The effect of COVID-19 pandemic on the length of stay and outcomes in the emergency department

Chun, Soh Yeon; Kim, Ho Jung; Kim, Han Bit

doi:10.15441/ceem.21.058

Cited by 10 publications

(9 citation statements)

References 23 publications

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“…23 Longer ED stays have been reported worldwide during the CO-VID-19 pandemic. 23,24 Various mandatory preoperative steps were added at the ED. The World Society of Emergency Surgery recommended performing tests for COVID-19 infection at the ED for all emergency surgical patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 outbreak on acute gallbladder disease in the emergency department

Sakong¹,

Choe²,

Nho³

et al. 2023

Clin Exp Emerg Med

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Objective Acute gallbladder disease (AGD) is frequent in the emergency department (ED) and usually requires emergency surgery. However, only a few studies have reported the impact of COVID-19 on AGD. The goal of this study was to evaluate the time between symptom onset and surgery and the perioperative severity of AGD during the COVID-19 pandemic compared to before the era of COVID-19. Methods This retrospective, single-center cohort study included patients who presented to the ED with suspected AGD and who underwent emergency cholecystectomy. We designed a beforeafter comparative study, and the intervention was the COVID-19 outbreak. The 6-month period after the COVID-19 outbreak was defined as the post-COVID group, whereas the pre-COVID group consisted of the same period in the previous year. The primary outcome was the time from symptoms to surgery. We evaluated the time intervals between symptom onset and ED arrival and between ED arrival and surgery. The secondary outcomes were preoperative and postoperative severity indexes.Results A total of 316 patients was analyzed. The post-COVID group showed longer duration from symptom onset to ED arrival (34.0 hours vs. 15.0 hours, P < 0.001) and longer time interval from ED arrival to surgery (16.2 hours vs. 10.2 hours, P < 0.001) than the pre-COVID group. The overall time interval between symptom onset to surgery was longer in the post-COVID group than the pre-COVID group (71.5 hours vs. 33.5 hours, P < 0.001). The post-COVID group showed higher preoperative Simplified Acute Physiology Score II scores than the pre-COVID group (20.1 vs. 18.2, P = 0.045). The proportion of moderate or severe disease increased in the post-COVID group (78% vs. 65%, P = 0.017). The durations of hospital stay (7.0 days vs. 5.0 days, P < 0.001) and intensive care unit stay (27.1 hours vs. 10.8 hours, P = 0.008) were longer in the post-COVID group than in the pre-COVID group. ConclusionDuring the pandemic, the time interval between symptom onset to surgery was significantly increased among patients with AGD. Concomitantly, higher preoperative severity indexes and longer hospital stay were reported with a delay in emergency surgery.

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Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 outbreak on acute gallbladder disease in the emergency department

Sakong¹,

Choe²,

Nho³

et al. 2023

Clin Exp Emerg Med

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“…PCR testing is essential for COVID-19 diagnosis, and as the number of confirmed COVID-19 patients in Korea increased, most Korean hospitals were admitting patients to the GW or ICU after confirming their test results. 26 One study showed that the time spent in the ED increased after COVID-19 compared with before COVID-19. 27 In that study, it was suggested that the cause of the increase in LOS and ED crowding was the time needed to obtain results from the COVID-19 PCR test.…”

Section: Discussionmentioning

confidence: 99%

“…Frequent shifts between nurses and doctors can impede continuity of care and prioritize new patients, resulting in poor-quality care. PCR testing is essential for COVID-19 diagnosis, and as the number of confirmed COVID-19 patients in Korea increased, most Korean hospitals were admitting patients to the GW or ICU after confirming their test results [ 26 ]. One study showed that the time spent in the ED increased after COVID-19 compared with before COVID-19 [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of the COVID-19 pandemic on in-hospital mortality in patients admitted through the emergency department

Kim¹,

Lee²,

Cho³

et al. 2023

Clin Exp Emerg Med

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Objective The COVID-19 pandemic might have adversely affected outcomes of patients in emergency departments (EDs). The aim of study is to evaluate the impact of the COVID-19 pandemic on in-hospital mortality in an ED. MethodsThis study is a single-center, retrospective, observational cohort study. We compared the prognosis of patients admitted through the ED before the COVID-19 outbreak (November 2018 to June 2019) and after COVID-19 (November 2020 to June 2021). The primary outcome was in-hospital mortality. Multivariable logistic regression analysis was performed to determine whether COVID-19 was independently associated with patient prognosis. ResultsThe number of patients admitted through the ED before and after COVID-19 was 5,333 and 4,625, respectively. The mean ED length of stay before and after COVID-19 was 401 and 442 minutes, respectively (P<0.001). The number of in-hospital mortalities before and after COVID-19 was 269(5.0%) and 322 (7.0%), respectively (P<0.001). Multivariable logistic regression analysis showed that the COVID-19 period was significantly associated with higher in-hospital mortality (odds ratio, 1.37; 95% confidence interval, 1.12-1.67; P=0.002). ConclusionIn the COVID-19 period, in-hospital mortality increased compared to that before COVID-19 among hospitalized ED patients.

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“…Overall, during the early stage of COVID-19, the percentage of patients seen within 4 h in the ED decreased by 6 percentage points. The prolonged waiting time at the ED was probably caused by the extra precautionary steps implemented in response to the spread of the disease and from patients having to wait for examination results [ 13 , 14 , 15 , 16 ]. The changes implemented at the Saudi hospitals in this study included patients presented in the ED with suspected COVID-19 having to be separated from other patients; infected patients being isolated in hospitals or hotels; the staff having to wear protective gear that slowed down their productivity; and the need for the vital parameters to be re-assessed more than once.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with suspected COVID-19 needed to be separated from others, the staff had to wear protective gear that limited their productivity, and vital parameters had to be re-evaluated with high frequency. 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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The effect of COVID-19 pandemic on the length of stay and outcomes in the emergency department

Cited by 10 publications

References 23 publications

Impact of COVID-19 outbreak on acute gallbladder disease in the emergency department

Impact of COVID-19 outbreak on acute gallbladder disease in the emergency department

The impact of the COVID-19 pandemic on in-hospital mortality in patients admitted through the emergency department

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

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