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Study Objectives: With COVID-19 cases and fatalities increasing globally, health officials implemented many policies and restrictions to slow the rate of infection In California, a statewide stay-at-home order was issued on March 19, 2020 Subsequently, individuals avoided gatherings and public places, which potentially increased their risk of contracting the virus, including emergency departments There is concern that delaying preventive and emergent care could have negative health consequences, especially among those managing chronic conditions and the elderly The objective of this study was to assess patterns of ED utilization during the initial COVD-19 pandemic, as compared to utilization during the prior year Methods: We conducted a multi-center, retrospective study among adult patients (>=18 years) presenting to two emergency departments (urban level 1 trauma center and suburban academic hospital with combined annual census of ∼83,000) We compared weekly ED utilization between two distinct time periods: March 1 to May 30 in 2019 (n=21,226 visits) and 2020 (n=15,927 visits) We calculated the percent change in ED utilization from 2019 to 2020 for each of the 13 weeks, assessing trends over time by patient age, sex, race/ethnicity, homelessness, presence of chronic conditions, and primary reason for ED visit Results: Compared to 2019, weekly ED volume and admissions in 2020 decreased by as much as 41 8% and 37 2%, respectively While weekly ED volume in 2020 did not return to 2019 levels (-17 0% at the highest), admissions did (-0 8% at the highest) Patients 65-74 year of age saw the highest weekly decrease at 50 8% below 2019, and while weekly admissions also decreased for this group by up to 48 3%, admissions spiked to an average of 23 0% above the previous year during the last two weeks of the study period On average, ED visits by females decreased in 2020 by 30 1%, compared to 20 2% for males ED visits by Non-Hispanic Asians were at least 30% below the prior year for 9/13 weeks, compared to Non-Hispanic Blacks who only surpassed a 30% decrease during one week ED volume was relatively unaffected among patients experiencing homelessness, with an average weekly decrease of 4 5% Patients with diabetes saw a high of 45 1% decrease in admission compared to 2019, but were within 5% of the previous year during 3 of the final 4 weeks of the study period Psychiatric-related visits and alcohol and substance-related visits decreased as much as 50 6% and 32 0%, respectively;however, alcohol and substance-related visits averaged only 6 8% below 2019 volumes during the last 4 weeks of the study period compared to -26 0% among psychiatric visits Visits for skin and subcutaneous tissue infections decreased up to 44 4%, but also saw volume above 2019 levels for 5 different weeks (range +2 2% to +34 1%) Similarly, weekly sepsis-related and cardiac dysrhythmia visits were at least 15% higher than 2019 for 2 of the last 4 weeks, and, 3 out of the last 4 weeks, respectively Conclusion: This study of ED utilization trends during the COVID-19 pandemic demonstrated that ED volume and admissions decreased dramatically compared to the prior year However, there was much variation among the patient population, and unfortunately elderly patients and those with chronic conditions may be paying the price for initially avoiding the ED Further study with a longer follow-up period is needed to evaluate potential health consequences for patients who may be delaying care |
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