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

Abstract

Background Despite the trend of rising Emergency Department (ED) visits over the past decade, researchers have observed drastic declines in number of ED visits due to the COVID-19 pandemic. The purpose of the current study was to examine the impact of the COVID-19 pandemic and governor mandated Stay at Home Order on ED super utilizers. Methods This was a retrospective chart review of patients presenting to the 12 emergency departments of the Franciscan Mission of Our Lady Hospital System in Louisiana between January 1, 2018 and December 31, 2020. Patients who were 18 years of age or older and had four ED visits within a one-year period (2018, 2019, or 2020) were classified as super-utilizers. We examined number and category of visits for the baseline period (January 2018 – March 2020), the governor's Stay at Home Order, and the subsequent Reopening Phases through December 31, 2020. Results The number of visits by super utilizers decreased by over 16% when the Stay at Home Order was issued. The average number of visits per week rose from 1010.63 during the Stay at Home Order to 1198.09 after the Stay at Home Order was lifted, but they did not return to Pre-COVID levels of approximately 1400 visits per week in 2018 and 2019. When categories of visits were examined, this trend was found for emergent visits ( p < 0.001) and visits related to injuries (p < 0.001). Non-emergent visits declined during the Stay at Home Order compared to the baseline period (p < 0.001), and did not increase significantly during reopening compared to the Stay at Home Order ( p = 0.87). There were no changes in number of visits for psychiatric purposes, alcohol use, or drug use during the pandemic. Conclusions Significant declines in emergent visits raise concerns that individuals who needed ED treatment did not seek it due to COVID-19. However, the finding that super utilizers with non-emergent visits continued to visit the ED less after the Stay at Home Order was lifted raises questions for future research that may inform policy and interventions for inappropriate ED use.

Demand for emergency services during the COVID-19 pandemic and disease burden: a case study in Portugal

“…In most of the studies available in the literature, there was a decrease in all priority codes, with the most accentuated reduction in the less urgent cases ( 2 , 3 , 5 , 13–17 ). Portugal’s approach resulted in a different pattern, as the epidemic was very well contained when it emerged.…”

Emergency Department Use by Young Adults With Chronic Illness Before and During the COVID-19 Pandemic

“…In contrast to our study, other research has found that this age group is one of the largest populations who are without health insurance [ 33 ]. Other researchers found an increase in uninsured patients during COVID-19 [ 20 ], while another study found the rate of patients presenting with government insurance varied during the pandemic [ 34 ]. The cause for the decrease in the number of uninsured patients at our institution is unknown.…”

“…Those seeking help for mental health conditions seem to be the exception to these findings. Studies done early in the COVID-19 pandemic found that the demand for mental health services increased significantly [ 20 , 21 ] and especially for young adults [ 22 ]. Similar to emergency department s across the country, our large urban emergency department in New York City experienced a dramatic change in overall registrations during the pandemic.…”

The impact of COVID-19 pandemic on revisits to emergency department

“…However, there are few studies on ED revisits during the COVID-19 period. Although Alwood et al conducted a study on ED revisits during the COVID-19 period, it did not apply to the general public because it included only frequent ED users who visited the ED more than four times a year [13] . Therefore, we aim to identify ED revisit rates and characteristics of ED revisits in the COVID-19 period by comparing them with those in the pre-COVID-19 period.…”