key: cord-0939718-clvwkxoj
authors: Feldman, Nicola; Lane, Rikki; Iavicoli, Laura; Delgado, Veronica; Fairweather, Phillip; Kessler, Stuart; Bentley, Suzanne
title: A snapshot of emergency department volumes in the “epicenter of the epicenter” of the COVID-19 pandemic
date: 2020-08-22
journal: Am J Emerg Med
DOI: 10.1016/j.ajem.2020.08.057
sha: 872aab3e3be1f1bdd05827628d356e0e26420b08
doc_id: 939718
cord_uid: clvwkxoj

• Elmhurst, COVID-19 “epicenter,” experienced surge in emergency department volumes. • Emergency department volumes reached unprecedented lows as pandemic spread. • High admission rates suggest elevated symptom severity in presenting patients.

March 18, a COVID-19 testing tent was placed at the entrance to the ED, and patients arriving at the hospital self-selected to either the ED or the testing tent. Beginning March 19, an ED provider was placed at the ED entrance to evaluate each incoming patient, triaging some to the ED and some to an alternate location for testing and/or treatment after a medical screening exam.

This strategy may prove useful in other locations as a way of mitigating surging ED volumes.

The striking decrease in [hospital] ED volumes then observed during April and May mirrors the trend seen throughout the country (2) . Stay-at-home orders limiting accidents and the spread of disease likely resulted in the decreased presentations of superficial injuries and mild viral infections that have been recorded (2), but interviews suggest that public fear of contracting COVID-19 by going to the hospital played a role as well (3) . Patients have reported delaying seeking care due to fear of COVID-19, even as they experienced concerning symptoms such as prolonged convulsions or acute cardiac symptoms (4, 5) ; bearing out these accounts, studies have reported elevated symptom-to-door times among patients with time-sensitive cardiac conditions (6, 7) .

Such delayed care seeking may be resulting in clinicians' perception that patients continuing to arrive in the ED during the pandemic are more critically ill than usual, a perception supported by our data. Assuming ED clinicians did not significantly change their standards for admission, the elevated admission rates from late March through late May 2020 suggest that patients who presented to the [hospital] ED during this time were generally more severely ill as J o u r n a l P r e -p r o o f compared to 2019. Decreased presentations of minor illnesses, severe complications of COVID-19 infection, and delayed care seeking for early or mild symptoms of serious conditions, causing progression to more critical symptoms, may together account for this increased acuity.

This perception of the hospital as a dangerous place during the pandemic must be addressed to encourage patients to seek care appropriately. Moreover, EDs must prepare for surges in volumes as the COVID-19 pandemic spreads. We hope others can apply these lessons learned early at [hospital] .

Impact of the COVID-19 pandemic on emergency department visits -United States

Where are all the patients? Addressing COVID-19 fear to encourage sick patients to seek emergency care. NEJM Catalyst

Delayed access or provision of care in Italy resulting from fear of COVID-19

Declines in acute cardiovascular emergencies during the COVID-19 pandemic

Impact of coronavirus disease 2019 (COVID-19) outbreak on ST-Segment-Elevation Myocardial Infarction care in Hong Kong, China

Acute Coronary Syndromes undergoing percutaneous coronary intervention in the COVID-19 era: comparable case volumes but delayed symptom onset to hospital presentation

None.