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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Title: The impact of the COVID-19 pandemic on patterns of attendance at emergency departments in two large London hospitals: an observational study
Authors: Vollmer, MAC
Radhakrishnan, S
Kont, MD
Flaxman, S
Bhatt, SJ
Costelloe, C
Honeyford, K
Aylin, P
Cooke, G
Redhead, J
Sanders, A
Mangan, H
White, PJ
Ferguson, N
Hauck, K
Perez Guzman, PN
Nayagam, S
Item 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
Issue Date: 23-Sep-2021
Date of Acceptance: 9-Sep-2021
URI: http://hdl.handle.net/10044/1/91609
DOI: 10.1186/s12913-021-07008-9
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 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 data made available in this article, unless otherwise stated in a credit line to the data.
Sponsor/Funder: 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
Funder's Grant Number: MR/R015600/1
NIHR200908
EP/V002910/1
EP/V520354/1
RP-2016-07-012
9815274 MC_PC_19025
Keywords: 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
Online Publication Date: 2021-09-23
Appears in Collections:Department of Infectious Diseases
Faculty of Medicine
Institute of Global Health Innovation
Imperial College London COVID-19
School of Public Health



This item is licensed under a Creative Commons License Creative Commons