Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US

Abstract

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.

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.

Design, 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.

Exposures: Time (day) as a continuous variable.

Main outcomes and measures: Daily counts of ED visits, hospital admissions, and COVID-19 cases.

Results: A total of 24 EDs were studied. 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. 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. 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.

Conclusions 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. 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.

Figure 1.. Daily Emergency Department (ED) Visits and Admissions to the Mount Sinai Health System from January 1 through April 30, 2020

A, Emergency department visit counts in 5 EDs in New York and US coronavirus disease 2019 (COVID-19) cases (plotted on a log scale) are shown. B, Hospital admission rates from the ED and New York’s new daily confirmed COVID-19 cases per 1 million population are shown. New York data are plotted separately to avoid obscuring trends in states with lower daily ED visit counts.

Figure 2.. Daily Emergency Department (ED) Visits in 4 Health Systems in 4 States from January 1 through April 30, 2020

Emergency department visit counts in 19 EDs in 4 states and US coronavirus disease 2019 cases (plotted on a log scale) are shown. Circles indicate specific daily values for each variable. UCHealth indicates University of Colorado Health; UNC, University of North Carolina.

Figure 3.. Daily Emergency Department (ED) Hospitalizations in 4 Health Systems in 4 States from January 1 through April 30, 2020

Hospital admission rates from the ED in 4 states and each state’s new daily confirmed coronavirus disease 2019 cases per 1 million population are shown. Circles indicate specific daily values for each variable. UCHealth indicates University of Colorado Health; UNC, University of North Carolina.