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Underutilization of the Emergency Department During the COVID-19 Pandemic

Anthony D Lucero1, Andre Lee1, Jenny Hyun2

  • 1Kaweah Delta Medical Center, Department of Emergency Medicine, Visalia, California.

The Western Journal of Emergency Medicine
|October 14, 2020
PubMed

Insights

Emergency department visits significantly decreased during COVID-19 shelter-in-place orders, with lower acuity visits declining more than emergent ones. Substance abuse and alcohol-related visits saw the smallest reductions.

Area of Science:

  • Public Health
  • Epidemiology
  • Emergency Medicine

Background:

  • The COVID-19 pandemic necessitated widespread containment measures, including shelter-in-place (SIP) orders in the United States.
  • These measures aimed to curb viral transmission but potentially impacted healthcare utilization patterns.

Purpose of the Study:

  • To evaluate the changes in the volume and proportion of emergency department (ED) encounters following the implementation of SIP orders.
  • To identify specific trends in ED visit types and acuities during the pandemic.

Main Methods:

  • Retrospective, observational, cross-sectional study utilizing billing data from 141 EDs across 16 states.
  • Analysis of 26,223,438 ED encounters from January 1, 2017, to April 20, 2020.
  • Generalized least squares regression used to assess changes in overall ED encounters, hospital admissions, and ED visit algorithm categories.

Main Results:

  • A significant overall decrease of 39.6% in ED encounters was observed post-SIP compared to expected pre-SIP volumes.
  • Emergent encounters decreased by 35.8%, while non-emergent encounters saw a larger reduction of 52.1%.
  • Psychiatric encounters declined by 30.2%, with drug and alcohol-related visits showing the least reduction (9.3% and 27.5%, respectively).

Conclusions:

  • Significant reduction in overall ED utilization occurred during the post-SIP period.
  • Lower acuity ED encounters experienced a greater reduction than higher acuity encounters.
  • Substance abuse and alcohol-related ED visits were least affected, while injury-related visits decreased most significantly.
Abstract

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