Advertisement
Mayo Clinic Proceedings Home

Impact of the SARS-CoV-2 Pandemic on Emergency Department Presentations in an Integrated Health System

Published:September 19, 2020DOI:https://doi.org/10.1016/j.mayocp.2020.09.019

      Abstract

      Objective

      To quantify the impact of the severe acute respiratory syndrome coronavirus 2 pandemic on emergency department volumes and patient presentations and evaluate changes in community mortality for the purpose of characterizing new patterns of emergency care use.

      Patients and Methods

      This is an observational cross-sectional study using electronic health records for emergency department visits in an integrated multihospital system with academic and community practices across 4 states for visits between March 17 and April 21, 2019, and February 9 and April 21, 2020. We compared numbers and proportions of common and critical chief symptoms and diagnoses, triage assessments, throughput, disposition, and selected hospital lengths of stay and out-of-hospital deaths.

      Results

      In the period of interest, emergency department visits decreased by nearly 50% (35037 to 18646). Total numbers of patients with myocardial infarctions, stroke, appendicitis, and cholecystitis diagnosed decreased. The percentage of visits for mental health symptoms increased. There was an increase in deaths, driven by out-of-hospital mortality.

      Conclusion

      Fewer patients presenting with acute and time-sensitive diagnoses suggests that patients are deferring care. This may be further supported by an increase in out-of-hospital mortality. Understanding which patients are deferring care and why will allow us to develop outreach strategies and ensure that those in need of rapid assessment and treatment will do so, preventing downstream morbidity and mortality.

      Abbreviations and Acronyms:

      COVID-19 (coronavirus disease 2019), ED (emergency department), EHR (electronic health record), ESI (emergency severity index), LOS (length of stay), ME (medical examiner), MI (myocardial infarction), MN (Minnesota), NSTEMI (non–ST-elevation myocardial infarction), SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), SMRMEO (Southern Minnesota Regional Medical Examiner’s Office), STEMI (ST-elevation myocardial infarction)
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bernstein L.
        • Sellers F.S.
        • Health
        Patients with heart attacks, strokes and even appendicitis vanish from hospitals. The Washington Post. April 19, 2020.
        • Molseed J.
        Lifestyle. Health officials: emergency rooms are open. Rochester Post Bulletin. COVID-19 Coverage. April 16, 2020.
        • Stradling R.
        Local. Fewer people are going to Triangle emergency rooms, and that could be a bad thing. The News and Observer. April 21, 2020.
        • Alvarez F.
        Health Care. As heart attack rates plummet, doctors worry patients are avoiding the ER. Sacramento Business Journal. April 27, 2020.
        • Krumholz H.M.
        Doctors. Where have all the heart attacks gone? The New York Times. April 6, 2020. Updated May 14, 2020.
        • De Filippo O.
        • D’Ascenzo F.
        • Angelini F.
        • et al.
        Reduced rate of hospital admissions for ACS during Covid-19 outbreak in Northern Italy.
        ([published online ahead of print April 28, 2020]. N Engl J Med)
        • Garcia S.
        • Albaghdadi M.S.
        • Meraj P.M.
        • et al.
        Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic.
        J Am Coll Cardiol. 2020; 75: 2871-2872
        • Metzler B.
        • Siostrzonek P.
        • Binder R.K.
        • Bauer A.
        • Reinstadler S.J.
        Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage.
        ([published online ahead of print April 16, 2020]. Eur Heart J)
        • Morelli N.
        • Rota E.
        • Terracciano C.
        • et al.
        The baffling case of ischemic stroke disappearance from the casualty department in the COVID-19 era.
        Eur Neurol. 2020; 83: 213-215
        • Solomon M.D.
        • McNulty E.J.
        • Rana J.S.
        • et al.
        The Covid-19 pandemic and the incidence of acute myocardial infarction.
        N Engl J Med. 2020; 383: 691-693
        • Gillum J.
        • Song L.
        • Kao J.
        There’s been a spike in people dying at home in several cities. That suggests that coronavirus deaths are higher than reported. ProPublica. Coronavirus. April 14, 2020.
        • Von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gotzsche P.C.
        • Vandenbroucke J.P.
        • STROBE Initiative
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        Ann Intern Med. 2007; 147: 573-577
        • Gilboy N.
        • Tanabe P.
        • Travers D.
        • Rosenau A.M.
        Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care, Version 4. Implementation Handbook 2012 Edition.
        AHRQ, Rockville, MDNovember 2011 (Publication No. 12-0014)
        • Miller A.C.
        • Arquilla B.
        Chronic diseases and natural hazards: impact of disasters on diabetic, renal and cardiac patients.
        Prehosp Disaster Med. 2008; 23: 185-194