Threat of COVID-19 impacting on a quaternary healthcare service: a retrospective cohort study of administrative data.

Autor:	McNamara E; Department of General Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia., Saxon L; Melbourne Academic Centre for Health, Parkville, Victoria, Australia., Bond K; Department of Microbiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia., Campbell BC; Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia., Douglass J; The Royal Melbourne Hospital, Melbourne, Victoria, Australia.; Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia., Dutch MJ; Centre for Integrated Critical Care Research, University of Melbourne, Melbourne, Victoria, Australia.; Department of Medicine and Radiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia., Grigg L; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia., Johnson D; Department of General Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.; Department of Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.; Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia., Knott JC; Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.; Department of Emergency Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia., Koye DN; The Royal Melbourne Hospital, Melbourne, Victoria, Australia.; Melbourne Clinical and Translation Science, University of Melbourne, Melbourne, Victoria, Australia., Putland M; Department of Emergency Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia., Read DJ; Trauma and Colorectal Units, The Royal Melbourne Hospital, Melbourne, Victoria, Australia., Smith B; Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia., Thomson BN; University of Melbourne Department of Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia., Williamson DA; Department of Microbiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia., Tong SY; Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia Steven.Tong@mh.org.au.; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia., Fazio TN; Department of General Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.; Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.; Health Intelligence, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2021 Jun 24; Vol. 11 (6), pp. e045975. Date of Electronic Publication: 2021 Jun 24.
DOI:	10.1136/bmjopen-2020-045975
Abstrakt:	Objectives: The threat of a pandemic, over and above the disease itself, may have significant and broad effects on a healthcare system. We aimed to describe the impact of the SARS-CoV-2 pandemic (during a relatively low transmission period) and associated societal restrictions on presentations, admissions and outpatient visits. Design: We compared hospital activity in 2020 with the preceding 5 years, 2015-2019, using a retrospective cohort study design. Setting: Quaternary hospital in Melbourne, Australia. Participants: Emergency department presentations, hospital admissions and outpatient visits from 1 January 2015 to 30 June 2020, n=896 934 episodes of care. Intervention: In Australia, the initial peak COVID-19 phase was March-April. Primary and Secondary Outcome Measures: Separate linear regression models were fitted to estimate the impact of the pandemic on the number, type and severity of emergency presentations, hospital admissions and outpatient visits. Results: During the peak COVID-19 phase (March and April 2020), there were marked reductions in emergency presentations (10 389 observed vs 14 678 expected; 29% reduction; p<0.05) and hospital admissions (5972 observed vs 8368 expected; 28% reduction; p<0.05). Stroke (114 observed vs 177 expected; 35% reduction; p<0.05) and trauma (1336 observed vs 1764 expected; 24% reduction; p<0.05) presentations decreased; acute myocardial infarctions were unchanged. There was an increase in the proportion of hospital admissions requiring intensive care (7.0% observed vs 6.0% expected; p<0.05) or resulting in death (2.2% observed vs 1.5% expected; p<0.05). Outpatient attendances remained similar (30 267 observed vs 31 980 expected; 5% reduction; not significant) but telephone/telehealth consultations increased from 2.5% to 45% (p<0.05) of total consultations. Conclusions: Although case numbers of COVID-19 were relatively low in Australia during the first 6 months of 2020, the impact on hospital activity was profound. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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