Emergency department doctors ask: 'Where did all the patients go?'


Date:
December 1, 2020
Source:
Massachusetts General Hospital
Summary:
Despite a surge in COVID-19 cases, emergency department visits
declined by nearly a third in five Boston-area hospitals during
the early days of the pandemic.



FULL STORY ========================================================================== During the early days of the COVID-19 pandemic in New England, emergency department visits for medical emergencies -- including psychiatric
problems, trauma and heart attacks -- declined by nearly a third, raising concerns among clinicians that critically ill patients were not seeking
the care they needed for fear of coronavirus infection.


========================================================================== Comparing emergency department (ED) visits in two major urban hospitals
and three community hospitals in the Mass General Brigham system for
the months of March and April 2020 with the same period in 2019, Joshua
J. Baugh, MD, MPP, Sayon Dutta, MD, MPH, and colleagues in the Department
of Emergency Medicine at Massachusetts General Hospital (MGH) found that
ED volumes -- the total number of patients treated -- declined by 30.9%
from one year to the next.

"Our health system experienced decreases in nearly all non-COVID-19
conditions presenting to EDs during the initial phase of the pandemic, including those requiring specialty consultation and urgent inpatient procedures. Findings have implications for both public health and health
system planning," Baugh and colleagues wrote in a study in the American
Journal of Emergency Medicine.

"While more people with less serious conditions may have stayed away from
the emergency department, many cases that we would not have expected to decrease went down as well," Baugh says. "For example, people requiring catheterization of their hearts for potential heart emergencies, people requiring appendectomies for appendicitis, people requiring consultation
for an acute psychiatric episode -- across the board we saw that patients
with other conditions weren't coming in at the rate that they usually do."
As was widely reported at the time, some patients who might otherwise
have sought care for non-emergency conditions opted not to go to a
hospital out of fear of contracting COVID-19 during the first surge of
the pandemic, and some may have sought care at primary care practices
or urgent care clinics.

"Some of the changes we saw may have been attributable to reductions
in risk from lockdowns, people driving less, and being outside less,
but we don't think that lifestyle changes adequately account for the
full effect that we saw," says Baugh.

"Obviously, we saw many more patients with COVID-19 who otherwise
wouldn't have been there," Dutta adds, "and a lot of the resources
that those patients needed were available because those other patients
did not show up. So this expectation that COVID-19 would add to the
overall hospital volume or emergency department volume didn't turn out
to be true." The retrospective study included data on all ED patients
at five hospitals in the Mass General Brigham health system (formerly
Partners HealthCare). The hospitals included MGH and Brigham and Women's Hospital, both Harvard- affiliated quaternary-care referral hospitals
with designated centers of excellence for emergency care of patients
with trauma, heart attacks and strokes. The three other hospitals
are community-based centers that included one that is a designated
level-three trauma center, heart attack center and stroke center, and
two others that are designated stroke centers.

The investigators drew on electronic health records for data on patient demographics, Emergency Severity Index, primary diagnosis in the ED,
bedside procedures performed, subspecialty consultations requested,
and related procedures occurring during each patient's hospital stay.

Other co-authors are Benjamin A. White, MD, Brian J. Yun, MD, MBA, MPH,
David F.M. Brown, MD, and Ali S. Raja, MD, MBA, MPH, all from MGH and
Harvard Medical School; and Dustin McEvoy from Mass General Brigham
Clinical Informatics.


========================================================================== Story Source: Materials provided by Massachusetts_General_Hospital. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Joshua J. Baugh, Benjamin A. White, Dustin McEvoy, Brian J. Yun,
David
F.M. Brown, Ali S. Raja, Sayon Dutta. The cases not seen: Patterns
of emergency department visits and procedures in the era of
COVID-19. The American Journal of Emergency Medicine, 2020; DOI:
10.1016/ j.ajem.2020.10.081 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/12/201201091836.htm

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