Decreased ED visits and increased rates of hospital admissions in early months of COVID-19

1. A decrease in emergency department visits occurred across five major U.S. healthcare systems in the first four months of COVID-19.

2. An increase in hospital admissions occurred during the early months of COVID-19 across sites.

3. Hospital admission rates were temporally associated with state-level COVID-19 case rates.

Evidence Rating Level: 2 (Good)

Study Rundown: As COVID-19 began to be transmitted in the U.S., messages were delivered to the public that suggested minimizing unnecessary healthcare visits. Much of this was due to the lack of knowledge surrounding this novel contagion and erring on the side of caution. This resulted in people reconsidering elective procedures and not seeking care even in more serious circumstances. The trends in emergency department (ED) visits and hospital admissions could shed some light on how patients navigated public health messages and how healthcare professionals managed presentations during the first four months of the COVID-19 pandemic within the U.S.

This retrospective, observational, cross-sectional study of 24 EDs across health care systems in Colorado, Connecticut, Massachusetts, New York, and North Carolina examined trends in visits and admissions between January 1 to April 30. There was an increase in hospital admission rates and a decrease in ED visits within 5 health care systems, suggesting lower overall volume but higher acuity, possibly owing to delay in seeking medical care. Given these trends, it is important for public health officials to ensure that the general public understands the importance of visiting hospitals when they are experiencing serious symptoms that should not go untreated.

Click to read the study in JAMA Internal Medicine

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In-Depth [cross-sectional study]:

This retrospective, observational, cross-sectional study focused on ED visits and hospital admissions between January 1, 2020 and April 30, 2020. This included 24 emergency departments across 5 health care systems: Colorado (n = 4), Connecticut (n = 5), Massachusetts (n = 5), New York (n = 5), North Carolina (n = 5). A total of 15 EDs were urban, 5 suburban, and 4 rural. Annual ED visits across these sites prior to COVID-19 were between 13,000 and 115,000.

A significant decrease in ED visits was found in Colorado (41.5%), North Carolina (46.5%), Connecticut (48.9%), Massachusetts (57.4%), and New York (63.5%). March 2020 appeared to be the time with the most rapid declines in hospital visits, temporally associated with national public health messaging. Admission rates from EDs were generally stable until case rates increased in the respective city. Relative increases in admission rates were 149.0% in New York, 51.7% in Massachusetts, 36.2% in Connecticut, 24.9% in Colorado, and 22.0% in North Carolina.

The noted trends were associated with state-level COVID-19 case rates, such that an increase in case rate resulted in a decrease in ED visits and an increase in admissions from the EDs. While this study cannot determine the root cause of these trends, public health messaging may have played a role in decision-making on the parts of individuals choosing against ED visits during the early months of COVID-19. Should this be the case, it will be important for officials to ensure that the general public realizes the importance of seeking care when symptoms arise.

Image: PD

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