Threat of COVID-19 impacting on a quaternary healthcare service: a retrospective cohort study of administrative data

Abstract

Objectives: The threat of a pandemic, over and above the disease itself, may have significant and broad effects on a healthcare system. We aimed to describe the impact of the SARS-CoV-2 pandemic (during a relatively low transmission period) and associated societal restrictions on presentations, admissions and outpatient visits.

Design: We compared hospital activity in 2020 with the preceding 5 years, 2015-2019, using a retrospective cohort study design.

Setting: Quaternary hospital in Melbourne, Australia.

Participants: Emergency department presentations, hospital admissions and outpatient visits from 1 January 2015 to 30 June 2020, n=896 934 episodes of care.

Intervention: In Australia, the initial peak COVID-19 phase was March-April.

Primary and secondary outcome measures: Separate linear regression models were fitted to estimate the impact of the pandemic on the number, type and severity of emergency presentations, hospital admissions and outpatient visits.

Results: During the peak COVID-19 phase (March and April 2020), there were marked reductions in emergency presentations (10 389 observed vs 14 678 expected; 29% reduction; p<0.05) and hospital admissions (5972 observed vs 8368 expected; 28% reduction; p<0.05). Stroke (114 observed vs 177 expected; 35% reduction; p<0.05) and trauma (1336 observed vs 1764 expected; 24% reduction; p<0.05) presentations decreased; acute myocardial infarctions were unchanged. There was an increase in the proportion of hospital admissions requiring intensive care (7.0% observed vs 6.0% expected; p<0.05) or resulting in death (2.2% observed vs 1.5% expected; p<0.05). Outpatient attendances remained similar (30 267 observed vs 31 980 expected; 5% reduction; not significant) but telephone/telehealth consultations increased from 2.5% to 45% (p<0.05) of total consultations.

Conclusions: Although case numbers of COVID-19 were relatively low in Australia during the first 6 months of 2020, the impact on hospital activity was profound.

Keywords: COVID-19; health services administration & management; public health.

Figure 1

Weekly number of positive COVID-19 cases in VIC and treated at the RMH and the corresponding changes in number of ED presentations (A), hospital admissions (B) and outpatient appointments (C) from 1 January to 30 June 2020. Complete hospital admission data are available till 30 May 2020. ED, emergency department; RMH, Royal Melbourne Hospital; VIC, Victoria.

Figure 2

Time series of the monthly number of presentations to emergency, inpatient admissions and outpatient appointments to the Royal Melbourne Hospital from January 2015 to June 2020. The solid line shows the actual numbers recorded for the month, while the hashed line indicates the predicted numbers based on the underlying trend. Year-by-year trend shows the case loads are increasing, except in 2020, where in March and April the numbers decreased dramatically and deviate from the predicted line.