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

Abstract

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.

The impact of COVID-19 epidemic on emergency department visits of older patients in Taiwan

“…This represents an 8.5% reduction compared with the numbers from the previous year and a surprising 25% reduction compared with that in 2019, just a year before the epidemic was declared. While the magnitude of the decline is already impressive, compared to the 37-65% reduction reported in foreign studies, it still trails these numbers by roughly 20 percentage points [11,19,[23][24][25]. In 2002, during the peak of the SARS epidemic in Taiwan, the reduction in daily ED visits reached 43.7-51.6% for pre-epidemic numbers, which was similar to the worldwide COVID-19 data [26,27].…”

“…This was a different result from the UK and US hospitals. It showed a great relative reduction in medical admission in the oldest age group, which might be due to concerns about COVID-19 acquisition in the hospital or about the futility of admission [23,42]. In the general adult group, we could see the trend of climb since the late-epidemic stage, but it did not reach the pre-epidemic level when the lockdown ceased.…”

A hospital-based independent domestic violence advisor service: demand and response during the Covid-19 pandemic

“…The use of the service depends on multiple factors, including demand and available and accessible supply. Given that provision had remained equivalent to pre-pandemic rates (2 FTE IDVAs) and reduced attendances in hospital ED and inpatient activity [ 28 ] the increase in referrals appears to reflect an increase in need for the service and the number of victims presenting at the Trust. There was consensus amongst our interviewees that the IDVAs had a strong presence and were known to many staff in person, factors which have been acknowledged as important at equivalent services [ 12 , 15 ].…”

Pandemic Treaty and Emergency Care

“…Emergency care capacities would comprise important part of such requirements, with several provisions -such as for simulation exercises, secured supplies of life-saving products, rapid deployment of health workforce, and special measures such as establishing oxygen plants [6] -gaining particular relevance. The requirements could also take into account lessons learned during the COVID-19 pandemic concerning access to, and utilization of, emergency services in selected countries [5]and facilities [8,9]. Finally, the prospective treaty requirements would utilize relevant features of existing international frameworks [10], such as the health system related provisions of the Sendai Framework for Disaster Risk Reduction [11] and the WHO's Health Emergency and Risk Management Framework [12].…”