The impact of the COVID-19 pandemic on patterns of attendance at emergency departments in two large London hospitals: an observational study
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Published version
Author(s)
Type
Journal Article
Abstract
Background Hospitals in England have undergone considerable change to address the surge
in demand imposed by the COVID-19 pandemic. The impact of this on emergency
department (ED) attendances is unknown, especially for non-COVID-19 related emergencies.
Methods This analysis is an observational study of ED attendances at the Imperial College
Healthcare NHS Trust (ICHNT). We calibrated auto-regressive integrated moving average
time-series models of ED attendances using historic (2015-2019) data. Forecasted trends
were compared to present year ICHNT data for the period between March 12, 2020 (when
England implemented the first COVID-19 public health measure) and May 31, 2020. We
compared ICHTN trends with publicly available regional and national data. Lastly, we
compared hospital admissions made via the ED and in-hospital mortality at ICHNT during
the present year to the historic 5-year average.
Results ED attendances at ICHNT decreased by 35% during the period after the first
lockdown was imposed on March 12, 2020 and before May 31, 2020, reflecting broader
trends seen for ED attendances across all England regions, which fell by approximately 50%
for the same time frame. For ICHNT, the decrease in attendances was mainly amongst those
aged <65 years and those arriving by their own means (e.g. personal or public transport) and
not correlated with any of the spatial dependencies analysed such as increasing distance from
postcode of residence to the hospital. Emergency admissions of patients without COVID-19
after March 12, 2020 fell by 48%; we did not observe a significant change to the crude
mortality risk in patients without COVID-19 (RR 1.13, 95%CI 0.94-1.37, p=0.19).
Conclusions Our study findings reflect broader trends seen across England and give an
indication how emergency healthcare seeking has drastically changed. At ICHNT, we find
that a larger proportion arrived by ambulance and that hospitalisation outcomes of patients
without COVID-19 did not differ from previous years. The extent to which these findings relate to ED avoidance behaviours compared to having sought alternative emergency health
services outside of hospital remains unknown. National analyses and strategies to streamline
emergency services in England going forward are urgently needed.
Keywords: COVID-19, emergency department, accident, and emergency
in demand imposed by the COVID-19 pandemic. The impact of this on emergency
department (ED) attendances is unknown, especially for non-COVID-19 related emergencies.
Methods This analysis is an observational study of ED attendances at the Imperial College
Healthcare NHS Trust (ICHNT). We calibrated auto-regressive integrated moving average
time-series models of ED attendances using historic (2015-2019) data. Forecasted trends
were compared to present year ICHNT data for the period between March 12, 2020 (when
England implemented the first COVID-19 public health measure) and May 31, 2020. We
compared ICHTN trends with publicly available regional and national data. Lastly, we
compared hospital admissions made via the ED and in-hospital mortality at ICHNT during
the present year to the historic 5-year average.
Results ED attendances at ICHNT decreased by 35% during the period after the first
lockdown was imposed on March 12, 2020 and before May 31, 2020, reflecting broader
trends seen for ED attendances across all England regions, which fell by approximately 50%
for the same time frame. For ICHNT, the decrease in attendances was mainly amongst those
aged <65 years and those arriving by their own means (e.g. personal or public transport) and
not correlated with any of the spatial dependencies analysed such as increasing distance from
postcode of residence to the hospital. Emergency admissions of patients without COVID-19
after March 12, 2020 fell by 48%; we did not observe a significant change to the crude
mortality risk in patients without COVID-19 (RR 1.13, 95%CI 0.94-1.37, p=0.19).
Conclusions Our study findings reflect broader trends seen across England and give an
indication how emergency healthcare seeking has drastically changed. At ICHNT, we find
that a larger proportion arrived by ambulance and that hospitalisation outcomes of patients
without COVID-19 did not differ from previous years. The extent to which these findings relate to ED avoidance behaviours compared to having sought alternative emergency health
services outside of hospital remains unknown. National analyses and strategies to streamline
emergency services in England going forward are urgently needed.
Keywords: COVID-19, emergency department, accident, and emergency
Date Issued
2021-09-23
Date Acceptance
2021-09-09
Citation
BMC Health Services Research, 2021, 21 (1008), pp.1-9
ISSN
1472-6963
Publisher
BioMed Central
Start Page
1
End Page
9
Journal / Book Title
BMC Health Services Research
Volume
21
Issue
1008
Copyright Statement
© The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
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data made available in this article, unless otherwise stated in a credit line to the data.
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if
changes were made. The images or other third party material in this article are included in the article's Creative Commons
licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons
licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the
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License URL
Sponsor
Medical Research Council (MRC)
National Institute for Health Research
Engineering & Physical Science Research Council (EPSRC)
Abdul Latif Jameel Foundation
Medical Research Council (MRC)
National Institute for Health Research
UK Research and Innovation
Wellcome Trust
Identifier
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-07008-9
Grant Number
MR/R015600/1
NIHR200908
EP/V002910/1
EP/V520354/1
RP-2016-07-012
9815274 MC_PC_19025
Subjects
Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
COVID-19
Emergency department
Accident
And emergency
Accident
And emergency
COVID-19
Emergency department
COVID-19
Communicable Disease Control
Emergency Service, Hospital
Hospitals
Humans
London
Pandemics
Retrospective Studies
SARS-CoV-2
Humans
Retrospective Studies
Communicable Disease Control
Emergency Service, Hospital
Hospitals
London
Pandemics
COVID-19
SARS-CoV-2
0807 Library and Information Studies
1110 Nursing
1117 Public Health and Health Services
Health Policy & Services
Publication Status
Published
Date Publish Online
2021-09-23