The Impact of COVID-19 Pandemic on Emergency Department Visits at a Canadian Academic Tertiary Care Center

Abstract

Introduction: Public health response to the coronavirus 2019 (COVID-19) pandemic has emphasized social distancing and stay-at-home policies. Reports of decreased emergency department (ED) visits in non-epicenters of the outbreak have raised concerns that patients with non-COVID-19 emergencies are delaying or avoiding seeking care. We evaluated the impact of the pandemic on ED visits at an academic tertiary care center. Methods: We conducted an observational health records review between January 1–April 22, 2020, comparing characteristics of all ED visits between pre- and post-pandemic declaration by the World Health Organization. Measures included triage acuity, presenting complaints, final diagnoses, disposition, and mortality. We further examined three time-sensitive final diagnoses: stroke; sepsis; and acute coronary syndrome (ACS). Results: In this analysis, we included 44,497 ED visits. Average daily ED visits declined from 458.1 to 289.0 patients/day (-36.9%). For the highest acuity triaged patients there was a drop of 1.1 patients/day (-24.9%). Daily ED visits related to respiratory complaints increased post-pandemic (+14.1%) while ED visits for many other complaints decreased, with the greatest decline in musculoskeletal (-52.5%) and trauma (-53.6%). On average there was a drop of 1.0 patient/day diagnosed with stroke (-17.6%); a drop of 1.6 patients/day diagnosed with ACS (-49.9%); and no change in patients diagnosed with sepsis (pre = 2.8 patients/day; post = 2.9 patients/day). Conclusion: Significant decline in ED visits was observed immediately following formal declaration of the COVID-19 pandemic, with potential for delayed/missed presentations of time-sensitive emergencies. Future research is needed to better examine long-term clinical outcomes of the decline in ED visits during pandemics.

Association between virtual primary care and emergency department use during the first year of the COVID-19 pandemic in Ontario, Canada

“…7 Several Canadian studies also reported that emergency department visits declined during the first wave of the pandemic, possibly owing to avoidance of in-person urgent care from fear of contracting SARS-CoV-2. [8][9][10] In later stages of the pandemic, questions arose about the quality of virtual care and the broader system effects of reduced access to in-person care, such as patients substituting emergency department visits when in-person care options were unavailable. [11][12][13] The impact of virtual care on emergency department use has been studied elsewhere, but we are not aware of published studies in the context of the COVID-19 pandemic in analysis to estimate the association between the proportion of a physician's visits that were delivered virtually and the number of emergency department visits among their enrolled patients.…”

Feasibility characteristics of wrist-worn fitness trackers in health status monitoring for post-COVID patients in remote and rural areas

“…More recently, smartwatches have been used to detect pre-symptomatic COVID infections (Mishra et al, 2020). Common and affordable smartwatches and fitness trackers might support remote patient monitoring (RPM) if the emergent data is high-enough quality to inform safe decision making (Iqbal et al, 2021, Kwok et al, 2021; Lu et al, 2020, Kang & Exworthy, 2022). Remote patient monitoring is particularly important for patients living in remote and rural areas where in-person care can be limited (Fraser et al, 2022; Liao et al, 2019; Canali et al, 2022).…”

Know your way around acute unenhanced CT during global iodinated contrast crisis: a refresher to ED radiologists

“…With CT considered the power horse of ED imaging, radiologists’ on-call workload more than doubled the growth rate of ED visits over an 8-year period [ 3 ]. However, the upward trend was abruptly reversed in 2020 following declaration of COVID-19 pandemic and related measures [ 4 ].…”