Decreased hospital admissions through the emergency department during the COVID-19 pandemic

Nourazari, Sara; Davis, Samuel R.; Granovsky, Rachel; Austin, Randolph; Straff, Dean J.; Joseph, Joshua W.; Sanchez, Leon D.

STUDY OBJECTIVE: Emergency Department (ED) visits decreased significantly in the United States during the COVID-19 pandemic. A troubling proportion of this decrease was among patients who typically would have been admitted to the hospital, suggesting substantial deferment of care. We sought to describe and characterize the impact of COVID-19 on admissions, with a specific focus on diagnosis group, age, gender, and insurance coverage. METHODS: We conducted a retrospective, observational study of aggregated third-party, anonymized ED patient data. This data included 501,369 patient visits from 12 EDs in Massachusetts from 1/1/2019–9/9/2020, and 1/1/2020–9/8/2020. We analyzed the total arrivals and admissions and calculated confidence intervals for the change in admissions for each characteristic. We then developed a Poisson regression estimating the relative contribution of each characteristic to the decrease in admissions after the statewide lockdown, corresponding to weeks 11 through 36 (3/12/2019–9/9/2019 and 3/11/2020–9/8/2020). RESULTS: We observed a 32% decrease in admissions during weeks 11–36, with significant decreases in admissions for chronic respiratory conditions and non-orthopedic needs. Decreases were particularly acute among women and children, as well as patients with Medicare or without insurance. The most common diagnosis during this time was SARS-CoV-2. CONCLUSION: Our findings corroborate recent work demonstrating decreased patient visits and admissions during the pandemic and suggest that several patient populations may have deferred necessary care. Further research is needed to determine the clinical and operational consequences of this delay.