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After the first wave and beyond lockdown: long-lasting changes in emergency department visit number, characteristics,
Fulvio Morello1,2, Paolo Bima3,4, Enrico Ferreri5
1S.C. Medicina d'Urgenza U, Ospedale Molinette, A.O.U. Città della Salute e della Scienza and Università degli Studi di Torino, C.so Bramante 88, 10126, Torino, Italy. fulvio.morello@unito.it.
Insights
The first wave of COVID-19 significantly reduced emergency department visits and non-COVID-19 hospital admissions. These reductions persisted post-wave, indicating a lasting impact beyond initial lockdown fears.
Area of Science:
- Public Health
- Epidemiology
- Emergency Medicine
Background:
- The initial phase of the COVID-19 pandemic caused a substantial decrease in emergency department (ED) visits and hospital admissions for conditions other than COVID-19.
- Uncertainty existed whether this decline was a temporary effect of "lockdown and fear" or a more enduring trend.
Purpose of the Study:
- To differentiate between acute and post-wave changes in emergency department (ED) patient flow, diagnoses, and hospital admissions following the first wave of COVID-19.
- To analyze the persistence of these trends during the subsequent period of lower COVID-19 incidence.
Main Methods:
- A multicenter, retrospective, cross-sectional study was conducted across five general EDs in a large Italian city.
- Data from January to August 2020 were compared with the same period in 2019, analyzing four distinct 14-day periods: the first wave peak and early, mid, and late post-wave phases.
- Percentage changes in ED visits, triage codes, diagnoses, and hospital admissions were calculated for non-COVID-19 related cases.
Main Results:
- During the first wave peak, total ED visits decreased by 66.4%, with the most significant drops observed during daytime hours and for pediatric patients.
- Non-COVID-19 hospital admissions fell by 39.5% during the peak, affecting most conditions except hematologic, metabolic/endocrine, respiratory diseases, and traumas.
- ED visit reductions persisted post-wave (23.5-25.4%), with notable ongoing decreases for female and pediatric patients. Non-COVID-19 hospital admissions showed transient changes post-wave.
Conclusions:
- Reductions in emergency department (ED) patient flow, primarily for non-critical conditions, continued even after the first wave of COVID-19 subsided.
- While non-COVID-19 hospital admissions experienced temporary fluctuations, the overall trend indicated a persistent impact on healthcare seeking behavior beyond the acute pandemic phase.
- These findings highlight the need to understand long-term effects on healthcare utilization and patient management in the post-pandemic era.
Abstract:
The first wave (FW) of COVID-19 led to a rapid reduction in total emergency department (ED) visits and hospital admissions for other diseases. Whether this represented a transient "lockdown and fear" phenomenon, or a more persisting trend, is unknown. We divided acute from post-wave changes in ED flows, diagnoses, and hospital admissions, in an Italian city experiencing a FW peak followed by nadir. This multicenter, retrospective, cross-sectional study involved five general EDs of a large Italian city (January-August 2020). Percent changes were calculated versus 2019, using four 14-day periods (FW peak, early/mid/late post-wave). ED visits were 147,446 in 2020, versus 214,868 in 2019. During the FW peak, visits were reduced by 66.4% (P < 0.001). The drop was maximum during daytime (69.8%) and for pediatric patients (89.4%). Critical triage codes were unchanged. Reductions were found for all non-COVID-19 diagnoses. Non-COVID-19 hospital admissions were reduced by 39.5% (P < 0.001), involving all conditions except hematologic, metabolic/endocrine, respiratory diseases, and traumas. In the early, mid, and late post-wave periods, visits were reduced by 25.4%, 25.3% and 23.5% (all P < 0.001) respectively. In the late period, reduction was greater for female (27.9%) and pediatric patients (44.6%). Most critical triage codes were unchanged. Oncological, metabolic/endocrine, and hematological diagnoses were unchanged, while other diagnoses had persistent reductions. Non-COVID-19 hospital admissions were reduced by 12.8% (P = 0.001), 6.3% (P = 0.1) and 12.2% (P = 0.001), respectively. Reductions in ED flows, led by non-critical codes, persisted throughout the summer nadir of COVID-19. Hospital admissions for non-COVID-19 diseases had transient changes.
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