The impact of the COVID-19 pandemic on patterns of attendance at emergency departments in two large London hospitals: an observational study.

Autor:	Vollmer MAC; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.; Modelling and Economics Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.; NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, Norfolk Place, London, W2 1PG, UK., Radhakrishnan S; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK., Kont MD; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK., Flaxman S; Department of Mathematics, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK., Bhatt S; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.; NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, Norfolk Place, London, W2 1PG, UK.; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark., Costelloe C; Imperial College London Department of Primary Care and Public Health, Global Digital Health Unit, St Dunstan's Rd, Hammersmith, London, W6 8RP, UK., Honeyford K; Imperial College London Department of Primary Care and Public Health, Global Digital Health Unit, St Dunstan's Rd, Hammersmith, London, W6 8RP, UK., Aylin P; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK., Cooke G; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.; Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, London, W2 1NY, UK., Redhead J; Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, London, W2 1NY, UK., Sanders A; Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, London, W2 1NY, UK., Mangan H; West London Mental Health NHS Trust, 1 Armstrong Way, Southall, London, UB2 4SD, UK., White PJ; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.; Modelling and Economics Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.; NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, Norfolk Place, London, W2 1PG, UK., Ferguson N; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.; NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, Norfolk Place, London, W2 1PG, UK., Hauck K; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.; NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, Norfolk Place, London, W2 1PG, UK., Nayagam S; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.; Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, London, W2 1NY, UK., Perez-Guzman PN; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK. p.perez-guzman@imperial.ac.uk.
Jazyk:	angličtina
Zdroj:	BMC health services research [BMC Health Serv Res] 2021 Sep 23; Vol. 21 (1), pp. 1008. Date of Electronic Publication: 2021 Sep 23.
DOI:	10.1186/s12913-021-07008-9
Abstrakt:	Background: Hospitals in England have undergone considerable change to address the surge in demand imposed by the COVID-19 pandemic. The impact of this on emergency department (ED) attendances is unknown, especially for non-COVID-19 related emergencies. Methods: This analysis is an observational study of ED attendances at the Imperial College Healthcare NHS Trust (ICHNT). We calibrated auto-regressive integrated moving average time-series models of ED attendances using historic (2015-2019) data. Forecasted trends were compared to present year ICHNT data for the period between March 12, 2020 (when England implemented the first COVID-19 public health measure) and May 31, 2020. We compared ICHTN trends with publicly available regional and national data. Lastly, we compared hospital admissions made via the ED and in-hospital mortality at ICHNT during the present year to the historic 5-year average. Results: ED attendances at ICHNT decreased by 35% during the period after the first lockdown was imposed on March 12, 2020 and before May 31, 2020, reflecting broader trends seen for ED attendances across all England regions, which fell by approximately 50% for the same time frame. For ICHNT, the decrease in attendances was mainly amongst those aged < 65 years and those arriving by their own means (e.g. personal or public transport) and not correlated with any of the spatial dependencies analysed such as increasing distance from postcode of residence to the hospital. Emergency admissions of patients without COVID-19 after March 12, 2020 fell by 48%; we did not observe a significant change to the crude mortality risk in patients without COVID-19 (RR 1.13, 95%CI 0.94-1.37, p = 0.19). Conclusions: Our study findings reflect broader trends seen across England and give an indication how emergency healthcare seeking has drastically changed. At ICHNT, we find that a larger proportion arrived by ambulance and that hospitalisation outcomes of patients without COVID-19 did not differ from previous years. The extent to which these findings relate to ED avoidance behaviours compared to having sought alternative emergency health services outside of hospital remains unknown. National analyses and strategies to streamline emergency services in England going forward are urgently needed. (© 2021. The Author(s).)
Databáze:	MEDLINE
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