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

Abstract

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 hospital admissions through EDs, 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 twelve EDs in Massachusetts from 1/1/2019-9/9/2019, and 1/1/2020-9/8/2020. We analyzed the total arrivals and hospital admissions and calculated confidence intervals for the change in admissions for each characteristic. We then developed a Poisson regression model to estimate the relative contribution of each characteristic to the decrease in admissions after the statewide lockdown, corresponding to weeks 11 through 36 (3/11/2020-9/8/2020).

Results: We observed a 32% decrease in admissions during weeks 11 to 36 in 2020, 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 demonstrate decreased hospital admissions through EDs 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.

Keywords: COVID-19; Care deferment; Emergency department; Hospital admissions.

Fig. 1

(a) Arrivals by Week. The first 10 weeks of both years are relatively consistent. A steep downward trend is observed in week 11 through week 15, after which point this trend changes and arrivals start to slowly recover. There is a notable increase in arrivals due to COVID-19 starting in week 11; (b) Admissions by Week. The first 10 weeks of 2019 and 2020 only display natural variations in hospital admissions through EDs. However, a steep decline in admissions occurred in week 11, continuing through week 15. Although admissions began to recover after week 15, they remained 25% lower than the 2019 admissions. Meanwhile, COVID-19 admissions appeared in week 11 of 2020, peaked at week 16, and continued to decline afterwards.

Fig. 2

(a) Admissions by Insurance Coverage. Admissions for Medicare patients decreased significantly by 37% while admissions for self-pay patients decreased only 15%; (b) Admissions by Gender. Admissions dropped 35% for females compared to only 29% for males; (c) Admissions by Age Group. Pediatric admissions, especially infants, dropped significantly while the 55–64 age group had the smallest drop in admissions.

Fig. 3

Admissions Diagnosis. Asthma, COPD, and Heart Failure had the largest declines among the hospital admissions through EDs, while TBI, respiratory symptoms, and respiratory failure admissions actually increased. Notably, COVID-19 is the most common diagnosis in 2020.