The impact of the COVID-19 pandemic on emergency department visits and patient safety in the United States

Boserup, Brad; McKenney, Mark; Elkbuli, Adel

doi:10.1016/j.ajem.2020.06.007

Cited by 204 publications

(231 citation statements)

References 5 publications

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“…Overall, German data seem to be in contrast to the most U.S. data of COVID-19 hotspots where medical admissions from the ED increased and motor vehicle accidents decreased [5,8,13]. Also in Israel signi cant reductions in ED visits were observed [14].…”

Section: Discussionmentioning

confidence: 89%

Impact of the COVID-19 Outbreak on Emergency Resources – An Observational Multicenter Study Including All Hospitals in a Major Urban Center of the Rhein Ruhr Metropolitan Region

Bergrath

Strapatsas

Tuemen

et al. 2020

Preprint

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Background: The outbreak of the coronavirus disease 2019 (COVID-19) caused by the severe respiratory distress syndrome coronavirus 2 (SARS-CoV-2) led to severe disruption in social life and economics. The present study should analyze the impact of the local COVID-19 epidemic on emergency resources for all hospitals in a major urban center (Moenchengladbach, Germany). Methods: An observational multicenter study was performed involving all four acute care hospitals. Systemic parameters department (ED) parameters from week 4 to 24 in 2020 were compared to the corresponding period in 2019 for each hospital and in a summative data analysis using a logistic regression model. Outcomes: ED visits, ED to hospital admission, ED to Intensive Care Unit (ICU) admission, medical specialties of admitted patients, work related accidents. Results: In week 9/2020 the first SARS-CoV-2 positive patients were detected in our region. All hospitals decided to minimize elective admissions to ensure operational capability for COVID-19 patients. The summative number of ED visits dropped from 34,659 to 28,008. Numbers decreased from week 8 on between 38% and 48% per week per hospital at the maximum and began to rise again from week 16 on. The pooled data analysis showed statistically significant decreases in outpatient ED visits (20,152 vs. 16,477, p=<0.001), hospital admissions of ED patients (14,507 vs. 11,531, p=<0.001), and work-related accidents (2,290 vs. 1,468, p=<0.001). The decrease in admissions from ED to ICU did not reach statistical significance (2,093 vs. 1,566, p=0.255). The decline in ED cases was mainly caused by a decrease in non-trauma and non-surgical patients. Conclusion: The regional COVID-19 outbreak led to significantly reduced ED contacts after the first COVID-19 cases appeared. Even the admissions to the hospitals and the number of ED to ICU-admissions decreased, which is potentially dangerous, because the ratio of emergency outpatients vs. inpatients remained stable. Therefore, one can assume that patients with severe medical problems did not seek ED care in many cases. The decline of patients was earlier than in other German hospitals and in contrast to the findings in the U.S. and Italy where ED visits and hospital admissions in medical disciplines increased.

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Section: Discussionmentioning

confidence: 89%

Impact of the COVID-19 Outbreak on Emergency Resources – An Observational Multicenter Study Including All Hospitals in a Major Urban Center of the Rhein Ruhr Metropolitan Region

Bergrath

Strapatsas

Tuemen

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…There were two such polls conducted: (a) March 11-15, 2020, and (b) March 25-30, 2020. Following are some of the findings from the two polls [11][12][13]:…”

Section: Health Tracking Pollsmentioning

confidence: 99%

“…There were two such polls conducted: (a) March 11–15, 2020, and (b) March 25–30, 2020. Following are some of the findings from the two polls [ 11 – 13 ]: The poll conducted on March 25–30, 2020 reported 72% of Americans expressing that their lives were disrupted “a lot” or “some” by the COVID-19 outbreak. This is a 32% increase from the poll conducted 2 weeks earlier [ 12 ].…”

Section: Health Tracking Pollsmentioning

confidence: 99%

“The COVID-19 Pandemic and its Effect on Mental Health in USA – A Review with Some Coping Strategies”

Bhattacharjee

Acharya

2020

Psychiatr Q

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The COVID-19 pandemic has resulted in enormous losses in terms of human lives and economy in United States. The outbreak has been continuing to heavily impact the mental health of people. Developing key strategies to prevent mental illnesses is extremely important for the well-being of people. A survey conducted during the last week of March 2020 showed that 72% of Americans felt that their lives were impacted by the outbreak, which was a 32% increase from the survey conducted only 2 weeks earlier. The results show a positive correlation between COVID-19 infections/casualties and growing public concern. These observations suggest possible increase in mental health illnesses in United States as a consequence of the pandemic. The authors review a recently published model on COVID-19 related fear among the people. The fear of being infected or dying from the disease is one of the most significant causes of mental health disorders. Loss of employment or the fear of losing employment is another major concern leading to mental illnesses. Several unique strategies to prevent or mitigate mental illnesses are discussed.

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“…There has also been a drop in non-COVID-19 patients. The 31%–45% reduction in ED visits across the US, raises concern for patients not seeking care [ 8 ]. For instance, there had been a decrease in patients presenting with strokes and STEMIs [ 8 ].…”

mentioning

confidence: 99%

“…The 31%–45% reduction in ED visits across the US, raises concern for patients not seeking care [ 8 ]. For instance, there had been a decrease in patients presenting with strokes and STEMIs [ 8 ]. This patient population is a crucial element for research; thus, the potential number of patients that could contribute to EM trials is decreased.…”

mentioning

confidence: 99%

The impact of COVID-19 pandemic on conducting emergency medicine clinical research

Ehrlich

McKenney

Elkbuli

2021

The American Journal of Emergency Medicine

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The impact of COVID-19 pandemic on conducting emergency medicine clinical researchThe COVID-19 pandemic challenges the status quo of conducting emergency medicine (EM) research [1]. Research generates new knowledge for the advancement of the medical field, abiding by ethical parameters [1-3]. As EM is on the frontlines of this global crisis, the aim of this correspondence is to consider the impacts of the COVID-19 pandemic on EM clinical research.Financial burdens for EM research have been an ongoing concern prior to the COVID-19 pandemic. For example, NIH funding has proved a challenge for EM researchers, garnering only 1.7% of funds [4][5][6]. Additional safety considerations in EM Departments due to COVID-19 drastically increased [7]. Researchers have the added obstacle of devising pathways to safely continue EM research. There has also been a drop in non-COVID-19 patients. The 31%-45% reduction in ED visits across the US, raises concern for patients not seeking care [8]. For instance, there had been a decrease in patients presenting with strokes and STEMIs [8]. This patient population is a crucial element for research; thus, the potential number of patients that could contribute to EM trials is decreased. On the other hand, COVID-19, though disruptive, has opened up new research opportunities [4,9]. For example, Stanford's EM Department is funding a study evaluating clinical characteristics of COVID-19 patients [10,11]. Other avenues include exploring topics regarding domestic safety during a pandemic, patient and physician well-being, and alternative communication avenues [3]. Though most institutions around the country have begun to proceed past the COVID-19 crisis, the new pathways devised to maintain research during such unsteady times must be incorporated into future practices, cultivating sustainable research methods that are resilient to crises.During this crisis, the price of patient-safety must be weighed against the cost of halting clinical trials. However, some clinical trials have adapted to the current circumstances and are carrying out their trials via telemedicine, producing sustainable research methods [12]. Though not all clinical research can be fully conducted via telemedicine, such as interventional research, it can be incorporated through its use in participant virtual consenting and follow-up [13][14][15]. This spares patients traveling, as well as reduces potential COVID-19 exposure [1]. For noninterventional research, virtual resources offer web-based platforms to execute survey-based studies as well as data processing components of various types of studies. There is a compelling applicability of utilizing telemedicine in a post-COVID-19 era to conduct clinical research. Continued use of telemedicine could allow clinical trials to address patient barriers to care. Addressing financial and geographical barriers, (although technical barriers could be created) could allow for a larger patient population in clinical trials, increasing the statistical power of trials.

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The impact of the COVID-19 pandemic on emergency department visits and patient safety in the United States

Cited by 204 publications

References 5 publications

Impact of the COVID-19 Outbreak on Emergency Resources – An Observational Multicenter Study Including All Hospitals in a Major Urban Center of the Rhein Ruhr Metropolitan Region

Impact of the COVID-19 Outbreak on Emergency Resources – An Observational Multicenter Study Including All Hospitals in a Major Urban Center of the Rhein Ruhr Metropolitan Region

“The COVID-19 Pandemic and its Effect on Mental Health in USA – A Review with Some Coping Strategies”

The impact of COVID-19 pandemic on conducting emergency medicine clinical research

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