Impact of temporary closures of emergency departments during the COVID-19 outbreak on clinical outcomes for emergency patients in a metropolitan area

Abstract

Background During the early phase of the coronavirus disease 2019 (COVID-19) outbreak, many emergency departments (EDs) were exposed to COVID-19 and were temporarily closed according to national protocol of Korea. We aimed to evaluate the effect of concurrent and recurrent temporary closures of EDs on the clinical outcomes of patients who visited EDs during the COVID-19 outbreak. Methods This cross-sectional study used a nationwide emergency patient database. Patients who visited one of the 46 EDs in Daegu and Gyeongbuk between January 21 and April 14, 2020 were included. The main exposure variable was the first medical contact (ED visit or 119 call to emergency medical services (EMS)) during closure of at least one ED. There were 25 temporary closures of six Level-1 and Level-2 EDs between February 18 and March 17, 2020. We constructed a dataset by performing bidirectional crossover matching and conducted a conditional logistic regression analysis where the primary outcome was in-hospital mortality. Results Of the 94,360 eligible study participants, 36,327 were classified into the non-EMS-use group and 10,116 were classified into the EMS-use group. In-hospital mortality rates were 2.0% and 1.6% for the temporary-closure and no-closure groups in the non-EMS-use group ( p -value, 0.03) and 8.7% and 7.4% in the EMS-use group ( p -value, 0.02), respectively. In the conditional logistic analysis for in-hospital mortality, the odds ratios (95% confidence intervals) of the temporary-closure group compared the no-closure group were 1.22 (1.03–1.44) among the non-EMS-use group and 1.23 (1.04–1.46) among the EMS-use group. Conclusion The temporary closures of EDs due to the unpredicted COVID-19 exposure resulted in an increase in emergency patients' in-hospital mortality rates irrespective of whether they used EMS. Preparing regional EMS systems to cope with new outbreaks is essential to protect the safety of all citizens.

Prevention of temporary emergency medical center closure through isolation zone and screening triage in COVID-19 outbreak

“…This can lead to multi-center closure in the region, making the situation even worse regionally. In the COVID-19 outbreak, temporary EMC closures were significantly associated with increased community hospital mortality and ICU hospitalization rates, and extended ED stays [8]. Therefore, the decision to temporarily EMC close must be made carefully.…”

“…Based on these experiences, hospitals in South Korea are performing temporary EMC closures to prevent the spread of SARS-CoV-2 to patients and healthcare workers in situations where an EMC is exposed to COVID-19. However, because EMC closure causes sudden loss of essential emergency resources, it can cause serious disruption to local emergency medical systems [8]. Therefore, efforts are needed to make judicious decisions about EMC closures.…”

The impact of COVID-19 on the patterns of emergency department visits among pediatric patients

“…During the early phase of the COVID-19 outbreak (February and March 2020), there were several shut down events of the EDs because COVID-19 confirmed cases were detected among the patients admitted to the ED. [ 11 ] In March 2020, the Ministry of Health and Welfare designated and operated the Severe Emergency Medical Care Centers (SEMC) to treat appropriately suspected and confirmed COVID-19 patients and to protect other uninfected emergency patients from infection. The information on resources, including available isolation units and beds in the SEMC, was shared in real time through the web-based national emergency care information system.…”

“…The NEDIS includes the demographic and clinical information of all patients who visited EDs across the country, such as patient demographics (such as sex, age, residential area, and insurance), symptoms (chief complaints, onset of symptoms, and reason for visit), prehospital factors (ambulance use and prehospital care), and ED (vital signs, triage, emergency operative procedures, diagnosis codes based on the International Classification of Disease 10th Edition-based (ICD-10), disposition, and final clinical outcomes) information. [ 11 , 18 ]…”

“…The COVID-19 outbreak is known to be associated with an unprecedented decline in emergency department (ED) utilization. [ [8] , [9] , [10] , [11] ] As an effect of the COVID-19 pandemic, there have been daily changes in routine activities and health care delivery. [ 1 , 12 ] Among pediatric patients, health care use has also been affected by policies, such as “stay-at-home” orders and school closures, and the rate of ED visits by children has decreased during the COVID-19 pandemic.…”