Impact of the COVID-19 pandemic on emergency department attendances and acute medical admissions

Abstract Background To better understand the impact of the COVID-19 pandemic on hospital healthcare, we studied activity in the emergency department (ED) and acute medicine department of a major UK hospital. Methods Electronic patient records for all adult patients attending ED (n = 243,667) or acut...

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Autores principales:	Michael E. Reschen, Jordan Bowen, Alex Novak, Matthew Giles, Sudhir Singh, Daniel Lasserson, Christopher A. O’Callaghan
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	COVID-19 Emergency department Acute medicine Hospital admissions Non-COVID-19 disease Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/700ae06f18f14d90906c8e1c55bc89dc
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spelling	oai:doaj.org-article:700ae06f18f14d90906c8e1c55bc89dc2021-11-21T12:14:43ZImpact of the COVID-19 pandemic on emergency department attendances and acute medical admissions10.1186/s12873-021-00529-w1471-227Xhttps://doaj.org/article/700ae06f18f14d90906c8e1c55bc89dc2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12873-021-00529-whttps://doaj.org/toc/1471-227XAbstract Background To better understand the impact of the COVID-19 pandemic on hospital healthcare, we studied activity in the emergency department (ED) and acute medicine department of a major UK hospital. Methods Electronic patient records for all adult patients attending ED (n = 243,667) or acute medicine (n = 82,899) during the pandemic (2020–2021) and prior year (2019) were analysed and compared. We studied parameters including severity, primary diagnoses, co-morbidity, admission rate, length of stay, bed occupancy, and mortality, with a focus on non-COVID-19 diseases. Results During the first wave of the pandemic, daily ED attendance fell by 37%, medical admissions by 30% and medical bed occupancy by 27%, but all returned to normal within a year. ED attendances and medical admissions fell across all age ranges; the greatest reductions were seen for younger adults in ED attendances, but in older adults for medical admissions. Compared to non-COVID-19 pandemic admissions, COVID-19 admissions were enriched for minority ethnic groups, for dementia, obesity and diabetes, but had lower rates of malignancy. Compared to the pre-pandemic period, non-COVID-19 pandemic admissions had more hypertension, cerebrovascular disease, liver disease, and obesity. There were fewer low severity ED attendances during the pandemic and fewer medical admissions across all severity categories. There were fewer ED attendances with common non-respiratory illnesses including cardiac diagnoses, but no change in cardiac arrests. COVID-19 was the commonest diagnosis amongst medical admissions during the first wave and there were fewer diagnoses of pneumonia, myocardial infarction, heart failure, cellulitis, chronic obstructive pulmonary disease, urinary tract infection and other sepsis, but not stroke. Levels had rebounded by a year later with a trend to higher levels of stroke than before the pandemic. During the pandemic first wave, 7-day mortality was increased for ED attendances, but not for non-COVID-19 medical admissions. Conclusions Reduced ED attendances in the first wave of the pandemic suggest opportunities for reducing low severity presentations to ED in the future, but also raise the possibility of harm from delayed or missed care. Reassuringly, recent rises in attendance and admissions indicate that any deterrent effect of the pandemic on attendance is diminishing.Michael E. ReschenJordan BowenAlex NovakMatthew GilesSudhir SinghDaniel LassersonChristopher A. O’CallaghanBMCarticleCOVID-19Emergency departmentAcute medicineHospital admissionsNon-COVID-19 diseaseSpecial situations and conditionsRC952-1245Medical emergencies. Critical care. Intensive care. First aidRC86-88.9ENBMC Emergency Medicine, Vol 21, Iss 1, Pp 1-14 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	COVID-19 Emergency department Acute medicine Hospital admissions Non-COVID-19 disease Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	COVID-19 Emergency department Acute medicine Hospital admissions Non-COVID-19 disease Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Michael E. Reschen Jordan Bowen Alex Novak Matthew Giles Sudhir Singh Daniel Lasserson Christopher A. O’Callaghan Impact of the COVID-19 pandemic on emergency department attendances and acute medical admissions
description	Abstract Background To better understand the impact of the COVID-19 pandemic on hospital healthcare, we studied activity in the emergency department (ED) and acute medicine department of a major UK hospital. Methods Electronic patient records for all adult patients attending ED (n = 243,667) or acute medicine (n = 82,899) during the pandemic (2020–2021) and prior year (2019) were analysed and compared. We studied parameters including severity, primary diagnoses, co-morbidity, admission rate, length of stay, bed occupancy, and mortality, with a focus on non-COVID-19 diseases. Results During the first wave of the pandemic, daily ED attendance fell by 37%, medical admissions by 30% and medical bed occupancy by 27%, but all returned to normal within a year. ED attendances and medical admissions fell across all age ranges; the greatest reductions were seen for younger adults in ED attendances, but in older adults for medical admissions. Compared to non-COVID-19 pandemic admissions, COVID-19 admissions were enriched for minority ethnic groups, for dementia, obesity and diabetes, but had lower rates of malignancy. Compared to the pre-pandemic period, non-COVID-19 pandemic admissions had more hypertension, cerebrovascular disease, liver disease, and obesity. There were fewer low severity ED attendances during the pandemic and fewer medical admissions across all severity categories. There were fewer ED attendances with common non-respiratory illnesses including cardiac diagnoses, but no change in cardiac arrests. COVID-19 was the commonest diagnosis amongst medical admissions during the first wave and there were fewer diagnoses of pneumonia, myocardial infarction, heart failure, cellulitis, chronic obstructive pulmonary disease, urinary tract infection and other sepsis, but not stroke. Levels had rebounded by a year later with a trend to higher levels of stroke than before the pandemic. During the pandemic first wave, 7-day mortality was increased for ED attendances, but not for non-COVID-19 medical admissions. Conclusions Reduced ED attendances in the first wave of the pandemic suggest opportunities for reducing low severity presentations to ED in the future, but also raise the possibility of harm from delayed or missed care. Reassuringly, recent rises in attendance and admissions indicate that any deterrent effect of the pandemic on attendance is diminishing.
format	article
author	Michael E. Reschen Jordan Bowen Alex Novak Matthew Giles Sudhir Singh Daniel Lasserson Christopher A. O’Callaghan
author_facet	Michael E. Reschen Jordan Bowen Alex Novak Matthew Giles Sudhir Singh Daniel Lasserson Christopher A. O’Callaghan
author_sort	Michael E. Reschen
title	Impact of the COVID-19 pandemic on emergency department attendances and acute medical admissions
title_short	Impact of the COVID-19 pandemic on emergency department attendances and acute medical admissions
title_full	Impact of the COVID-19 pandemic on emergency department attendances and acute medical admissions
title_fullStr	Impact of the COVID-19 pandemic on emergency department attendances and acute medical admissions
title_full_unstemmed	Impact of the COVID-19 pandemic on emergency department attendances and acute medical admissions
title_sort	impact of the covid-19 pandemic on emergency department attendances and acute medical admissions
publisher	BMC
publishDate	2021
url	https://doaj.org/article/700ae06f18f14d90906c8e1c55bc89dc
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Impact of the COVID-19 pandemic on emergency department attendances and acute medical admissions

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