Impact of the COVID-19 Pandemic on Inappropriate Use of the Emergency Department

Abstract

Inappropriate use of the emergency department (IEDU)—consisting of the unnecessary use of the resource by patients with no clinical need—is one of the leading causes of the loss of efficiency of the health system. Specific contexts modify routine clinical practice and usage patterns. This study aims to analyse the influence of COVID-19 on the IEDU and its causes. Methods: A retrospective, cross-sectional study conducted in the emergency department of a high-complexity hospital. The Hospital Emergency Suitability Protocol (HESP) was used to measure the prevalence of IEDU and its causes, comparing three pairs of periods: (1) March 2019 and 2020; (2) June 2019 and 2020; and (3) September 2019 and 2020. A bivariate analysis and multivariate logistic regression models, adjusted for confounding variables, were utilized. Results: In total, 822 emergency visits were included (137 per period). A total prevalence of IEDU of 14.1% was found. There was a significant decrease in IEDU in March 2020 (OR: 0.03), with a prevalence of 0.8%. No differences were found in the other periods. A mistrust in primary care was the leading cause of IEDU (65.1%). Conclusions: The impact of COVID-19 reduced the frequency of IEDU during the period of more significant population restrictions, with IEDU returning to previous levels in subsequent months. Targeted actions in the field of population education and an improvement in primary care are positioned as strategies that could mitigate its impact.

Community dwelling older adults experience of attending the Emergency Department during COVID-19: A qualitative study

“…Interestingly, these factors were like those seen in the period before the pandemic. Additionally, the study highlighted that younger patients and those classi ed as less severe were the primary users of the ED for inappropriate use [25]. In our research, the choice to visit the ED involved a complex decision-making process.…”

“…The researchers noted that this rise could be attributed to a decrease in visits to GP's, leading patients to choose to visit the ED instead of opting for a virtual consultation [24]. Furthermore a study conducted in Spain, which investigated the effects of COVID-19 on the inappropriate use of the ED, they identi ed that the inappropriate use of the ED was a result of delays in patient care in the primary care settings and a growing lack of trust in the primary care [25].…”

“…Most of our participants were deemed appropriate referrals considering the complexity of their health conditions. Interestingly, older adults were not categorized as inappropriate users of the ED in these studies [24,25]. The Virtual assessments were noted to be very bene cial going forward monitoring patients with chronic conditions such as diabetes, therefore following on from the COVID-19 pandemic virtual health assessments may be the norm in managing certain chronic conditions but not for acute illnesses [26].…”

Special Issue: Advances in SARS-CoV-2 Infection

“…Ultimately, innovative tests such as MqSOFA and NEWS-2 were applied to assess intra-hospital mortality (IHM) and 30-day COVID-19 mortality. MqSOFA, although not able to predict treatment, is easier to use than NEWS-2, especially in the emergency setting and when appropriate [5,6].…”

“…A total of 15 manuscripts have been published in this Special Issue. These papers provided insights into epidemiology, pathogenesis, epigenetics [3,4] COVID-19 emergencies in hospital settings [5,6], advanced diagnosis [6][7][8], vaccination [9,10], and SARS-CoV-2 infection in the experimental setting [11]. The high scientific rigor, originality, and, for some of them, the high number of citations obtained, are well evident.…”