The Attend Study: A Retrospective Observational Study of Emergency Department Attendances During the Early Stages of the COVID-19 Pandemic

Abstract

Introduction: The coronavirus disease-19 (COVID-19) pandemic was associated with a large reduction in the number of attendances at emergency departments (EDs) in March 2020 in the United Kingdom (UK). We sought to identify which patient groups attended EDs least. Methods: Single-centre before and after study. We used routine administrative data from March 2020 and compared this to a composite control of March 2019 and February 2020. Results: Mean daily attendance fell by 30% from 342 patients per day in the composite control months to 242 patients per day in March 2020. Reductions in attendance were seen in almost all patient groups but were greatest in patients with injuries, those referred by another clinician, those arriving at the weekend, and in patients who received no investigations. Multivariate analysis revealed that the proportion of patients who were admitted to hospital fell, despite the patients being sicker, older, needing more investigations, and more likely to arrive by ambulance. Discussion: The reduction in ED attendances seen in the early phases of the UK pandemic occurred in all patient groups, but was greatest in the lower acuity patients. Reasons for this are complex and likely to be multifactorial.

Lessons Learnt from Managing Orthopaedic Trauma During the First Wave of the COVID-19 Pandemic at a UK District General Hospital

“…Our finding of a reduction in presentations to the emergency department during the COVID-19 pandemic is consistent with both national and international trends [ 7 – 10 ]. This directly influences the number of orthopaedic injuries cases being managed (either operatively or non-operatively) during the pandemic.…”

“…The reduction in orthopaedic injury referrals has several possible explanations. First, it may reflect travel restrictions and social curfews resulting in decreased exposure to physical injury [ 7 ]. Second, it may reflect a reduction in work-related injuries associated with more people working from home [ 7 ].…”

“…First, it may reflect travel restrictions and social curfews resulting in decreased exposure to physical injury [ 7 ]. Second, it may reflect a reduction in work-related injuries associated with more people working from home [ 7 ]. Third, it may reflect a reduction in face-to-face primary care consultations leading to fewer referrals from general practitioners [ 11 ].…”

Impact of the 2019 Novel Coronavirus Disease Pandemic on the Performance of a Cardiovascular Department in a Non-epidemic Center in Beijing, China

“…First of all, the reduction of the number of ED attendances is consistent with previous studies. The Attend Study compared the daily ED attendances before and during the pandemic and observed a reduction by 30% daily ED visits ( 34 ). Franchini et al described the impact of the COVID-19 outbreak on an urban major-hospital ED attendance in Italy and observed a reduction in ED attendance by 37% ( 35 ).…”

A descriptive analysis of the impact of COVID-19 on Emergency Department attendance and visit characteristics in Singapore

“…As with all outbreaks, the Emergency Department (ED) has been the primary portal of entry into hospitals for COVID-19 patients [3][4][5] . Despite the surge in suspected COVID-19 cases, there is global evidence to show that the Emergency Department (ED)'s overall daily attendance has declined [6][7][8][9][10][11] . Several studies have reported signi cant reductions in visits associated with time-sensitive and life-threatening conditions such as acute myocardial infarction and stroke [12][13][14][15] .…”