Effect of shelter-in-place on emergency department radiology volumes during the COVID-19 pandemic

Abstract

Purpose The coronavirus disease 2019 (COVID-19) pandemic has led to significant disruptions in the healthcare system including surges of infected patients exceeding local capacity, closures of primary care offices, and delays of non-emergent medical care. Government-initiated measures to decrease healthcare utilization (i.e., "flattening the curve") have included shelterin-place mandates and social distancing, which have taken effect across most of the USA. We evaluate the immediate impact of the Public Health Messaging and shelter-in-place mandates on Emergency Department (ED) demand for radiology services. Methods We analyzed ED radiology volumes from the five University of California health systems during a 2-week time period following the shelter-in-place mandate and compared those volumes with March 2019 and early April 2019 volumes. Results ED radiology volumes declined from the 2019 baseline by 32 to 40% (p < 0.001) across the five health systems with a total decrease in volumes across all 5 systems by 35% (p < 0.001). Stratifying by subspecialty, the smallest declines were seen in non-trauma thoracic imaging, which decreased 18% (p value < 0.001), while all other non-trauma studies decreased by 48% (p < 0.001). Conclusion Total ED radiology demand may be a marker for public adherence to shelter-in-place mandates, though ED chest radiology demand may increase with an increase in COVID-19 cases.

Quantifying the decrease in emergency department imaging utilization during the COVID-19 pandemic at a multicenter healthcare system in Ohio

“…These exams compose 69% of all ED CT C/A/Ps normally and their decline likely reflects the aforementioned decrease in civilian movement due to stay-at-home orders. The UC health system study demonstrated similar findings [5]. Since the volume trough in mid-April, the preliminary volume data has been trending upward as demonstrated in Fig.…”

“…Combined with the 46% decrease in ED imaging volume at our system during this period, the relatively flat, low-volume curve of the new cases in the nine counties supports the anecdotal idea that strictly from an ED imaging utilization perspective the northeast Ohio region was less impacted by the direct health effects of the COVID-19 pandemic and more impacted by the policies set forth to curtail its spread. In contrast, a similar study conducted at five University of California (UC) health centers demonstrated a 35% overall decrease in ED imaging volumes during a similar timeframe [5]. At the time of this writing, California has thus far seen the second highest number of positive COVID-19 cases in the country compared with Ohio, which has the 16th highest.…”

“…The purpose of this study is to illustrate our health system's experience with imaging utilization in the ED setting during a 10-week period amidst the COVID-19 pandemic. Predictive models and anecdotal articles suggest ED imaging volumes have declined by around 50%; however, minimal actual data has been published to substantiate these figures [4][5][6]. By quantifying the imaging utilization change experienced at our multi-centered system, we hope similar organizations may be able to extrapolate the effect of the crisis on their own institutions.…”

The Effects of Lockdown During the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic on Neurotrauma-Related Hospital Admissions

“…While several hospitals found a decreasing trend in general trauma admissions from February to April 2020, none of these studies thoroughly evaluated the effects on emergent operative cases or changes in mechanisms of injury. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18…”

Changes in Healthcare Utilization, Spending, and Perceived Health during COVID–19: A Longitudinal Study from Singapore

“…Singaporeans reduced their healthcare utilization by 23% in terms of total out-of-pocket healthcare spending. During the pandemic, there was a similar decrease in healthcare utilization in the U.S.: 32-40% in Emergency Department (ED) radiology volumes [33] and 49% in acute ischemic stroke patients. [34] Delaying healthcare is associated with longer hospital stays and poor health outcomes in the future.…”