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

Kwan, Nick; Giordano, Steve; Chiu, Ching-Hsiu; Yeh, Chia-Hsing; Chon, John; Teng, Wen-Hsiang; Wu, Su-Yen; Toy, Stanley; Chiu, Wen-Ta; Wu, Q. M. Jonathan

doi:10.1016/j.ajem.2021.03.065

Cited by 5 publications

(4 citation statements)

References 6 publications

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“…Fear of virus exposure in healthcare settings created widespread reluctance, leading many individuals to postpone or avoid essential medical attention. [1] This resulted in delayed diagnoses and treatments, potentially worsening health conditions and negatively impacting patient outcomes. [2] As healthcare providers engage with these complex issues, the healthcare system's quest for solutions and strategies has become imperative.…”

Section: Introductionmentioning

confidence: 99%

Quality of care and emergency department throughput during the COVID-19 pandemic in a community health system Pandemic in a Community Health System

Chiu,

Toy,

Lin

et al. 2024

JHA

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Objective: This retrospective study explores the strategic plan formulated by AHMC Health System in California, USA, to sustain and improve quality of care and emergency department (ED) efficiency during the COVID-19 pandemic. It also analyzes the plan’s outcomes.Background: The COVID-19 pandemic has posed challenges for both individuals and healthcare industries alike, impacting decision-making and access to care. AHMC faced staff and resource shortages, patient reluctance, and difficulties adapting to rapidly evolving public health guidelines. These challenges highlighted the critical need for effective plans to maintain or improve healthcare quality and ED performance.Methods: AHMC adopted a comprehensive three-layer strategic plan in 2020. The first layer, “Pandemic Response,” focused on leadership, staff training and education, infection control, new treatments, and employee vaccination rates. The second layer, “ED Throughput,” set objectives for metrics such as door-to-doctor (door-to-doc) time, ancillary turnaround time (TAT), ED length of stay (LOS), and the left-without-being-seen (LWBS) rates. Progress was monitored through monthly improvement meetings. The third layer, “Quality Excellence,” tracked improvements in COVID-adapted objectives on quality initiatives, based on CMS Quality Star Ratings, Leapfrog Hospital Safety Grades, and Yelp review scores.Results: By 2023, the three-layer strategic plan had led to many improvements in the quality of care and ED efficiency. AHMC identified 22,287 positive COVID-19 cases, expanded its ventilator inventory by 50%, and enhanced patient outcomes by applying updated treatments. Additionally, AHMC saw a 3% reduction in ED wait times and sustained its overall patient satisfaction rates, CMS Quality Star Rating, and Leapfrog Hospital Safety Grade scores.Conclusions: AHMC’s three-layer strategic plan showed effectiveness in maintaining quality of care and ED efficiency during the COVID-19 pandemic. By focusing on “Pandemic Response,” “ED Throughput,” and “Quality Excellence,” AHMC was able to adapt to the rapidly evolving public health guidelines, expand its capacity to treat COVID-19 patients and sustain its overall patient safety, satisfaction, and quality ratings. The implementation of this plan highlights the importance of proactive and comprehensive strategies in managing healthcare crises.

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Section: Introductionmentioning

confidence: 99%

Quality of care and emergency department throughput during the COVID-19 pandemic in a community health system Pandemic in a Community Health System

Chiu,

Toy,

Lin

et al. 2024

JHA

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“…[1,2] After the declaration of a national emergency in the United States on March 13, 2020, it was estimated that average weekly hospital ED visits sharply declined by 42% (March 29-April 25, 2020) until July of the same year before increasing again, resulting in a net ED visit decline of 25% in 2020 versus the same months in the pre-pandemic year of 2019, according to the CDC's National Syndromic Surveillance Program. [1,3,4] Subsequent ED visit declines occurred following the Alpha peak at the end of 2020, to which studies seemed to also indicate a correlation between case surges and ED visits. [5] However, it remained unclear if different variants of SARS-CoV-2 had differing effects on ED visits following the Delta and Omicron peaks in COVID-19 cases in August 2021 and January 2022, respectively.…”

Section: Introductionmentioning

confidence: 99%

Difference in impact on emergency department visits following four major peaks of COVID-19 cases

Chiu,

Toy,

Chon

et al. 2023

JHA

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Objective: Several variants of SARS-CoV-2 have emerged since its first appearance in 2019, greatly impacting healthcare systems across the globe. Previous literature indicated a substantial decline in emergency department (ED) visits in hospitals since the start of the COVID-19 pandemic. However, little research has been done to compare different variants’ (Ancestral, Alpha, Delta, Omicron, etc.) impact on patients presenting to the ED. Thus, the purpose of this retrospective observational study is to compare the changes in total ED volume following four major peaks of SARS-CoV-2 infection within a multi-hospital health system.Methods: Utilizing electronic healthcare record (EHR) data, total ED visits (484,268) and COVID-19 case counts (24,358) were collected and analyzed to compare ED census and COVID-19 trends across four years and four variant peak periods, from January 2019 to June 2022.Results: Results showed that ED visits declined after the first two major peaks (Ancestral and Alpha) in COVID-19 cases, which was consistent with national trends and prevailing literature. In contrast, ED visits increased following the fourth major peak (Omicron) in COVID-19 cases.Conclusions: The increase in ED visits following the fourth major peak was inconsistent with previous literature and trends. This may be attributed to the severity differences between variants, increased vaccination uptake, newly adopted public countermeasures, and evolving perceptions of safety and fear regarding COVID-19. These results underscore the critical importance for health administrators and policy planners to be cognizant of new strategies that alleviate barriers to receiving emergency care, especially during times of crisis.

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“…Instead, the decrease in the ED or hospital utilization likely reflects the tendency for patients to defer care due to fear of contagion, even when they are acutely ill [3,7,15]. Indeed, several studies described a decline in ED admission driven by a fall in both emergent and non-emergent ED visits, suggesting that the decrease may also be due to patient reluctance to visit hospitals during the pandemic [16][17][18]. Thus, the fall in the utilization of emergency medical services (EMS) during the pandemic could portend substantial harm to public health and not simply the absence of need.…”

Section: Introductionmentioning

confidence: 99%

The indirect impact of COVID-19 pandemic on the utilization of the emergency medical services during the first pandemic wave: A system-wide study of Tuscany Region, Italy

et al. 2022

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Background Utilization of Emergency Medical Services (EMS) declined during COVID-19 pandemic, but most of the studies analyzed components of the EMS system individually. The study aimed to evaluate the indirect impact of COVID-19 pandemic on the utilization of all the components of the EMS system of Tuscany Region (Italy) during the first pandemic wave. Methods Administrative data from the health care system of Tuscany were used. Changes in utilization for out-of-hospital emergency calls and emergency vehicle dispatched, emergency department (ED) visits, and patients being admitted from the ED to an inpatient hospital bed (hospitalizations from ED) during the first pandemic wave were analyzed in relation with corresponding periods of the previous two years. Percentage changes and 95%CI were calculated with Poisson models. Standardized Ratios were calculated to evaluate changes in in-hospital mortality and hospitalizations requiring ICU. Results Significant declines were observed in the utilization of all the EMS considered starting from the week in which the first case of COVID-19 was diagnosed in Italy till the end of the first pandemic wave. During the epidemic peak, the maximum decreases were observed: -33% for the emergency calls, -45% for the dispatch of emergency vehicles, -71% for ED admissions. Furthermore, a decline of 37% for hospitalizations from ED was recorded. Significant decreases in ED admissions for life threatening medical conditions were observed: acute cerebrovascular disease (-36%, 95% CI: -43, -29), acute myocardial infarction (-42%, 95% CI: -52, -31) and renal failure (-42%, 95% CI: -52, -31). No significant differences were found between the observed and the expected in-hospital mortality and hospitalizations requiring ICU during the epidemic peak. Conclusion All the components of the EMS showed large declines in their utilization during COVID-19 pandemic; furthermore, major reductions were observed for admissions for time-dependent and life-threatening conditions. Efforts should be made to ensure access to safe and high-quality emergency care during pandemic.

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

Cited by 5 publications

References 6 publications

Quality of care and emergency department throughput during the COVID-19 pandemic in a community health system Pandemic in a Community Health System

Quality of care and emergency department throughput during the COVID-19 pandemic in a community health system Pandemic in a Community Health System

Difference in impact on emergency department visits following four major peaks of COVID-19 cases

The indirect impact of COVID-19 pandemic on the utilization of the emergency medical services during the first pandemic wave: A system-wide study of Tuscany Region, Italy

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