Trends in outpatient emergency department visits during the COVID-19 pandemic at a large, urban, academic hospital system

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic has critically affected healthcare delivery in the United States. Little is known on its impact on the utilization of emergency department (ED) services, particularly for conditions that might be medically urgent. The objective of this study was to explore trends in the number of outpatient (treat and release) ED visits during the COVID-19 pandemic. Methods We conducted a cross-sectional, retrospective study of outpatient emergency department visits from January 1, 2019 to August 31, 2020 using data from a large, urban, academic hospital system in Utah. Using weekly counts and trend analyses, we explored changes in overall ED visits, by patients' area of residence, by medical urgency, and by specific medical conditions. Results While outpatient ED visits were higher (+6.0%) in the first trimester of 2020 relative to the same period in 2019, the overall volume between January and August of 2020 was lower (−8.1%) than in 2019. The largest decrease occurred in April 2020 (−30.4%), followed by the May to August period (−12.8%). The largest declines were observed for visits by out-of-state residents, visits classified as non-emergent, primary care treatable or preventable, and for patients diagnosed with hypertension, diabetes, headaches and migraines, mood and personality disorders, fluid and electrolyte disorders, and abdominal pain. Outpatient ED visits for emergent conditions, such as palpitations and tachycardia, open wounds, syncope and collapse remained relatively unchanged, while lower respiratory disease-related visits were 67.5% higher in 2020 relative to 2019, particularly from March to April 2020. However, almost all types of outpatient ED visits bounced back after May 2020. Conclusions Overall outpatient ED visits declined from mid-March to August 2020, particularly for non-medically urgent conditions which can be treated in other more appropriate care settings. Our findings also have implications for insurers, policymakers, and other stakeholders seeking to assist patients in choosing more appropriate setting for their care during and after the pandemic.

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

“…Our findings that there was a significant reduction in overall ED visits across the system is consistent with other studies examining the impact of COVID-19 on healthcare utilization [ 6 , 13 , 16 , 18 ]. A proposed reason for reduction in ED visits is fear of contracting COVID-19 in the ED among patients [ [39] , [40] , [41] ].…”

“…However, other authors propose a more complex interaction related to unanticipated effects of government enforced lockdowns including fewer traffic accidents, fewer accidents related to nightlife and intoxication, fewer elective procedures reducing ED visits for complications, and reduced spread of infectious diseases of all sorts due to social distancing [ 42 , 43 ]. Additional mitigating factors that have been proposed include increased use of telehealth services and patient triaging [ 8 , 18 , [44] , [45] , [46] ]. In fact, the CDC recommended that healthcare systems provide care in the safest way possible, one of which included optimizing telehealth services to minimize the need for in-person services [ 46 ].…”

“…As COVID-19 spread and healthcare resources became strained, patients were encouraged to avoid using healthcare resources unnecessarily [ 14 ]. In the United States, ED visits were estimated to have declined more than 40% in early 2020 [ [11] , [12] , [13] ] with an overall reduction in both urgent [ 15 , 16 ] and non-medically urgent emergency department visits [ 17 ]. Studies indicate visits increased after many stay at home orders were lifted, though visits to emergency departments, clinics, and hospitals did not return to pre-COVID-19 levels [ 6 , 18 ].…”

Trends in outpatient emergency department census during the COVID-19 pandemic at a California health system

“…We have read the article entitled: “Trends in outpatient emergency department visits during the COVID-19 pandemic at a large, urban, academic hospital system” by Giannouchos TV, Biskupiak J, Moss MJ, Brixner D, Andreyeva E, and Ukert B, published in the American Journal of Emergency Medicine, Volume 40, Page 20–26, February 2021 [ 1 ]. We would like to congratulate the authors for presenting such detailed data and analysis.…”

“…Community hospital EDs such as those at AHMC tend to serve less medically complex patients compared to University level hospitals [ 4 , 5 ]. As the referenced article suggests the decrease may also be due to patient reluctance to visit hospitals during a pandemic, especially for non-urgent conditions [ 1 , [6] , [7] , [8] ]. Our data further reinforces these findings and provides insight into patient behavior in seeking emergency medical treatment during a pandemic.…”