key: cord-0790008-v05zuuo1
authors: Butt, Adeel A.; Azad, Aftab; Kartha, Anand; Masoodi, Naseer; Bertollini, Roberto; Abou-Samra, Abdul-Badi
title: Volume and Acuity of Emergency Department Visits Before and After COVID-19
date: 2020-08-07
journal: J Emerg Med
DOI: 10.1016/j.jemermed.2020.08.013
sha: 86649fb75b4d7a78b63ed2678a61302a5d723c4c
doc_id: 790008
cord_uid: v05zuuo1

Abstract Background There are scant data regarding the change in volume and acuity of patients presenting to Emergency Departments (ED) after COVID-19 compared with the pre-COVID-19 era. Objective To determine ED volumes and triage acuity before and after COVID-19. Methods We determined the volume of patients presenting to four large EDs affiliated with a general, cardiac, cancer and obstetrics hospitals, and the acuity of presenting illness (using the Canadian Triage Acuity Scale, CTAS) for March and April 2020 and compared them with the same months in 2019 and January 2020. Together, these facilities see over 80% of the ED visits in Qatar. First COVID-19 patient in Qatar was diagnosed on February 29, 2020. Results A total of 192,157 ED visits were recorded during the study period. There was a 20%-43% overall drop in ED visits with significant variability across hospitals. The Heart Hospital experienced the sharpest decline (33-89%) while the National Center for Cancer Care and Research experienced the least decline in volumes. The decline was observed across all CTAS levels, with the largest decline observed in individuals presenting with CTAS 1 and 2 (26-69% decline month-on-month). No increase in overall number of deaths or crude morality rate were observed in the COVID-19 era according to national statistics. Conclusions Sharp declines in ED visits and the triage acuity seen in both general and specialty hospitals raise the concern that severely ill patients may not be seeking timely care, and a surge may be expected once current restrictions on movement are lifted.

COVID-19 pandemic has been associated with a decrease in acute care hospitalizations for 28 cardiovascular and other acute care conditions. 1, 2 There are scant data regarding the change in 29 volumes and triage acuity of patients presenting to the Emergency Departments (ED) before 30 and after COVID-19. A recent single center report at an urban hospital in the United States 31 reported a 35% decline in Emergency Department (ED) visits compared with the previous year. 3 

A reduction in volumes, particularly among those with severe acute conditions, may lead to a 33 higher rate of complications and higher mortality in the general population. 34 35 36

The study was conducted at Hamad Medical Corporation (HMC), the public The number of patients presenting to the all EDs and the triage acuity dropped sharply in the 137 COVID-19 era. These declines were observed in both general and specialty hospitals and raise 138 the concern that severely ill patients may not be seeking timely care, and a surge may be 139 expected once current restrictions on movement are lifted. It is imperative to determine whether 140 these declines are associated with an increase in long term overall mortality and rate of 141 complications in the general population. If confirmed, this requires interventions to identify and 142 provide appropriate care to these individuals. 143

1. Why is this topic important?

Understanding the impact of COVID-19 upon ED care is critical in planning and ensuring appropriate and timely care of patients with medical emergencies.

This study demonstrates the changes in volumes and severity of presenting complaints in the COVID-19 era compared with the per-COVID-19 era.

• A 20-40% drop in ED visits was observed in COVID-era compared with pre-COVID era • The decline was observed in EDs affiliated with all hospitals • Proportion of persons presenting with CTAS 1&2 also dropped sharply 4. How is patient care impacted?

• Drops in CTAS 1&2 suggests that severely ill patients are not seeking timely care CTAS, Canadian Triage and Acuity Scale. *Missing triage category represents those individuals who registered to be seen but were not evaluated, having left the Emergency Department before triage evaluation. CTAS, Canadian Triage and Acuity Scale. *Missing triage category represents those individuals who registered to be seen but were not evaluated, having left the Emergency Department before triage evaluation.

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