The following is a summary of “Cross-sectional analysis of avoidable emergency department visits before and during the COVID-19 pandemic,” published in the April 2023 issue of Emergency Medicine by Gottlieb, et al.

Emergency departments (ED) were significantly impacted by COVID-19, with preliminary statistics indicating a decrease in unnecessary ED visits. Uncertainty surrounds the long-term impact. To assess the differences in ED visit categories, including total, avoidable, and unavoidable visits, researchers analyzed ED discharges across a two-year time period following the start of the COVID-19 pandemic and compared it with a control time period before the pandemic.

Using data from two hospitals within a health system over a three-year period (1/1/2019-12/31/2021), the retrospective, cross-sectional study evaluated the distribution of visits with ED discharges. The enlarged NYU-EDA algorithm was adjusted to classify visits that were associated with COVID-19. Included were the categories of Emergent – Not Preventable/Avoidable, Emergent – Preventable/Avoidable, Emergent – Primary Care Treatable, Non-Emergent, Mental Health, Alcohol, Drug Abuse, Injuries, and COVID-19. As well as post hoc testing using Fisher’s exact tests with Bonferroni correction, chi-square testing, and ED visit category comparisons were done for the period before COVID-19 (1/1/2019-12/31/2019), the initial and delayed COVID-19 time frames (1/1/2020-12/31/2020), and the ED visit categories (1/1/2021-12/31/2021). Differences based on the daily census for each ED visit category were assessed using an ANOVA with post hoc Bonferroni testing.

Throughout the three years, 228,010 ED discharges (Hospital #1 = 126,858; Hospital #2 = 101,152) matched the inclusion criteria. The distribution of the NYU-EDA categories for the combined hospitals (P< 0.001), Hospital #1 (P< 0.001), and Hospital #2 (P< 0.001) significantly differed between the two time periods (pre-COVID-19 versus during COVID-19). Except for “Emergent – Not Preventable/Avoidable,” which stayed unchanged, and “Substance Abuse,” which climbed, all categories of daily ED discharges showed a reduction from 2019 to 2020. No variations in ED avoidable visits were seen between 2020 and 2021. Nonetheless, there were decreases in “COVID-19” and increases in discharged visits for “Injuries,” “Alcohol,” and “Mental health.”

The study identified a sustained decline in discharged avoidable ED visits during the two years following the start of the COVID-19 pandemic, which was partially offset by the increase in COVID-19 visits. The findings could be used to inform ED and healthcare systems in resource allocation, hospital staffing, and financial planning during future COVID-19 resurgences and pandemics.

Source: sciencedirect.com/science/article/pii/S0735675723000475