The impact of COVID-19 on Emergency Department length of stay for urgent and life-threatening patients

Abstract

Objectives To determine the impact of the Coronavirus disease-2019 (COVID-19) pandemic on the length of stay (LOS) and prognosis of patients in the resuscitation area. Methods A retrospective analysis of case data of patients in the resuscitation area during the early stages of the COVID-19 pandemic (January 15, 2020– January 14, 2021) was performed and compared with the pre-COVID-19 period (January 15, 2019 – January 14, 2020) in the First Affiliated Hospital of Soochow University. The patients’ information, including age, sex, length of stay, and death, was collected. The Wilcoxon Rank sum test was performed to compare the LOS difference between the two periods. Fisher's Exact test and Chi-Squared test were used to analyze the prognosis of patients. The LOS and prognosis in different departments of the resuscitation area (emergency internal medicine, emergency surgery, emergency neurology, and other departments) were further analyzed. Results Of the total 8278 patients, 4159 (50.24%) were enrolled in the COVID-19 pandemic period group, and 4119 (49.76%) were enrolled pre-COVID-19 period group. The length of stay was prolonged significantly in the COVID-19 period compared with the pre-COVID-19 period (13h VS 9.8h, p < 0.001). The LOS in the COVID-19 period was prolonged in both emergency internal medicine (15.3h VS 11.3h, p < 0.001) and emergency surgery (8.7h VS 4.9h, p < 0.001) but not in emergency neurology or other emergency departments. There was no significant difference in mortality between the two cohorts (4.8% VS 5.3%, p = 0.341). Conclusion The COVID-19 pandemic was associated with a significant increase in the length of resuscitation area stay, which may lead to resuscitation area crowding. The influence of the COVID-19 pandemic on patients of different departments was variable. There was no significant impact on the LOS of emergency neurology. According to different departments of the resuscitation area, the COVID-19 pandemic didn’t significantly impact the prognosis of patients.

Diagnostic Performance of the Rapid Antigen Test as a Screening Tool for SARS-CoV-2 Infection in the Emergency Department

“…The length of stay (LOS) and crowding are significantly associated with the outcomes of patients in the ED [ 27 , 28 ]. During the COVID-19 pandemic, the ED LOS was significantly longer than the pre-pandemic LOS despite the decreased number of patients visiting the ED in many countries [ 12 , 13 , 14 ]. Furthermore, an increased length of stay could lead to crowding in the resuscitation area in the pandemic period [ 13 ].…”

“…During the COVID-19 pandemic, the ED LOS was significantly longer than the pre-pandemic LOS despite the decreased number of patients visiting the ED in many countries [ 12 , 13 , 14 ]. Furthermore, an increased length of stay could lead to crowding in the resuscitation area in the pandemic period [ 13 ]. The limited number of isolation areas or resuscitation areas causes delays for the patients admitted to the ED, especially when there are a high number of patients with COVID-19 in the community.…”

“…However, RT–PCR has limitations in that the test requires specialized equipment with expertise, the turn-around time is approximately 1 to 3 days, and the cost is higher [ 10 ]. In the ED situation, the time required to confirm the test result can cause a delay in assessing patients, which causes unnecessary damage [ 12 , 13 , 14 ]. Rapid antigen tests (RATs) are immunoassays that detect a specific viral antigen and can be used as a screening test.…”

“…In the ED situation, the time required to confirm the test result can cause a delay in assessing patients, which causes unnecessary damage [12][13][14]. Rapid antigen tests (RATs) are immunoassays that detect a specific viral antigen and can be used as a screening test.…”

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

“…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 ].…”