Impact of the Coronavirus Disease 2019 Pandemic on an Emergency Department Service: Experience at the Largest Tertiary Center in Taiwan

Abstract

Purpose Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) is an emerging contagious pathogen that has caused community and nosocomial infections in many countries. This study aimed to evaluate the impact of Coronavirus disease 2019 (COVID-19) on emergency services of the largest medical center in Taiwan by comparing emergency department (ED) usage, turnover, and admission rates before the COVID-19 outbreak with those during the outbreak. Materials and Methods A retrospective cohort study was conducted in the ED of the largest tertiary medical center in Taiwan. Trends of adult, non-trauma patients who visited the ED during February–April 2019 were compared with those during February–April 2020. The number of visits, their dispositions, crowding parameters, and turnover rates were analyzed. The primary outcome was the change in ED attendance between the two periods. The secondary outcomes were changes in hospital admission rates, crowding parameters, and turnover rates. Results During the outbreak, there were decreased non-trauma ED visits by 33.45% (p < 0.001) and proportion of Taiwan Triage and Acuity Scale (TTAS) 3 patients (p=0.02), with increased admission rates by 4.7% (p < 0.001). Crowding parameters and turnover rate showed significant improvements. Conclusion Comparison of periods before and during the COVID-19 outbreak showed an obvious decline in adult, non-trauma ED visits. The reduction in TTAS 3 patient visits and the increased hospital admission rates provide references for future public-health policy-making to optimise emergency medical resource allocations globally.

Examining patient flow in a tertiary hospital’s emergency department at a low coronavirus prevalence region

“…In February 2020, most parameters used to measure the input of patient flow in our ED dropped sharply and reached their lowest point in April. Other tertiary hospitals and the largest healthcare organization in northern Taiwan found that ED visits decreased, similarly, from February to April 2020 [ 29 , 33 , 37 ].…”

“…The COVID-19 pandemic has posed a dramatic, unexpected, and unprecedented burden on many healthcare systems worldwide. Universally decreased numbers of ED visits by age, disease categories, and the characteristics and case severity of patients have been revealed by anecdotal reports [18][19][20][21][22][23][24][25][26][27][28][29][31][32][33][34][35][36]. Most studies originated from severe pandemic areas that analyzed the change in the early stage (4-8 weeks) of the COVID-19 outbreak and reported a significant decrease, ranging from 31.0 to 63.5%, in ED patient flow compared to a historical control period [18,19,21,23,27,31,34].…”

“…Identifying changes in the pattern of patient flow in the ED is important for preparedness and mitigation. During the early days of the COVID-19 pandemic, a characteristic change and significant decrease in the number of patients who came to the ED with complaints unrelated to COVID-19 was reported [18][19][20][21][22][23][24][25][26][27][28][29], mostly in devastated regions, limited sections, or only for a short period of observation. However, the impact of patient flow throughout the pandemic year on the ED of a tertiary hospital, in a low-prevalence region, has not been comprehensively examined, especially in a health system that from April to December 2020 (i.e., 253 days) had no locally transmitted cases reported [30].…”

Shock Index Is a Validated Prediction Tool for the Short-Term Survival of Advanced Cancer Patients Presenting to the Emergency Department

“…This prospective observational study was conducted in the ED of Linkou Chang Gung Memorial Hospital (3406 beds with approximately 15,000 ED visits monthly in 2019), the largest tertiary centre in Taiwan [ 40 , 41 ]. This study was approved by Chang Gung Medical Foundation Institutional Review Board (IRB No.…”

Ventilation Performance Evaluation of a Negative-Pressurized Isolation Room for Emergency Departments

“…A new emerging novel virus (SARS-CoV-2) that caused Coronavirus disease 2019 (COVID- 19) was first detected in late 2019, with the possible risk to be transmissible through respiratory droplets and direct contact [1]. In March 2020, the World Health Organization (WHO) declared COVID-19 to be a global pandemic [2].…”