16 Temporal Associations Between Decreasing Emergency Department and Increasing Emergency Telehealth Volumes During the COVID-19 Pandemic: A Time-Series Analysis From Two Academic Medical Centers

Reno, E.; Eutermoser, M.; Li, B.; Davis, C. B.; Shy, B. D.

Study Objectives: During the initial periods of rising COVID-19 cases and critically ill patients in 2020, overall ED volumes fell substantially. Our goal was to compare the contrasting increase in emergency telehealth volume with the decreasing ED volumes to identify staffing strategies that can be used in future epidemics. Methods: We performed interrupted time series analyses to compare the associations of COVID-19 surges on daily ED and telehealth volumes at Denver Health Medical Center (DHMC) in Denver, Colorado, and the University of Colorado Hospital (UCH) in Aurora, Colorado. Consecutive adults from January 1, 2019, through December 31, 2020 were included, with time periods corresponding to baseline volumes (January 1, 2019 to March 24, 2020), and first (March 25, 2020 to June 15, 2020), second (June 16, 2020 to September 12, 2020), and third (September 13, 2020 to December 31, 2020) COVID-19 surges according to Colorado epidemiological data. We performed pairwise comparisons between baseline versus each COVID-19 surge for ED and telehealth daily volumes, using linear regression to account for secularity and non-parametric statistics to compare median values. Results: DHMC ED daily volumes differed between baseline (median, 346 [interquartile range {IQR}, 325- 367]), and first (219 [196-237];p<.0001), second (281 [264-298];p<.0001), and third (284 [260-301];p<.0001) COVID-19 surges. DHMC telehealth median daily volumes also differed between baseline (181 [156-199]), and first (257 [231-285];p<.0001), second (227 [202-256];p<.0001), and third (241 [208-274];p<.0001) COVID-19 surges. Similarly, UCH ED median daily volumes differed between baseline (276 [257-292]), and first (207 [188-223];p<.0001), second (243 [227-255];p<.0001), and third (245 [225-264];p<.0001) COVID-19 surges. Lastly, UCH telehealth median daily volumes also differed between baseline (9 [6-15]), and first (97 [65-141];p<.0001), second (60 [51-69];p<.0001), and third (74 [62-89];p<.0001) COVID-19 surges (Figure). Conclusions: ED volumes decreased and remained depressed through all 3 COVID-19 surges in Colorado, and in response, COVID-19 was associated with an unprecedented increase for emergency telehealth and virtual services. Patients adopted telehealth as an alternative to seek care while trying to stay protected from infection. Shifting providers in this manner, from physical ED to acute-care telehealth shifts, may allow EDs to meet dynamically changing patient volumes during future pandemics. [Formula presented]