Experts suggest encouraging patients to visit ED for serious, non-Covid-related illnesses that cannot be managed elsewhere

Emergency department (ED) visits declined considerably in the early phases of the Covid-19 pandemic—and as a result, according to authors of a recent study, clinicians should make a concerted effort to encourage patients to visit the ED for serious illnesses and other conditions when needed, despite the ongoing pandemic.

“As the Covid-19 pandemic developed and intensified in the U.S. during the first 4 months of 2020, we found that ED visit counts decreased and the rates of hospital admissions from the ED increased in 5 health care systems in 5 states,” wrote study first author Molly Jeffery, PhD, of the emergency medicine department at the Mayo Clinic in Minnesota, and colleagues, in JAMA Internal Medicine. “From their height in January to their lowest point in April, ED visits decreased by more than 40% in all the health care systems and by more than 60% in New York, where the pandemic was most severe.”

In the pandemic’s infancy, experts recommended hospitals and patients reduce non-essential care to reduce transmission of the virus. Previous reports had shown evidence of declines, with reductions potentially spurred by patients failing to seek emergency care even under life-threatening (and non-Covid-related) circumstances.

The cross-sectional study from Jeffery and colleagues examined daily ED visit and hospitalization rates from January 1 to April 30. The data were gathered from 24 EDs in 5 large health care systems in Colorado (n=4), Connecticut (n=5), Massachusetts (n=5), New York (n=5), and North Carolina (n=5). Before the pandemic, average annual ED volume ranged from 13,000 to 115,000 visits per year.

Jeffery and colleagues unearthed major ED decreases across all 5 systems, with steeper declines beginning the week of March 11—a week when Covid-19 cases accelerated considerably around the country. In descending order, rates of decrease in ED use among systems in the study were 63.5% in New York, 57.4% in Massachusetts, 48.9% in Connecticut, 46.5% in North Carolina, and 41.5% in Colorado.

What’s more, rates of hospital admission from the ED held steady until local Covid-19 case rates began to climb, with admission rates increasing by 149% in New York, 51.7% in Massachusetts, 36.2% in Connecticut, 29.4% in Colorado, and 22% in North Carolina.

Although the study covered January and February—a time before the coronavirus spiked in earnest in the United States—the biggest ED declines in the study clearly occurred after Covid-19 gained higher levels of local, national, and global prominence.

“The weeks with the most rapid rates of decrease in visits were in March 2020, which corresponded with national public health messaging about Covid-19,” Jeffery and colleagues observed. “Rates of hospital admission from the ED were stable until Covid-19 cases increased locally, suggesting lower patient volume and higher acuity in the ED as the Covid-19 pandemic spread…A possible explanation for these temporal associations is that the public responded more to national-level risk messaging about Covid-19 than to changes in the local situation with regard to reported cases.”

According to Jeffery and colleagues, limitations in the study included the fact that the findings may not be generalizable outside the health care systems included in the study, and that the data did not capture diagnoses.

In an accompanying editorial, David Schriger, MD, MPH, an emergency physician with University of California, Los Angeles and associate editor of JAMA, but who was not affiliated with the study, wrote that a decrease in ED visits may be the result of not only a change in patient perceptions but a rapid expansion and acceptance of alternate options in anticipation of a potential crush of Covid-19 patients in the ED.

“Even if some sicker patients are not presenting to the ED, this does not mean that they are forgoing medical care altogether,” Schriger wrote. “Many hospitals and clinics rapidly instituted better access to practitioners and care coordinators via the telephone or telemedicine, providing patients with alternatives.”

Moving forward, Jeffery and colleagues said physicians and care teams should make a concerted effort to ensure patients felt comfortable seeking emergency care when necessary.

“These findings suggest that practitioners and public health officials should emphasize the importance of visiting the ED during the Covid-19 pandemic for serious symptoms, illnesses, and injuries that cannot be managed in other settings,” the study authors wrote.

Schriger suggested the pandemic might ultimately provide a “silver lining” for learning more about ED use patterns and care delivery as a whole.

“At a time of great social discord in the U.S. and when funding priorities for various government functions are being rethought, a potential silver lining of the Covid-19 pandemic is the opportunity to consider how health care resources could be better used, particularly with respect to emergency care,” Schriger wrote. “What might we learn from the patients who avoided or deferred ED care and who did not have a condition thought to benefit unambiguously from that care?”

  1. Emergency department visits declined substantially at five U.S. health systems as the Covid-19 pandemic gained national prominence.
  2. Findings suggest that patients should be counseled to still seek emergency care for serious symptoms, illnesses, and injuries that cannot be managed elsewhere.

Scott Harris, Contributing Writer, BreakingMED™

No source appearing in this report disclosed any relevant financial relationship with industry.

 

Cat ID: 254

Topic ID: 253,254,254,930,730,933,190,926,192,927,151,928,925,934