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Underutilization of the Emergency Department During the COVID-19 Pandemic

2020; eScholarship Publishing, University of California; Volume: 21; Issue: 6 Linguagem: Inglês

10.5811/westjem.2020.8.48632

1936-9018

Anthony Lucero, André Lee, Jenny K. Hyun, Carol Lee, Chadi I. Kahwaji, Gregg Miller, Michael Neeki, Joshua H. Tamayo‐Sarver, Luhong Pan,

Emergency and Acute Care Studies

Introduction: The novel coronavirus 2019 (COVID-19) pandemic in the United States (US) prompted widespread containment measures such as shelter-in-place (SIP) orders. The goal of our study was to determine whether there was a significant change in overall volume and proportion of emergency department (ED) encounters since SIP measures began.Methods: This was a retrospective, observational, cross-sectional study using billing data from January 1, 2017–April 20, 2020. We received data from 141 EDs across 16 states, encompassing a convenience sample of 26,223,438 ED encounters. We used a generalized least squares regression approach to ascertain changes for overall ED encounters, hospital admissions, and New York University ED visit algorithm categories.Results: ED encounters decreased significantly in the post-SIP period. Overall, there was a 39.6% decrease in ED encounters compared to expected volume in the pre-SIP period. Emergent encounters decreased by 35.8%, while non-emergent encounters decreased by 52.1%. Psychiatric encounters decreased by 30.2%. Encounters related to drugs and alcohol decreased the least, by 9.3% and 27.5%, respectively.Conclusion: There was a significant overall reduction in ED utilization in the post-SIP period. There was a greater reduction in lower acuity encounters than higher acuity encounters. Of all subtypes of ED encounters, substance abuse- and alcohol-related encounters reduced the least, and injury-related encounters reduced the most.