Impact of the COVID-19 pandemic on the unplanned patient flow in a Danish healthcare region, focusing on emergency departments: a multicentre cohort study

Abstract

Background: Understanding the impact of COVID-19 on the unplanned patient flow within hospitals is crucial for future preparedness planning and response strategies. We examined the impact of COVID-19 on the unplanned patient flow in a Danish healthcare region, with particular focus on emergency departments (EDs).

Methods: A descriptive multicentre cohort study was conducted comparing unplanned patient contacts during the first year of the COVID-19 pandemic (1 March 2020-28 February 2021) with the previous year (1 March 2019-29 February 2020). The study examined changes in patient flow and key flow variables-number of contacts, length of stay (LOS), triage, re-contacts, mortality, International Classification of Diseases (ICD)-10 codes, isolations and SARS-CoV-2-positive patients-and compared differences between five EDs in the Central Denmark Region.

Results: The overall number of unplanned patient contacts decreased 3.6% from the previous period (257 657) to the COVID-19 period (248 706). The decrease was lowest in EDs compared with other departments and was primarily detected during lockdowns, which were followed by months of increased ED contacts.Although overall patient contacts decreased, an increase in proportions was observed in contacts with a LOS <12 hours compared with the year prior to COVID-19 in both EDs (63.9%-64.2%) and other departments (36.0%-37.7%).Moreover, patients tended to be older, ED contacts triggered a higher triage level and an increase in ED re-contacts was observed. The ICD-10 pattern changed, with fewer contacts with injuries and diseases of the respiratory and digestive systems compared with the year before. Finally, one ED experienced a considerably higher number of SARS-CoV-2-positive patients at the start of the pandemic, reflecting infection fluctuations within the region.

Conclusion: Our results demonstrate changes in unplanned patient flow and patient characteristics in hospital contacts during the first year of the COVID-19 pandemic. These findings are relevant for national, regional and local healthcare agencies and policy makers to prepare for and respond to future pandemics and large-scale healthcare crises.

Keywords: COVID-19; Emergency Departments; Health & safety; Quality in health care.

Figure 1. Flowchart of the unplanned patient flow in the Central Denmark Region during the pre-COVID-19 period (1 March 2019–29 February 2020) and the COVID-19 period (1 March 2020–28 February 2021). ED, emergency department; * n=344 591 includes patients’ first visit in each period.

Figure 2. All unplanned contacts, unplanned contacts to EDs and unplanned contacts to other departments at the five acute hospitals in the Central Denmark Region during the pre-COVID-19 period (1 March 2019–29 February 2020) and the COVID-19 period (1 March 2020–28 February 2021). The major lockdown periods in Denmark were from 11 March to 15 April 2020 and from 16 December 2020 to 27 January 2021. ED, emergency department.

Figure 3. SARS-CoV-2-positive and isolated unplanned ED contacts per hospital in the Central Denmark Region during the COVID-19 period (1 March 2020–28 February 2021). The major lockdown periods in Denmark were from 11 March to 15 April 2020 and from 16 December 2020 to 27 January 2021. ED, emergency department.