Effect of the COVID-19 pandemic lockdown on non-COVID-19 emergency department visits in Eastern France: Reduced risk or avoidance behavior?

Wartelle, Adrien; Mourad-Chehade, Farah; Yalaoui, Farouk; Chrusciel, Jan; Laplanche, David; Sanchez, Stéphane

doi:10.1016/j.puhip.2021.100109

Cited by 19 publications

(20 citation statements)

References 9 publications

(8 reference statements)

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“…This was also noticed in our hospital, with a total reduction of 58% in ED attendances (3304 vs. 10,172 in 2019, p<0.0001), matching, if not surpassing, similar reductions in Germany (35%), France (41.47%), USA (42%) and Italy (66.2%) [ 10 , 12 , 13 , 16 ]. This trend shows some signs of reversal during the second and, especially, the third phase of the lockdown; however, it never reached the level of attendances noted in 2019.…”

Section: Discussionsupporting

confidence: 81%

“…Hospitals had to be reorganized, staff retrained, and redeployed to meet the demands of the pandemic. Along with a significant reduction or even a complete cessation of elective surgery, in order to preserve resources for the critically ill COVID-19 patients [ 8 ], a significant reduction in the number of patients seeking medical help for non-COVID-19 conditions was noted, an effect noticed across multiple countries [ 9 - 13 ]. Recently, the term "COVID collateral damage syndrome" has been utilized to describe the effect that delayed or unavailable medical care may have on patients that require intensive or urgent care [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Emergencies in the COVID-19 Era: Less Attendances, More Admissions

Fyntanidou¹,

Stavrou²,

Apostolopoulou³

et al. 2022

Cureus

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Introduction Healthcare systems suffered a significant hit by the COVID-19 pandemic since the spring of 2020, and a need for major reorganization emerged. Along with the constant increase in COVID-19 cases, a significant drop in emergency attendances for non-COVID-19-related conditions was noted worldwide. We decided to document attendances in our hospital's emergency department during the first lockdown period in order to monitor this trend, compare it to data from other countries, and start monitoring the effects of this reduction in the years to come. Materials and methods Emergency department attendances at AHEPA University Hospital, Thessaloniki, Greece, from March 10, 2020, to May 31, 2020, were documented and compared to the corresponding period in 2019. The data collected included the number of patients per specialty, severity upon admission, as well as the need for admission. Results We found a 58% reduction in emergency department attendance during the studied period compared to the corresponding period in 2019 (p<0.0001). The reduction was more noticeable in ears, nose, throat (ENT), and ophthalmology attendances (75.7% and 78.1% reductions, respectively, p<0.001), but other specialties, such as cardiology and general surgery, were also significantly affected (60% and 63% reductions, respectively, p<0.001). However, the percentage of attendances that required admission increased significantly by 25-33% (p<0.001) during the lockdown, reflecting the higher severity of cases reaching the hospital. Conclusion Despite the obvious reduction in attendances during the COVID-19 pandemic, patients still suffer from serious conditions that require hospital admission. Therefore, hospitals need to be supported to also care for these patients. The long-term effects of avoiding hospital attendance need to be closely monitored.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Emergencies in the COVID-19 Era: Less Attendances, More Admissions

Fyntanidou¹,

Stavrou²,

Apostolopoulou³

et al. 2022

Cureus

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“…In some areas, closure of higher education institutions will have prompted some students to return to their family homes [34,35]. However, similar falls have been seen elsewhere and may be consistent with younger patients not attending ED with self-limiting conditions and possibly experiencing less minor trauma with reductions in some activities during the lockdown [7,10]. The greatest relative reduction in medical admissions were in the oldest age groups possibly due to concerns about COVID-19 acquisition in hospital or about the futility of admission [36].…”

Section: Discussionmentioning

confidence: 72%

“…Factors influencing hospital attendance during the pandemic may have included fear of acquiring COVID-19 infection, a desire to reduce the pressure on hospitals or a higher threshold among referring and receiving clinicians for hospital review or admission. Conversely, others have suggested patients avoiding ED had more minor illness and this had a beneficial effect by reducing crowding in ED [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on emergency department attendances and acute medical admissions

et al. 2021

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Background To better understand the impact of the COVID-19 pandemic on hospital healthcare, we studied activity in the emergency department (ED) and acute medicine department of a major UK hospital. Methods Electronic patient records for all adult patients attending ED (n = 243,667) or acute medicine (n = 82,899) during the pandemic (2020–2021) and prior year (2019) were analysed and compared. We studied parameters including severity, primary diagnoses, co-morbidity, admission rate, length of stay, bed occupancy, and mortality, with a focus on non-COVID-19 diseases. Results During the first wave of the pandemic, daily ED attendance fell by 37%, medical admissions by 30% and medical bed occupancy by 27%, but all returned to normal within a year. ED attendances and medical admissions fell across all age ranges; the greatest reductions were seen for younger adults in ED attendances, but in older adults for medical admissions. Compared to non-COVID-19 pandemic admissions, COVID-19 admissions were enriched for minority ethnic groups, for dementia, obesity and diabetes, but had lower rates of malignancy. Compared to the pre-pandemic period, non-COVID-19 pandemic admissions had more hypertension, cerebrovascular disease, liver disease, and obesity. There were fewer low severity ED attendances during the pandemic and fewer medical admissions across all severity categories. There were fewer ED attendances with common non-respiratory illnesses including cardiac diagnoses, but no change in cardiac arrests. COVID-19 was the commonest diagnosis amongst medical admissions during the first wave and there were fewer diagnoses of pneumonia, myocardial infarction, heart failure, cellulitis, chronic obstructive pulmonary disease, urinary tract infection and other sepsis, but not stroke. Levels had rebounded by a year later with a trend to higher levels of stroke than before the pandemic. During the pandemic first wave, 7-day mortality was increased for ED attendances, but not for non-COVID-19 medical admissions. Conclusions Reduced ED attendances in the first wave of the pandemic suggest opportunities for reducing low severity presentations to ED in the future, but also raise the possibility of harm from delayed or missed care. Reassuringly, recent rises in attendance and admissions indicate that any deterrent effect of the pandemic on attendance is diminishing.

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“…All of this increased the workload which led to crowding in the ED [ 13 , 14 , 15 , 16 ]. On the other hand, there was a decreased volume of patients seeking health care [ 17 , 18 ] or visiting ED during the COVID-19 pandemic, especially those presenting as lower acuity [ 19 , 20 , 21 , 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Door to Disposition Key Performance Indicator in Three Saudi Arabian Hospitals’ Emergency Departments during COVID-19 Pandemic

Almana¹,

Alharbi²

2022

Healthcare

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Objective: The COVID-19 pandemic impacted health systems and Emergency Departments (ED) services worldwide. This study attempts to assess the impact of COVID-19 on the performance of the emergency department during COVID-19 in three hospitals in Riyadh city, Saudi Arabia. Methods: Ada’a data was used for this retrospective cohort study. The hospitals included in this study were: a 300-bed maternity and children’s hospital; a 643-bed general hospital; and a 1230-bed tertiary hospital. All patients who visited the ED in the time period from September 2019 to December 2021 were included. The outcome variable was the Door to Disposition (DTD) which estimates the percentage of patients seen within 4 h from Door to Disposition. A two-way ANOVA test was used to examine the differences in the outcome variable by hospital and by the phase of COVID-19. Results: Both hospital and the phase of COVID-19 were significantly different in terms of the percentage of patients seen within four hours in the ED (DTD) (p-value < 0.05). On average, the DTD percentages dipped slightly in the early phase of COVID-19 (64.0% vs. 69.8%) and jumped sharply in the later phase (73.6%). Additionally, the average DTD score for the maternity and pediatric hospital (87.6%) was sharply higher than both general and tertiary hospitals (63.2%, and 56.5%, respectively). Conclusion: COVID-19 led to a significant drop in emergency department services performance in the early stage of the pandemic as patients spent more time at the ED. However, for the designated COVID-19 hospital, the ED performance improved as more patients spent less than 4 h at the ED in the early stages of COVID-19. This is a clear indication that careful planning and management of resources for ED services during a pandemic is effective.

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Effect of the COVID-19 pandemic lockdown on non-COVID-19 emergency department visits in Eastern France: Reduced risk or avoidance behavior?

Cited by 19 publications

References 9 publications

Emergencies in the COVID-19 Era: Less Attendances, More Admissions

Emergencies in the COVID-19 Era: Less Attendances, More Admissions

Impact of the COVID-19 pandemic on emergency department attendances and acute medical admissions

Door to Disposition Key Performance Indicator in Three Saudi Arabian Hospitals’ Emergency Departments during COVID-19 Pandemic

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