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Shifting patterns in emergency department attendance: a time series analysis
Ahmad Alkhatib1, Paul Aylin2, Robert Klaber3
1Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK a.alkhatib@imperial.ac.uk.
Emergency Medicine Journal : EMJ
|December 4, 2025
Summary
Emergency department (ED) attendances stabilized post-pandemic, but rose for older adults and those with complex conditions. This highlights increasing demands on urgent care services.
Area of Science:
- Public Health
- Healthcare Management
- Epidemiology
Background:
- Rising demand and limited primary care capacity strain emergency departments (EDs).
- The COVID-19 pandemic reshaped healthcare services, exacerbating existing pressures.
- Increasing patient case complexity is a critical, often overlooked, factor impacting EDs.
Purpose of the Study:
- To assess emergency department (ED) attendance trends in Northwest London (NWL) from February 2017 to September 2023.
- To analyze pre-, during-, and post-pandemic ED attendance patterns.
- To examine trends across sociodemographic factors and multimorbidity profiles.
Main Methods:
- Utilized the Whole System Integrated Care (WSIC) data warehouse for NWL population data.
- Employed segmented time-series quasi-Poisson regression for weekly ED attendance analysis.
- Stratified models by age, sex, Index of Multiple Deprivation, and multimorbidity status.
Main Results:
- Total ED attendances showed a significant annual growth of 3.4% pre-pandemic.
- Overall ED attendance stabilized post-pandemic (RR 1.002), but rose for older age groups (61-75, 76+).
- Attendances increased for patients with multimorbidity and complex multimorbidity, while declining for the least deprived.
Conclusions:
- Post-pandemic, total ED attendances stabilized, but trends show increased utilization by older individuals, especially those with complex care needs.
- These shifts have significant implications for hospital capacity and strain on urgent and emergency care systems.
- Further research is recommended to investigate the specific drivers behind these evolving ED attendance patterns.
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