After the first wave and beyond lockdown: long-lasting changes in emergency department visit number, characteristics, diagnoses, and hospital admissions

Morello, Fulvio; Bima, Paolo; Ferreri, Enrico; Chiarlo, Michela; Balzaretti, Paolo; Tirabassi, Gloria; Petitti, Paolo; Aprà, Franco; Vallino, Domenico; Carbone, Giorgio; Pivetta, Emanuele; Lupia, Enrico

doi:10.1007/s11739-021-02667-2

Cited by 40 publications

(45 citation statements)

References 12 publications

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“…Gender and age were almost equally distributed between the 2 years. ED visits consistently dropped in March (− 52%) and April (− 52%) 2020 during the first pandemic wave as already described in other Italian settings [6][7][8]. During summer, the reduction of SARS-CoV-2 contagion and COVID-19 related-hospitalization rates were associated with a gradual increase in ED presentations.…”

supporting

confidence: 64%

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Adult emergency department visits during the COVID-19 pandemic in Veneto region, Italy: a time-trend Analysis

et al. 2021

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supporting

confidence: 64%

“…During the COVID-19 pandemic, a consistent decrease in ED visits has been recorded worldwide. Italy has been the first western country to register a reduction in individuals seeking medical attention in EDs, although studies describing this phenomenon are mostly limited to the first pandemic wave [6][7][8].…”

mentioning

confidence: 99%

Adult emergency department visits during the COVID-19 pandemic in Veneto region, Italy: a time-trend Analysis

et al. 2021

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“…Overall metrics like DTB time obscure the contribution of EDs because they combine triage and diagnosis with transportation to the cath lab and the PCI procedure itself. Studies from the emergency medicine literature have reported significantly lower overall patient visits and admissions during the pandemic [ [20] , [21] , [22] , [23] , [24] , [25] , [26] ] as well as lower volumes of patients with cardiac emergencies. [ [27] , [28] , [29] , [30] , [31] , [32] , [33] ].…”

Section: Introductionmentioning

confidence: 99%

Flattening the other curve: Reducing emergency department STEMI delays during the COVID-19 pandemic

McLaren¹,

Taher²,

Chartier³

2021

The American Journal of Emergency Medicine

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Background The COVID-19 pandemic has been associated with ST-Elevation Myocardial Infarction (STEMI) reperfusion delays despite reduced emergency department (ED) volumes. However, little is known about ED contributions to these delays. We sought to measure STEMI delays and ED quality benchmarks over the course of the first two waves of the pandemic. Study This study was a multi-centre, retrospective chart review from two urban, academic medical centres. We obtained ED volumes, COVID-19 tests and COVID-19 cases from the hospital databases and ED Code STEMIs with culprit lesions from the cath lab. We measured door-to-ECG (DTE) time and ECG-to-Activation (ETA) time during the phases of the pandemic in our jurisdiction: pre-first wave (Jan-Mar 2020), first wave (Apr-June 2020), post-first wave (July-Nov 2020), and second wave (Dec 2020 to Feb 2021). We calculated median DTE and ETA times and compared them to the 2019 baseline using Wilcox rank-sum test. We calculated the percentages of DTE ≤10 min and of ETA ≤10 min and compared them to baseline using chi-square test. We also utilized Statistical Process Control (SPC) Xbar-R charts to assess for special cause variation. Results COVID-19 cases began during the pre-wave phase, but there was no change in ED volumes or STEMI quality metrics. During the first wave ED volumes fell by 40%, DTE tripled (10.0 to 29.5 min, p = 0.016), ETA doubled (8.5 to 17.0 min, p = 0.04), and percentages for both DTE ≤10 min and ETA ≤10 min fell by three-quarters (each from more than 50%, to both 12.5%, both p < 0.05). After the first wave all STEMI quality benchmarks returned to baseline and did not significantly change during the second wave. A brief period of special cause variation was noted for DTE during the first wave. Conclusions Both DTE and ETA metrics worsened during the first wave of the pandemic, revealing how it negatively impacted the triage and diagnosis of STEMI patients. But these normalized after the first wave and were unaffected by the second wave, indicating that nurses and physicians adapted to the pandemic to maintain STEMI quality of care. DTE and ETA metrics can help EDs identify delays to reperfusion during the pandemic and beyond.

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“…Consequently, emergency departments (EDs) were reorganized to cope with a growing number of COVID-19 patients, with considerable impact on the handling of other clinical conditions. Indeed, several reports described a significant reduction from 29 to 47% of total ED admissions unrelated to COVID-19 [1][2][3][4][5][6], including with regard to conditions requiring prompt medical or surgical management [7][8][9][10][11]. In a single American center, it was recorded a decline in non-emergent care ED visits, in particular for patients diagnosed with hypertension, diabetes, mood and personality disorders, fluid and electrolyte disorders, abdominal pain, and, finally, headaches and migraine (− 32.5%) [12].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 lockdown attack on headache emergency admissions: a multidisciplinary retrospective study

et al. 2021

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Background During the first COVID-19 lockdown in Italy, it was observed a reduction in emergency department (ED) attendances due to non-SARS-COV-2-related acute/chronic conditions. Objective To analyze the impact of the COVID-19 lockdown on patients reporting headache as the principal presenting symptom on admission to the ED of the tertiary care University Hospital of Trieste over the relevant period. Methods We retrospectively evaluated the frequency, features, and management of ED attendances for headache during the COVID-19 lockdown from 8 March to 31 May 2020, comparing it with the pre-lockdown period (January-February 2020) and the first 5 months of 2019. Results A reduction in ED total attendances was observed in the first 5 months of 2020 compared to the same period in 2019 (21.574 and 30.364, respectively; − 29%), in particular with respect to headache-related attendances (174 and 339 respectively; − 49%). During the COVID-19 lockdown, it was recorded a minor reduction in the ED access rate of female patients (p = 0.03), while no significant variation was detected in repeaters' prevalence, diagnostic assessment, and acute treatment. The ratio of not otherwise specified, secondary, and primary headaches (48.4%, 30.6%, and 21.0% respectively) remained unchanged during the COVID-19 lockdown, in comparison to the control periods. ConclusionThe COVID-19 pandemic impacted the number of ED attendances for headache but not their management and setting. Despite a reduction of accesses for headache due to the pandemic emergency, the distribution of headache subtypes and the rate of repeaters did not change. KeywordsCOVID-19 • Headache • Emergency department • Lockdown • Repeaters Abbreviations ED Emergency department SARS-COV-2 Severe acute respiratory syndrome coronavirus 2 COVID-19 Coronavirus disease 19 NOS Not otherwise specified CT Computed tomography * Paolo Manganotti

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After the first wave and beyond lockdown: long-lasting changes in emergency department visit number, characteristics, diagnoses, and hospital admissions

Cited by 40 publications

References 12 publications

Adult emergency department visits during the COVID-19 pandemic in Veneto region, Italy: a time-trend Analysis

Adult emergency department visits during the COVID-19 pandemic in Veneto region, Italy: a time-trend Analysis

Flattening the other curve: Reducing emergency department STEMI delays during the COVID-19 pandemic

COVID-19 lockdown attack on headache emergency admissions: a multidisciplinary retrospective study

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