Emergency department visits plummeted during the Covid-19 pandemic, and new research now shows that the patients who did come to the ED for care were sicker and more likely to be hospitalized.
Researchers from the Epic Health Research Network analyzed weekly ED visit volume from Jan. 1, 2017, to Dec. 12, 2020. Gathered from 31 healthcare organizations, the data set also included patients who had either been discharged or had died by Jan. 10, 2021.
The steepest decline in ED visit volume occurred between March and May last year, with visits dropping as low as 50% of predicted volume. Though visit volumes rebounded a little over the summer, they remained approximately 30% lower than predicted volume through the second half of 2020.
This was the most surprising finding for the researchers because “hospital admissions and cancer screenings returned to near-normal levels after a few months,” said Dr. Christopher Alban, vice president of clinical informatics at Epic Systems, in an email. “[But] ED visits are still down by a third almost a full year into the pandemic.”
Further, the patients coming into the ED were more likely to be hospitalized, the research shows.
Prior to March 2020, an average of 12% to 13% of ED patients were admitted for inpatient care. The hospital admission rate from ED visits spiked to 19% by last April, which is 55% above the predicted rate, according to the report.
In the second half of the year, the inpatient admission rate from the ED stabilized at around 15% to 16%. These figures were still 20% to 30% higher than predicted for that time of the year.
Researchers then focused on the conditions people were coming to the ED with. They narrowed their analysis to ED visits with diagnoses of stroke and heart attacks to get a sense of higher acuity conditions, and visits with diagnoses of dermatitis and conjunctivitis, which served as examples of lower acuity conditions.
Early on in the pandemic, the number of ED visits dropped 77% below the predicted volume for heart attacks and 73% for stroke, the report states. By the summer, ED visits for heart attacks and stroke were increasing and reaching normal levels once again.
But inpatient admissions from the ED for strokes and heart attacks increased during the pandemic, from 79% and 83%, respectively, pre-pandemic to 83% and 89% last April.
Similarly, ED visits for dermatitis and conjunctivitis dropped as low as 34% and 19% of predicted volumes, respectively. Visits are now approximately 50% of predicted volumes for dermatitis and 25% for conjunctivitis.
Inpatient admissions from the ED for these conditions soared, from average rates of 6% for conjunctivitis and 15% for dermatitis pre-pandemic to 16% and 27%, respectively, in April 2020.
“This suggests that, regardless of diagnosis, the average presentation of these problems to the ED during the pandemic was more severe (i.e., more likely to result in admission),” the researchers wrote in the report.
The reason for this may be that people with milder cases of the above conditions were avoiding the ED and instead, seeking care at non-emergency facilities or delaying treatment, they wrote.
Looking ahead to 2021, clinicians should expect patients coming to the ED to have higher severity conditions and require more resource-intensive care than normal, Epic’s Alban said. But the lower overall ED volumes may allow providers to allocate more time to each patient than they could pre-pandemic.
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