Abstract
As coronavirus disease 2019 (COVID-19) spread throughout the US in the early months of 2020, acute care delivery changed to accommodate an influx of patients with a highly contagious infection about which little was known. To examine trends in emergency department (ED) visits and visits that led to hospitalizations covering a 4-month period leading up to and during the COVID-19 outbreak in the US. This retrospective, observational, cross-sectional study of 24 EDs in 5 large health care systems in Colorado (n = 4), Connecticut (n = 5), Massachusetts (n = 5), New York (n = 5), and North Carolina (n = 5) examined daily ED visit and hospital admission rates from January 1 to April 30, 2020, in relation to national and the 5 states' COVID-19 case counts. Time (day) as a continuous variable. Daily counts of ED visits, hospital admissions, and COVID-19 cases. A total of 24 EDs were studied. The annual ED volume before the COVID-19 pandemic ranged from 13 000 to 115 000 visits per year; the decrease in ED visits ranged from 41.5% in Colorado to 63.5% in New York. The weeks with the most rapid rates of decrease in visits were in March 2020, which corresponded with national public health messaging about COVID-19. Hospital admission rates from the ED were stable until new COVID-19 case rates began to increase locally; the largest relative increase in admission rates was 149.0% in New York, followed by 51.7% in Massachusetts, 36.2% in Connecticut, 29.4% in Colorado, and 22.0% in North Carolina. From January through April 2020, as the COVID-19 pandemic intensified in the US, temporal associations were observed with a decrease in ED visits and an increase in hospital admission rates in 5 health care systems in 5 states. These findings suggest that practitioners and public health officials should emphasize the importance of visiting the ED during the COVID-19 pandemic for serious symptoms, illnesses, and injuries that cannot be managed in other settings.
Highlights
The annual emergency department (ED) volume before the COVID-19 pandemic ranged from 13 000 to 115 000 visits per year; the decrease in ED visits ranged from 41.5% in Colorado to 63.5% in New York
Hospital admission rates from the ED were stable until new COVID-19 case rates began to increase locally; the largest relative increase in admission rates was 149.0% in New York, followed by 51.7% in Massachusetts, 36.2% in Connecticut, 29.4% in Colorado, and 22.0% in North Carolina
From January through April 2020, as the COVID-19 pandemic intensified in the US, temporal associations were observed with a decrease in ED visits and an increase in hospital admission rates in 5 health care systems in 5 states
Summary
This cross-sectional study used data from a number of large US health care systems that were collected as part of an ongoing trial of ED prescribing practices for opioid use disorder; the original study protocol was approved by the Western Institutional Review Board with reliance agreements by the individual institutions’ institutional review boards.[5]. For January 1 to April 30, 2020, we examined trends in daily ED visits and the rate of hospital admissions from EDs that are part of 5 large, independent health care systems in 5 states. One data set came from Mount Sinai Health System (New York), and four came from health systems in the EMBED trial: Baystate Health (Massachusetts), University of Colorado Health (UCHealth, Colorado), Mount Sinai Health (New York), University of North Carolina (UNC) Health, and Yale New Haven Health (Connecticut). We analyzed these trends in the context of publicly reported national and state COVID-19 case counts. We standardized new confirmed state COVID-19 cases to state populations using US Census Bureau data on estimated population as of July 1, 2019.7
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