Log in to MyACC
Trends in ED Visits and Hospital Admissions During COVID-19 Pandemic
Quick Takes
- A substantial and widespread decrease in emergency department (ED) visits was seen from mid-March to mid-April 2020.
- Over this same time period, the fraction of ED visits that resulted in admission remained stable initially and then eventually increased as each state saw a rise in the number of COVID-19 cases.
- The data do not clarify why ED visits declined, what diagnoses were under-represented, or if the trend reflected sick patients deferring emergency care or a decline in nonemergent ED utilization.
Study Questions:
How did emergency department visits and hospitalizations change leading up to and during the first few weeks of the coronavirus disease 2019 (COVID-19) pandemic?
Methods:
This was a cross-sectional, observational, retrospective study of a total of 24 emergency departments (EDs) across five large hospital systems in Colorado (UCHealth), Connecticut (Yale-New Haven Health), Massachusetts (Baystate Health), New York (Mount Sinai Health), and North Carolina (UNC Health). For four of these hospital systems, data were collected as part of an ongoing trial of opiate prescribing practices. The fifth was the Mount Sinai Health System in New York City, the epicenter of the pandemic in the United States during this period. ED visits and rate of hospital admission from the ED were tracked between January 1 and April 30, 2020, and correlated temporally with the number of COVID-19 cases nationally and in each state.
Results:
Beginning in early March and continuing through April, all five hospital systems had substantial decreases in ED visits. New York had the largest decline (63.5%), followed by Massachusetts (57.4%), Connecticut (48.9%), North Carolina (46.5%), and Colorado (41.5%). While the number of hospital admissions from the ED also decreased in each state, the “admission rate” (defined here as the fraction of ED visits that resulted in admission) remained stable and eventually rose in April as each state saw a rise in the number of COVID-19 cases. The largest relative increase was seen in New York (149%), followed by Massachusetts (51.7%), Connecticut (36.2%), Colorado (29.4%), and North Carolina (22%).
Conclusions:
As the COVID-19 pandemic developed over the first 4 months of 2020, there was a decrease in ED visits by >40% in all four states and >60% in New York. The fraction of ED visits resulting in admission (which the authors refer to as the “admission rate”) initially remained stable. With an increase in state COVID-19 cases, however, the admission rate eventually increased, with the largest effect seen in New York.
Perspective:
The decline in ED volume in the first 6 weeks of the pandemic was striking in both its magnitude and uniformity across five different hospital systems and geographic locations. While Mount Sinai, the only health system in New York, experienced the largest decline, the data suggest that the public responded more to the national situation than to the local incidence of COVID-19. The manuscript is somewhat misleading in its use of the term “admission rate,” which refers here to the fraction of ED visits resulting in admission, rather than the overall number of admissions per unit time.
Beyond this, the data have little to offer in terms of the key questions surrounding ED utilization during the first weeks of the pandemic. The authors do not compare the temporal patterns they observe in March and April 2020 to those of prior years, and they collect no information on chief complaints or diagnoses associated with any of the visits or admissions. As such, it is impossible to determine what types of visits or diagnoses were under-represented in these months. Likewise, it is unclear if the decline reflected sicker patients deferring emergency care, fewer patients requiring emergency care, or a reduction in ED utilization for nonemergent conditions. Finally, while the fraction of ED visits resulting in admission eventually increased, it is unknown if this reflected admissions for COVID-19 or non-COVID conditions (e.g., hospitalization of patients who had deferred care previously).
Clinical Topics: COVID-19 Hub, Prevention
Keywords: Coronavirus, COVID-19, Emergency Medical Services, Emergency Service, Hospital, Emergency Treatment, Patient Admission, Primary Prevention, severe acute respiratory syndrome coronavirus 2
< Back to Listings
