5 The Western Institutional Review Board approved an amendment to this study protocol with an exemption of informed consent to collect data on ED visits and hospital admissions to better understand the association of COVID-19 with trial enrollment. This cross-sectional study used data from a number of large US health care systems that were collected as part of an ongoing trial of ED prescribing practices for opioid use disorder the original study protocol was approved by the Western Institutional Review Board with reliance agreements by the individual institutions’ institutional review boards. 4 We studied changes in ED use in 5 health care systems representing geographically diverse areas in 5 states in the first months of the COVID-19 pandemic in the US. Reductions in emergency department (ED) use could reflect (1) failure by patients with serious or life-threatening conditions to seek care, including conditions unrelated to COVID-19 3 (2) avoidance of the ED for nonemergency conditions or (3) displacement of ED care to other venues, such as telemedicine visits.
1 An early report 2 suggested that use of health care services for elective and emergency conditions decreased during this period. Initial public health messaging advised avoiding unnecessary health care use to reduce transmission of the virus and to ensure capacity to accommodate surges in COVID-19 cases. These findings suggest that practitioners and public health officials should emphasize the importance of visiting the ED during the COVID-19 pandemic for serious symptoms, illnesses, and injuries that cannot be managed in other settings.Īs coronavirus disease 2019 (COVID-19) spread throughout the US in the early months of 2020, the delivery of acute care changed to accommodate an influx of patients with a highly contagious infection about which little was known. Hospital admission rates from the ED were stable until new COVID-19 case rates began to increase locally the largest relative increase in admission rates was 149.0% in New York, followed by 51.7% in Massachusetts, 36.2% in Connecticut, 29.4% in Colorado, and 22.0% in North Carolina.Ĭonclusions and Relevance From January through April 2020, as the COVID-19 pandemic intensified in the US, temporal associations were observed with a decrease in ED visits and an increase in hospital admission rates in 5 health care systems in 5 states. The weeks with the most rapid rates of decrease in visits were in March 2020, which corresponded with national public health messaging about COVID-19. The annual ED volume before the COVID-19 pandemic ranged from 13 000 to 115 000 visits per year the decrease in ED visits ranged from 41.5% in Colorado to 63.5% in New York. Main Outcomes and Measures Daily counts of ED visits, hospital admissions, and COVID-19 cases. Objective To examine trends in emergency department (ED) visits and visits that led to hospitalizations covering a 4-month period leading up to and during the COVID-19 outbreak in the US.ĭesign, Setting, and Participants This retrospective, observational, cross-sectional study of 24 EDs in 5 large health care systems in Colorado (n = 4), Connecticut (n = 5), Massachusetts (n = 5), New York (n = 5), and North Carolina (n = 5) examined daily ED visit and hospital admission rates from January 1 to April 30, 2020, in relation to national and the 5 states’ COVID-19 case counts.Įxposures Time (day) as a continuous variable. Importance As coronavirus disease 2019 (COVID-19) spread throughout the US in the early months of 2020, acute care delivery changed to accommodate an influx of patients with a highly contagious infection about which little was known.
Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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