The impact of COVID-19 on hospital admissions and emergency department visits: A population-based study

Abstract

Background As a result of the novel coronavirus disease 2019 (COVID-19), there have been widespread changes in healthcare access. We conducted a retrospective population-based study in Alberta, Canada (population 4.4 million), where there have been approximately 1550 hospital admissions for COVID-19, to determine the impact of COVID-19 on hospital admissions and emergency department (ED visits), following initiation of a public health emergency act on March 15, 2020. Methods We used multivariable negative binomial regression models to compare daily numbers of medical/surgical hospital admissions via the ED between March 16-September 23, 2019 (pre COVID-19) and March 16-September 23, 2020 (post COVID-19 public health measures). We compared the most frequent diagnoses for hospital admissions pre/post COVID-19 public health measures. A similar analysis was completed for numbers of daily ED visits for any reason with a particular focus on ambulatory care sensitive conditions (ACSC). Findings There was a significant reduction in both daily medical (incident rate ratio (IRR) 0.86, p<0.001) and surgical (IRR 0.82, p<0.001) admissions through the ED in Alberta post COVID-19 public health measures. There was a significant decline in daily ED visits (IRR 0.65, p<0.001) including ACSC (IRR 0.75, p<0.001). The most common medical/surgical diagnoses for hospital admissions did not vary substantially pre and post COVID-19 public health measures, though there was a significant reduction in admissions for chronic obstructive pulmonary disease and a significant increase in admissions for mental and behavioral disorders due to use of alcohol. Conclusions Despite a relatively low volume of COVID-19 hospital admissions in Alberta, there was an extensive impact on our healthcare system with fewer admissions to hospital and ED visits. This work generates hypotheses around causes for reduced hospital admissions and ED visits which warrant further investigation. As most publicly funded health systems struggle with health-system capacity routinely, understanding how these reductions can be safely sustained will be critical.

The Impact of COVID-19 on Hospital Admissions in Croatia

“…An initial dip in admissions occurred in April 2020, soon after the WHO declared COVID-19 a pandemic. In that period, Croatia experienced a 51% drop in hospital admissions, a trend also observed to varying degrees in other countries, across a number of medical specialties and emergency department visits (9)(10)(11)(12)(13)(14)(15)(16).…”

“…There is however, evidence from international sources to support the argument that patient reluctance to attend hospitals could be a major contributing factor. For example, a number of studies on emergency department (ED) admissions during the COVID-19 pandemic report reductions in both daily attendances and surgical admissions through EDs, indicating that patients may not be presenting for needed care ( 10 , 12 , 13 , 26 ). Such patient behavior was investigated in an Italian study ( 27 ) which found that 32% of the cohort surveyed, faced delays in scheduled services, 12% refused to attend scheduled services for fear of contagion, 6% avoided health services despite the onset of an acute issue, and 1.5% avoided EDs when in need.…”

A Systematic Review: The Dimensions utilized in the Performance Evaluation of Healthcare- An Implication during the COVID-19 Pandemic

“…Analyzing the number of patients' visits and admissions in the USA [98] revealed a decrease in ER visits, with an increase in hospital admissions. However, another study in Alberta [99] perceived decreased admissions and ER visits to the hospital, despite the low volume of COVID-19 hospital admissions.…”

A Rapid Ethnographic Assessment of the Impact of the COVID-19 Pandemic on Mental Health Services Delivery in an Acute Care Medical Emergency Department and Trauma Center

“…1 , the characteristics of COVID-19 and the initial surge in Seattle led to the implementation of policies and protocols in both the healthcare system and in the community to control the pandemic. Efforts to control the spread of the disease led to a significant reduction in hospital admissions and ED visits, which led to a reduction in clinical revenue (Rennert-May et al, 2021 ). These efforts adversely impacted the delivery of mental health services initially during the April surge and over the subsequent three months due to the costs of these efforts.…”