Underutilization of the Emergency Department During the COVID-19 Pandemic

Abstract

Introduction The novel coronavirus 2019 (COVID-19) pandemic in the United States (US) prompted widespread containment measures such as shelter-in-place (SIP) orders. The goal of our study was to determine whether there was a significant change in overall volume and proportion of emergency department (ED) encounters since SIP measures began. Methods This was a retrospective, observational, cross-sectional study using billing data from January 1, 2017–April 20, 2020. We received data from 141 EDs across 16 states, encompassing a convenience sample of 26,223,438 ED encounters. We used a generalized least squares regression approach to ascertain changes for overall ED encounters, hospital admissions, and New York University ED visit algorithm categories. Results ED encounters decreased significantly in the post-SIP period. Overall, there was a 39.6% decrease in ED encounters compared to expected volume in the pre-SIP period. Emergent encounters decreased by 35.8%, while non-emergent encounters decreased by 52.1%. Psychiatric encounters decreased by 30.2%. Encounters related to drugs and alcohol decreased the least, by 9.3% and 27.5%, respectively. Conclusion There was a significant overall reduction in ED utilization in the post-SIP period. There was a greater reduction in lower acuity encounters than higher acuity encounters. Of all subtypes of ED encounters, substance abuse- and alcohol-related encounters reduced the least, and injury-related encounters reduced the most.

Influence of post-COVID-19 deconfinement on psychiatric visits to the emergency department

“…This main result was explained by the low surgical and medical activity during deconfinement. This finding is consistent with observations from other ED showing a lesser to no decline of psychiatric visits compared to other conditions [ [15] , [16] , [17] ]. It seemed unlikely that the fear of hospital admission and the associated risk of contracting COVID-19 might have subsided among psychiatric patients more rapidly than among medical and surgical patients.…”

EMS responses and non-transports during the COVID-19 pandemic

“…We also noted increases in abnormal mental status, loss of consciousness, and advanced airway utilization. While the individual differences in vital signs were rather modest, this either suggests a higher level of patient acuity during EMS encounters or could represent a similar decrease in low-acuity encounters as has been seen in emergency department utilization [ 13 , 14 , 20 , 21 ]. Despite an increase in abnormal vital signs, we saw less use of medications, cardiac monitoring, and intravenous catheter placement.…”

“…Other studies have identified parallel findings in other countries [ 11 , 12 ], and in specific patient populations [ [13] , [14] , [15] , [16] , [17] , [18] , [19] ]. Emergency department visits were also identified to not only be of lower volume, but lower acuity cases demonstrated the largest proportional decrease [ 20 , 21 ].…”

The impact of the COVID-19 pandemic and governor mandated stay at home order on emergency department super utilizers

“…It is unclear at this time, whether the differences between studies reflect differences in patient demographics or differences that emerge when examining super utilizers with mental health and substance abuse visits rather than the total population of individuals mental health and substance abuse patients. However, Lucero and colleagues reported that of all types of visits, substance abuse and alcohol related encounters were least reduced during the pandemic [ 47 ]. It is possible that the relatively small number of visits for alcohol, drug use, and psychiatric purposes by super utilizers impacted the power to detect the effects of the pandemic.…”