 Emerging research suggests ED visits have rebounded but have not returned to pre-pandemic levels, and those that frequently receive their care at the ED may not return to the ED until they feel it is safe to do so. 51 Understanding the role of the factors examined in our study may be integral with increased populations that would shift to primary and alternative care settings for their care. Due to the cross-sectional data and the causal relationship between risk factors and ED visits, utilization cannot be readily determined.…”

Section: Limitationsmentioning

confidence: 98%

Factors associated with frequent emergency department visits among health centre patients receiving primary care

Pourat¹,

Lu²,

Chen³

et al. 2023

Evaluation Clinical Practice

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Rationale, Aims and ObjectivesWe sought to examine specific care‐seeking behaviours and experiences, access indicators, and patient care management approaches associated with frequency of emergency department (ED) visits among patients of Health Resources and Services Administration‐funded health centres that provide comprehensive primary care to low‐income and uninsured patients.MethodWe used cross‐sectional data of a most recent nationally representative sample of health centre adult patients aged 18–64 (n = 4577) conducted between October 2014 and April 2015. These data were merged with the 2014 Uniform Data System to incorporate health centre characteristics. We measured care‐seeking behaviours by whether the patient called the health centre afterhours, for an urgent appointment, or talked to a provider about a concern. Access to care indicators included health centre continuity of care and receipt of transportation or translation services. We included receipt of care coordination and specialist referral as care management indicators. We used a multilevel multinomial logistic regression model to identify the association of independent variables with number of ED visits (4 or more visits, 2–3 visits, 1 visit, vs. 0 visits), controlling for predisposing, enabling, and need characteristics.ResultsCalling the health centre after‐hours (OR = 2.41) or for urgent care (OR = 2.53), and being referred to specialists (OR = 2.36) were associated with higher odds of four or more ED visits versus none. Three or more years of continuity with the health centre (OR = 0.32) was also associated with lower odds of four or more ED visits versus none.ConclusionsFindings underscore opportunities to reduce higher frequency of ED visits in health centres, which are primary care providers to many low‐income populations. Our findings highlight the potential importance of improving patient retention, better access to providers afterhours or for urgent visits, and access to specialist as areas of care in need of improvement.

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“…During the early stages of the COVID-19 pandemic, total ED visits dropped by 42%-50% when compared to the same period of time in 2019 [6,7]. ED volumes in 2021 and 2022 have continued to be less than in 2019 by 10% and 12%, respectively [8]. The volume of low-acuity ED visits notably decreased, while the decrease in the volume of high-acuity patients was relatively small [6].…”

Section: Introductionmentioning

confidence: 96%

Using Virtual Emergency Medicine Clinicians as a Health System Entry Point (Virtual First): Cross-Sectional Survey Study

Potter¹,

Watson²,

Gardner³

et al. 2023

J Med Internet Res

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Background The COVID-19 pandemic accelerated the use and acceptance of telemedicine. Simultaneously, emergency departments (EDs) have experienced increased ED boarding. With this acceptance of telemedicine and the weighty increase in patient boarding, we proposed the innovative Virtual First (VF) program to leverage emergency medicine clinicians’ (EMCs) ability to triage patients. VF seeks to reduce unnecessary ED visits by connecting patients with EMCs prior to seeking in-person care rather than using traditional ED referral systems. Objective The goal of this study is to investigate how patients’ access to EMCs from home via the establishment of VF changed how patients sought care for acute care needs. Methods VF is a synchronous virtual video visit at a tertiary care academic hospital. VF was staffed by EMCs and enabled full management of patient complaints or, if necessary, referral to the appropriate level of care. Patients self-selected this service as an alternative to seeking in-person care at a primary care provider, urgent care center, or ED. A postvisit convenience sample survey was collected through a phone SMS text message or email to VF users. This is a cross-sectional survey study. The primary outcome measure is based on responses to the question “How would you have sought care if a VF visit was not available to you?” Secondary outcome measures describe valued aspects and criticisms. Results were analyzed using descriptive statistics. Results There were 3097 patients seen via VF from July 2021 through May 2022. A total of 176 (5.7%) patients completed the survey. Of these, 87 (49.4%) would have sought care at urgent care centers if VF had not been available. There were 28 (15.9%) patients, 26 (14.8%) patients, and 1 (0.6%) patient that would have sought care at primary care providers, EDs, or other locations, respectively. Interestingly, 34 (19.3%) patients would not have sought care. The most valued aspect of VF was receiving care in the comfort of the home (n=137, 77.8%). For suggested improvements, 58 (33%) patients most commonly included “Nothing” as free text. Conclusions VF has the potential to restructure how patients seek medical care by connecting EMCs with patients prior to ED arrival. Without the option of VF, 64.2% (113/177) of patients would have sought care at an acute care facility. VF’s innovative employment of EMCs allows for acute care needs to be treated virtually if feasible. If not, EMCs understand the local resources to better direct patients to the appropriate site. This has the potential to substantially decrease patient costs because patients are given the appropriate destination for in-person care, reducing the likelihood of the need for transfer and multiple ED visits.

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COVID–19 driven decline in emergency visits: Has it continued, is it permanent, and what does it mean for emergency physicians?

Cited by 16 publications

References 5 publications

Patterns in Patient Encounters and Emergency Department Capacity in California, 2011-2021

Patterns in Patient Encounters and Emergency Department Capacity in California, 2011-2021

Factors associated with frequent emergency department visits among health centre patients receiving primary care

Using Virtual Emergency Medicine Clinicians as a Health System Entry Point (Virtual First): Cross-Sectional Survey Study

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