Vanishing visitors

Hospitals around the United States have been seriously disrupted by COVID-19. One example is the reduction of total hospital visits, where the pandemic led hospitals to postpone or cancel many elective medical procedures and surgeries. Additionally, visits to hospital emergency departments (EDs) decreased across the country, especially between February and April. However, not much is known about the characteristics of patients that reduced ED visits, such as whether urgent or non-urgent cases drove the decline.

A new study published in the American Journal of Emergency Medicine set out to gain a clearer view of the decrease in ED visits in 2020. In this study, recent doctoral graduate from the Texas A&M University School of Public Health Theodoros Giannouchos, PhD, along with Benjamin Ukert, PhD, and Elena Andreyeva, PhD, assistant professors in the Department of Health Policy and Management at the School of Public Health, as well as colleagues from the University of Utah, analyzed data on outpatient ED visits at a hospital in Salt Lake City, Utah. They looked at the diagnoses of patients who were treated and immediately released (discharged within the same day) and compared the trend of visits for patients between January and August of 2019 to the same period in 2020.

Because of legal mandates to treat all patients regardless of ability to pay, EDs are one of the few health care options available for many people. Because of this, not all people visiting an ED are experiencing an emergency. Hospital EDs see a mixture of urgent cases such as suspected heart attacks, serious but preventable cases such as dehydration or asthma attacks, cases that are treatable in a primary care setting such as severe abdominal pain, and non-urgent cases that do not need care within 12 hours such as headaches and low back pain. Researchers used a specialized algorithm to separate patient diagnoses into these categories and then analyzed patient data in three COVID-19 periods: January to March, April, and May to August.

Giannouchos and colleagues found an overall decrease in ED visits of around 8 percent in 2020 compared to 2019, and the largest decrease in cases occurred in preventable or avoidable cases. Visit volumes were higher in the first two months of 2020 than the same period in 2019 but showed a notable lower volume by the last week in March. Visits were relatively flat, but lower, in April and started to increase in May, but the overall total visits in 2020 were still lower than in the previous year. However, although visits for most diagnoses dropped in March and April, visits for urgent lower respiratory complaints increased dramatically during the early COVID-19 months. The hospital also saw notable drops in out-of-state patients.

The analysis showed that the decrease in ED visits was consistent with other recent reports on lower ED visits in early 2020. Additionally, visits for urgent needs were relatively stable during the pandemic. The researchers note that because the decline was largely driven by less urgent matters, patients seem to be able to determine how serious their medical needs are. This points to the potential opportunity to reduce ED use by people with less serious conditions after the COVID-19 pandemic; however, many lack other health care options. Because of this, the researchers note the importance of efforts to improve primary care capacity, increase insurance coverage and further develop telemedicine capabilities. Such efforts have the potential to give patients better care while reducing the burden on EDs.

Although this study focused on data from only one hospital, further research into the behavior of ED patients during the pandemic could help health care providers deliver better care to patients by building new care options. Changes could improve patient outcomes, improve ED efficiency and effectiveness and reduce disruptions to hospitals due to pandemics or other emergencies in the future.