- Hospital emergency department visits dropped precipitously during the first weeks of the onset of the COVID-19 pandemic in the United States. Visit rates fell between 41.5% and 63.5% across the hospitals studied, according to research published Monday in JAMA Internal Medicine.
- Meanwhile, hospital admission rates from the ED rose as much as nearly 150% at one facility, according to the study of emergency visit rates and admissions data from five large healthcare systems in five states — Colorado, Connecticut, Massachusetts, New York and North Carolina.
- A JAMA editor suggested those who regularly use the hospital ED as a medical safety net are likely staying away for now. As a result, the changes in ED use caused by the pandemic are "likely to further exacerbate racial/ethnic and socioeconomic level health disparities in the U.S. They also make more apparent the need for universal health insurance coverage."
While media coverage of the pandemic has focused on overwhelmed hospital workers on the front lines, less attention has been paid to some hospital emergency departments seeing far fewer patients as many avoid the risk of exposure to the novel coronavirus.
Earlier research has shown emergency visits lagged behind recovery of other types as hospitals recapture volume put off when elective procedures were halted in the first weeks of COVID-19 outbreaks in the U.S.
For the new study, researchers with the Mayo Clinic, Yale University, Yale New Haven Health System and several other institutions pored over ED and hospital admission records from 24 hospitals within five major hospital systems throughout the country. Those systems, which included major providers such as Mount Sinai Health in New York, Baystate Health in Massachusetts and Yale-New Haven in Connecticut, saw annual ED visits of between 13,000 and 115,000 patients per year under normal circumstances.
Typical ED and admissions data was compared from Jan. 1 of this year, to April 30. By mid-March, as COVID-19 began to take hold in the U.S., ED visits dropped dramatically. For example, while ED visits dropped by 63.5% at Mount Sinai Health, admissions of patients from the ED rose 149%; nearly 52% at Baystate and between 22% and 36.2% in the other systems studied.
As a result of the drop in ED visits and rise in admissions from those visits, the study's authors concluded that "public health authorities and healthcare systems should provide guidance and resources to help patients determine the best place to receive care as the available healthcare capacity changes during the pandemic."
A commentary accompanying the study authored by David Schriger, an associate JAMA editor and a member of the faculty of the emergency medicine department at UCLA School of Medicine, said the study should be considered a starting point about how patients should seek care if they are feeling unwell.
Schriger observed that "many hospitals and clinics rapidly instituted better access to practitioners and care coordinators via the telephone or telemedicine, providing patients with alternatives." However, he also suggested that many low-income people who have no other provider to turn to other than the hospital ED are forgoing care — requiring a deeper discussion of healthcare inequities in the U.S.