Trends in outpatient emergency department visits during the COVID-19 pandemic at a large, urban, academic hospital system

Jeffery M.M., D’Onofrio G., Paek H., Platts-Mills T.F., Soares W.E., Hoppe J.A., Genes N., Nath B., Melnick E.R.

Importance As coronavirus disease 2019 (COVID-19) spread throughout the US in the early months of 2020, acute care delivery changed to accommodate an influx of patients with a highly contagious infection about which little was known. Objective To examine trends in emergency department (ED) visits and visits that led to hospitalizations covering a 4-month period leading up to and during the COVID-19 outbreak in the US. Design, Setting, and Participants This retrospective, observational, cross-sectional study of 24 EDs in 5 large health care systems in Colorado (n = 4), Connecticut (n = 5), Massachusetts (n = 5), New York (n = 5), and North Carolina (n = 5) examined daily ED visit and hospital admission rates from January 1 to April 30, 2020, in relation to national and the 5 states’ COVID-19 case counts. Exposures Time (day) as a continuous variable. Main Outcomes and Measures Daily counts of ED visits, hospital admissions, and COVID-19 cases. Results A total of 24 EDs were studied. The annual ED volume before the COVID-19 pandemic ranged from 13 000 to 115 000 visits per year; the decrease in ED visits ranged from 41.5% in Colorado to 63.5% in New York. The weeks with the most rapid rates of decrease in visits were in March 2020, which corresponded with national public health messaging about COVID-19. Hospital admission rates from the ED were stable until new COVID-19 case rates began to increase locally; the largest relative increase in admission rates was 149.0% in New York, followed by 51.7% in Massachusetts, 36.2% in Connecticut, 29.4% in Colorado, and 22.0% in North Carolina. Conclusions and Relevance From January through April 2020, as the COVID-19 pandemic intensified in the US, temporal associations were observed with a decrease in ED visits and an increase in hospital admission rates in 5 health care systems in 5 states. These findings suggest that practitioners and public health officials should emphasize the importance of visiting the ED during the COVID-19 pandemic for serious symptoms, illnesses, and injuries that cannot be managed in other settings.

Boserup B., McKenney M., Elkbuli A.

COVID-19 pandemic effects are still being elucidated. Stay-at-home orders and social distancing compounded with COVID-19 concerns have caused significant disruptions in daily life. One notable effect of these variables may be a change in the number of emergency department (ED) visits. This study aims to investigate the effects of COVID-19 on ED visits, and possible reasons for changes. Retrospective analysis using CDC data for ED visits and percentage of visits for COVID-19-Like Illness (CLI) and Influenza-Like Illness (ILI). Google Trends was used to assess COVID-19 public awareness. Motor vehicle collision (MVC) data was collected from cities, which reported current data. A descriptive statistical analysis and two-sample t -test was performed on ED visit data to assess for significance and a descriptive analysis was conducted to assess COVID-19's impact on MVCs. The mean number of ED visits per week for the last four weeks of available data during the pandemic was significantly less than the four weeks prior to COVID-19 pandemic ( p = 0.008). The ED visit decrease per week varied by region, with Region 1 having the greatest decrease (45%). MVCs decreased substantially across all cities studied, with New York City and Baton Rouge experiencing the greatest decrease (66%) during the pandemic. A number of factors have likely contributed to the substantial decrease in ED visits observed in this study. In light of these findings, it is important to raise patient awareness regarding acute conditions that are deadlier than COVID-19 and require immediate medical intervention to ensure recovery.

DiFazio L.T., Curran T., Bilaniuk J.W., Adams J.M., Durling-Grover R., Kong K., Nemeth Z.H.

Fuchs V.R.

This Viewpoint discusses the necessity and prospects for health care reform in the wake of the coronavirus disease 2019 (COVID-19) pandemic, reviewing policy options to fund universal coverage, incentivize efficiencies, and reduce political opposition to change.

Metzl J.M., Maybank A., De Maio F.

Baum A., Schwartz M.D.

To assess the effect of COVID-19 on health care, this study compares admissions data from the Veterans Affairs system for overall admissions and for 6 common emergencies immediately before and for 6 weeks during the pandemic.

Shachar C., Engel J., Elwyn G.

Hartnett K.P., Kite-Powell A., DeVies J., Coletta M.A., Boehmer T.K., Adjemian J., Gundlapalli A.V.

On March 13, 2020, the United States declared a national emergency to combat coronavirus disease 2019 (COVID-19). As the number of persons hospitalized with COVID-19 increased, early reports from Austria (1), Hong Kong (2), Italy (3), and California (4) suggested sharp drops in the numbers of persons seeking emergency medical care for other reasons. To quantify the effect of COVID-19 on U.S. emergency department (ED) visits, CDC compared the volume of ED visits during four weeks early in the pandemic March 29-April 25, 2020 (weeks 14 to 17; the early pandemic period) to that during March 31-April 27, 2019 (the comparison period). During the early pandemic period, the total number of U.S. ED visits was 42% lower than during the same period a year earlier, with the largest declines in visits in persons aged ≤14 years, females, and the Northeast region. Health messages that reinforce the importance of immediately seeking care for symptoms of serious conditions, such as myocardial infarction, are needed. To minimize SARS-CoV-2, the virus that causes COVID-19, transmission risk and address public concerns about visiting the ED during the pandemic, CDC recommends continued use of virtual visits and triage help lines and adherence to CDC infection control guidance.

Solomon M.D., McNulty E.J., Rana J.S., Leong T.K., Lee C., Sung S., Ambrosy A.P., Sidney S., Go A.S.

Acute Myocardial Infarction and Covid-19 Data from the Kaiser Permanente Northern California health care system were used to compare rates of hospitalization for acute MI from March 4 through April...

Hollander J.E., Carr B.G.

Virtually Perfect? Telemedicine for Covid-19 Telemedicine’s payment and regulatory structures, licensing, credentialing, and implementation take time to work through, but health systems that have a...

Giannouchos T.V., Washburn D.J., Kum H., Sage W.M., Ohsfeldt R.L.

Background: Research on frequent emergency department (ED) use shows that a subgroup of patients visits multiple EDs. This study characterizes these individuals. Objective: The objective of this study was to determine how many frequent ED users seek care at multiple EDs and to identify sociodemographic, clinical, and contextual factors associated with such behavior. Research Design: We used the 2011–2014 Healthcare Cost and Utilization Project State Emergency Department Databases data on all outpatient ED visits in New York, Massachusetts, and Florida. We studied all adult ED users with ≥5 visits in a year and defined multisite use as visits to ≥3 different sites. We estimated predictors of multisite use with multivariate logistic regressions. Results: Across all 3 states, 1,033,626 frequent users accounted for 7,613,077 ED visits. Of frequent users, 25% were multisite users, accounting for 30% of the visits studied. Frequent users with at least 1 visit for mental health or substance use-related diagnosis were more likely to use multiple sites. Uninsured frequent users and those with public insurance were associated with less use of multiple EDs than those with private coverage while lacking consistent coverage by the same insurance within each year were associated with using multiple sites. Conclusions: Health policy interventions to reduce duplicative or unnecessary ED use should apply a population health perspective and engage multiple hospitals. Community-level preventive approaches and a stronger infrastructure for mental health and substance use are essential to mitigate multisite ED use.

Barnett M.L., Ray K.N., Souza J., Mehrotra A.

Johnston K.J., Allen L., Melanson T.A., Pitts S.R.

Objective To document erosion in the New York University Emergency Department (ED) visit algorithm's capability to classify ED visits and to provide a “patch” to the algorithm. Data Sources The Nationwide Emergency Department Sample. Study Design We used bivariate models to assess whether the percentage of visits unclassifiable by the algorithm increased due to annual changes to ICD-9 diagnosis codes. We updated the algorithm with ICD-9 and ICD-10 codes added since 2001. Principal Findings The percentage of unclassifiable visits increased from 11.2 percent in 2006 to 15.5 percent in 2012 (p < .01), because of new diagnosis codes. Our update improves the classification rate by 43 percent in 2012 (p < .01). Conclusions Our patch significantly improves the precision and usefulness of the most commonly used ED visit classification system in health services research.

Lowthian J.A., Smith C., Stoelwinder J.U., Smit D.V., McNeil J.J., Cameron P.A.

To examine non-clinical factors associated with emergency department (ED) attendance by lower urgency older patients.An exploratory descriptive study comprising structured interviews with lower urgency community-dwelling patients aged ≥70 years presenting to a tertiary metropolitan Melbourne public hospital ED. Demographical and clinical characteristics, self-reported feelings of social connectedness, perceived accessibility to primary care, reason for attending ED were measured.One hundred patients were interviewed: mean age 82 years, 56% female, 57% lived alone; 73% presented during business hours, 58% arrived by ambulance, 80% presented for illness, and 65% were discharged home within 48 h. Fifty-six per cent of patients reported feeling socially disconnected, comprising 49% living alone compared with 65% who lived with their spouse/family. All patients attended a regular general practitioner, 31% reporting regular review appointments. Thirty-five per cent reported waiting times >2-3 days for urgent problems; 59% stated accessing care 'after hours' without attending ED as difficult, with 20% having attended ED 3-6 times in the previous 12 months. Reasons for attending ED were referral by a third party, difficulty with accessibility to primary care, patient preferences for timely care and fast-track access to specialist care.Most older patients of lower clinical urgency presented to ED because of perceived access block to primary or specialist services, alongside an expectation of more timely and specialised care. This suggests that EDs should be redesigned and/or integrated community-based models of care developed to meet the specific needs of this age group who have growing demand for acute care.

Durand A., Gentile S., Devictor B., Palazzolo S., Vignally P., Gerbeaux P., Sambuc R.

Nonurgent visits to emergency departments (ED) are a controversial issue; they have been negatively associated with crowding and costs. We have conducted a critical review of the literature regarding methods for categorizing ED visits into urgent or nonurgent and analyzed the proportions of nonurgent ED visits. We found 51 methods of categorization. Seventeen categorizations conducted prospectively in triage areas were based on somatic complaint and/or vital sign collection. Categorizations conducted retrospectively (n = 34) were based on the diagnosis, the results of tests obtained during the ED visit, and hospital admission. The proportions of nonurgent ED visits varied considerably: 4.8% to 90%, with a median of 32%. Comparisons of methods of categorization in the same population showed variability in levels of agreement. Our review has highlighted the lack of reliability and reproducibility.

Alnashri Y., Andreyeva E., Giannouchos T.V.

Karimifard M., Hosseini M., Mahmudimanesh M., Jahanghiri F., Mahmoodi R., Talebi H., Soodejani M.T.

Introduction The COVID-19 epidemic in 2019 directly or indirectly had an impact on the healthcare system of hospitals. Iran was among the countries whose hospitals and especially the emergency system were affected by the outbreak of Coronavirus. The main objective of this study is to compare the number of emergency services, including heart and respiratory diseases, accidents, drowning, and CO poisoning, after the coronavirus pandemic in Chaharmahal and Bakhtiari provinces. Methods In this study, after obtaining the necessary permissions, an attempt was made to analyze the data on the most common Emergency Medical Services (EMS) extracted monthly by the city from the ASAYAR system during 2020-2023 using time series and Auto-regressive Integrated Moving Average (ARIMA) model. Results The number of emergency services related to accidents had an upward trend and was based on seasonal changes. Examination of seasonal effects shows that most emergency services occurred in the months of June through September; the number of emergency services related to heart disease was relatively constant. In addition, the number of emergency services related to respiratory diseases was constant on average despite many fluctuations in the observations. During the COVID-19 pandemic, the number of interventions and emergency calls increased. Conclusion Therefore, emergency services should increase their response capacity in these cases by modifying their programs and approaches, increasing response capacity and the number of staff, and providing appropriate training.

Sofuoğlu Z., Turhan Damar H., Sehitoglu Alpagut G., Calik B., Kebapci E., Gulmez H., Kurtulus M., Damar M.

Shaw D.L., Stenson B.A., Sanchez L.D., Chiu D.T.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) pandemic disrupted medical education in many care settings, including the Emergency Department (ED). It is unclear what effects these changes have had on resident training and clinical productivity. The purpose of this study is to determine Emergency Medicine (EM) resident productivity in the ED during the COVID-19 pandemic. This was a retrospective observational study at an academic medical center with an EM residency program. Data were collected from the electronic medical record from 7/1/2017–10/31/2021. The primary outcome was patients per hour (PPH). Postgraduate year (PGY) 1 and 2 shifts were included. Analysis included descriptive statistics (mean ​± ​standard deviation), correlation testing, and multivariate linear regression. Overall, PGY1 residents saw fewer PPH than PGY2 residents (1.00 ​± ​0.12 vs 1.40 ​± ​0.13 ​PPH, p ​< ​0.001). During academic year (AY) 2019–2020, there was a trend towards lower resident productivity compared to pre-COVID (2017–2019) that was statistically significant at the PYG2 level (PGY1 0.96 ​± ​0.13, p ​= ​0.06; PGY2 1.31 ​± ​0.10 ​PPH, p ​= ​0.004). This difference resolved over the course of AY 2020–2021. Multivariate linear regression showed association of resident productivity with patient volume, month of residency, and year of residency. The period surrounding the COVID-19 pandemic showed a trend towards decreased resident productivity during AY 2019–2020, which proved transient and resolved during AY 2020–2021. Resident productivity was associated with both month of training and ED volume. Additional research is needed to describe the long-term effects on the training environment during COVID-19 on physician productivity.

Zheng J., Abudayyeh I., Rakovski C., Ehwerhemuepha L., Mianroodi A.R., Patel J.N., Ihab A., Ani C.

Abstract Background Although prior research has estimated the overarching cost burden of heart failure (HF), a thorough analysis examining medical expense differences and trends, specifically among commercially insured patients with heart failure, is still lacking. Thus, the study aims to examine historical trends and differences in medical costs for commercially insured heart failure patients in the United States from 2006 to 2021. Methods A population-based, cross-sectional analysis of medical and pharmacy claims data (IQVIA PharMetrics® Plus for Academic) from 2006 to 2021 was conducted. The cohort included adult patients (age > = 18) who were enrolled in commercial insurance plans and had healthcare encounters with a primary diagnosis of HF. The primary outcome measures were the average total annual payment per patient and per cost categories encompassing hospitalization, surgery, emergency department (ED) visits, outpatient care, post-discharge care, and medications. The sub-group measures included systolic, diastolic, and systolic combined with diastolic, age, gender, comorbidity, regions, states, insurance payment, and self-payment. Results The study included 422,289 commercially insured heart failure (HF) patients in the U.S. evaluated from 2006 to 2021. The average total annual cost per patient decreased overall from $9,636.99 to $8,201.89, with an average annual percentage change (AAPC) of -1.11% (95% CI: -2% to -0.26%). Hospitalization and medication costs decreased with an AAPC of -1.99% (95% CI: -3.25% to -0.8%) and − 3.1% (95% CI: -6.86–0.69%). On the other hand, post-discharge, outpatient, ED visit, and surgery costs increased by an AAPC of 0.84% (95% CI: 0.12–1.49%), 4.31% (95% CI: 1.03–7.63%), 7.21% (95% CI: 6.44–8.12%), and 9.36% (95% CI: 8.61–10.19%). Conclusions The study’s findings reveal a rising trend in average total annual payments per patient from 2006 to 2015, followed by a subsequent decrease from 2016 to 2021. This decrease was attributed to the decline in average patient costs within the Medicare Cost insurance category after 2016, coinciding with the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Additionally, expenses related to surgical procedures, emergency department (ED) visits, and outpatient care have shown substantial growth over time. Moreover, significant differences across various variables have been identified.

Aslim E.G., Fu W., Liu C., Tekin E.

Abstract This paper evaluates the effect of COVID-19 vaccination on the individual propensity to delay or skip medical care. Our research design exploits the arguably exogenous variation in age-specific vaccine eligibility rollout across states and over time as an instrument for individual vaccination status. We find that receiving a COVID-19 vaccine reduces the likelihood of delaying care for any medical condition by 37 percent. Furthermore, our analysis reveals that children are significantly less likely to delay or skip healthcare as a result of their parents becoming vaccine eligible, indicating the presence of a positive health spillover within households that extends beyond protection against infection. Our analysis also shows that vaccination reduces concerns about contracting or spreading COVID-19, leading to increased mobility and potentially reducing delays or avoidance in seeking healthcare. Additionally, we find that vaccination notably increased access to elective care and surgeries but had no significant impact on emergency department admissions, mental health cases, or other medical conditions. Our results highlight the important role that vaccines play in, not only protecting against coronavirus, but also safeguarding against the worsening of health due to delayed or foregone medical care. The decline in delayed or foregone care caused by vaccination is particularly strong among minorities and those with a low socioeconomic background, revealing an important role that vaccination efforts can play in narrowing inequities in health and healthcare. In supplementary analysis, we use novel data on debit and credit card spending to demonstrate that increased vaccine uptake has a positive, albeit statistically insignificant, effect on consumer healthcare spending in the short run. Taken together, our findings imply that advancements in vaccine development coupled with a regulatory process that accelerates the availability of vaccines to public in a safe manner can have the additional benefit of tackling unmet healthcare needs during a public health crisis.

Kar E., Fakhimi M., Turner C., Eldabi T.

Marthey D., Ramy M., Ukert B.

AbstractObjectiveThe objective was to describe characteristics of emergency department visits to Texas satellite and independent freestanding emergency departments (FrEDs) relative to hospital emergency departments (EDs).Data Sources and Study SettingThe study used all 2021–2022 hospital and FrED discharges from the publicly available Texas Emergency Department Public Use Data Files (PUDF).Study DesignWe conducted a descriptive analysis, comparing patient and visit characteristics at satellite and independent FrEDs and hospital EDs using chi‐square tests. We characterized the top 20 diagnoses and procedures ranked by volume, treatment intensity, and potentially avoidable ED use.Data Collection/Extraction MethodsDischarge data from 2021 to 2022 were combined for the analysis, and ED data at critical access hospitals were excluded.Principal FindingsOur sample consisted of 21,605,421 ED visits, 76% occurring at hospitals, 12% at satellite FrEDs, and 12% at independent FrEDs. Compared with hospitals and satellite FrEDs, patients to independent FrEDs were younger, healthier, more likely covered by private insurance, and less likely to be identified as non‐Hispanic Black or Hispanic. Visits at satellite and independent FrEDs were more likely to be of moderate and low intensity and potentially avoidable.ConclusionsOur results underscore the need to address potentially avoidable utilization of emergency services.

Bui H., Lai H., Nguyen T., Vu T., Bui N., Nguyen V., Tran T., Nguyen T., Nguyen T., Al-Tawfiq J.A., Chu D.

To describe the status of using biological Disease Modifying Anti Rheumatic Drugs (bDMARDs) to treat rheumatoid arthritis (RA) and related factors. In addition, the study determined the impact of COVID-19 on the usage of bDMARDs. This is a cross-sectional study and included 219 RA patients over 18 years old. The Kaplan–Meier method and the log-rank test (p < 0.05) were used to estimate the retention time and compare between different times. Cox regression analysis was used to determine the factors affecting the retention time of biological drugs (p < 0.05). Out of 1967 courses of treatment, there were 149 (7.6%) drug discontinuations, 760 (38.6%) doses extensions and 64 (3.3%) drug switch. Moderate disease level and choosing tumor necrosis factor (TNF) inhibitors initially were associated with retention time of COVID-19. Drug discontinuations and dose extensions increased after COVID-19 emergence. The retention time during COVID-19 was significantly different from that of pre-COVID-19. Gender, type of first-used bDMARD, conventional synthetic DMARDs (csDMARDs) and corticoid usage status, disease activity levels were associated with retention time. The presence of COVID-19 has a significant effect on usage status of the biologic drug. Further longitudinal studies are needed to clarify the relationship between COVID-19 and drug usage as well as related factors. Describir el estado del uso de fármacos antirreumáticos modificadores de la enfermedad biológica (bDMARD) para tratar la artritis reumatoide (AR) y los factores relacionados. Además, el estudio determinó el impacto de COVID-19 en el uso de bDMARD. Este es un estudio transversal que incluyó a 219 pacientes con AR mayores de 18 años. El método Kaplan-Meier y la prueba Log-rank (p < 0,05) se usaron para estimar el tiempo de retención y compararlo entre diferentes tiempos. El análisis de regresión de Cox se utilizó para determinar los factores que afectan el tiempo de retención de los medicamentos biológicos (p < 0,05). De 1.967 cursos de tratamiento, hubo 149 (7,6%) interrupciones del fármaco, 760 (38,6%) extensiones de dosis y 64 (3,3%) cambios de fármaco. Nivel de enfermedad moderado y elección del factor de necrosis tumoral (TNF) inhibidores inicialmente se asociaron con el tiempo de retención de COVID-19. Las discontinuaciones de los medicamentos y las extensiones de las dosis aumentaron después de la aparición de COVID-19. El tiempo de retención durante COVID-19 fue significativamente diferente del pre-COVID-19. Género, tipo de bDMARD de primer uso, convencional DMARD sintéticos (csDMARDs) y el estado de uso de corticoides, los niveles de actividad de la enfermedad se asociaron con el tiempo de retención. La presencia de COVID-19 tiene un efecto significativo en el estado de uso del medicamento biológico. Se necesitan más estudios longitudinales para aclarar la relación entre COVID-19 y el uso de fármacos, así como los factores relacionados.

Bui H., Lai H., Nguyen T., Vu T., Bui N., Nguyen V., Tran T., Nguyen T., Nguyen T., Al-Tawfiq J.A., Chu D.

To describe the status of using biological Disease Modifying Anti Rheumatic Drugs (bDMARDs) to treat rheumatoid arthritis (RA) and related factors. In addition, the study determined the impact of COVID-19 on the usage of bDMARDs. This is a cross-sectional study and included 219 RA patients over 18 years old. The Kaplan–Meier method and the log-rank test (p < 0.05) were used to estimate the retention time and compare between different times. Cox regression analysis was used to determine the factors affecting the retention time of biological drugs (p < 0.05). Out of 1967 courses of treatment, there were 149 (7.6%) drug discontinuations, 760 (38.6%) doses extensions and 64 (3.3%) drug switch. Moderate disease level and choosing tumor necrosis factor (TNF) inhibitors initially were associated with retention time of COVID-19. Drug discontinuations and dose extensions increased after COVID-19 emergence. The retention time during COVID-19 was significantly different from that of pre-COVID-19. Gender, type of first-used bDMARD, conventional synthetic DMARDs (csDMARDs) and corticoid usage status, disease activity levels were associated with retention time. The presence of COVID-19 has a significant effect on usage status of the biologic drug. Further longitudinal studies are needed to clarify the relationship between COVID-19 and drug usage as well as related factors. Describir el estado del uso de fármacos antirreumáticos modificadores de la enfermedad biológica (bDMARD) para tratar la artritis reumatoide (AR) y los factores relacionados. Además, el estudio determinó el impacto de COVID-19 en el uso de bDMARD. Este es un estudio transversal que incluyó a 219 pacientes con AR mayores de 18 años. El método Kaplan-Meier y la prueba Log-rank (p < 0,05) se usaron para estimar el tiempo de retención y compararlo entre diferentes tiempos. El análisis de regresión de Cox se utilizó para determinar los factores que afectan el tiempo de retención de los medicamentos biológicos (p < 0,05). De 1.967 cursos de tratamiento, hubo 149 (7,6%) interrupciones del fármaco, 760 (38,6%) extensiones de dosis y 64 (3,3%) cambios de fármaco. Nivel de enfermedad moderado y elección del factor de necrosis tumoral (TNF) inhibidores inicialmente se asociaron con el tiempo de retención de COVID-19. Las discontinuaciones de los medicamentos y las extensiones de las dosis aumentaron después de la aparición de COVID-19. El tiempo de retención durante COVID-19 fue significativamente diferente del pre-COVID-19. Género, tipo de bDMARD de primer uso, convencional DMARD sintéticos (csDMARDs) y el estado de uso de corticoides, los niveles de actividad de la enfermedad se asociaron con el tiempo de retención. La presencia de COVID-19 tiene un efecto significativo en el estado de uso del medicamento biológico. Se necesitan más estudios longitudinales para aclarar la relación entre COVID-19 y el uso de fármacos, así como los factores relacionados.

Stowell J.R., Henry M.B., Pugsley P., Edwards J., Jordan H., Norquist C., Katz E.D., Koenig B.W., Indermuhle S., Subbian V., Ghaderia H., Akhter M.

Background 2019 marked the emergence of the novel Coronavirus (COVID-19) pandemic. Public avoidance of healthcare facilities, including the Emergency Department (ED), has been noted prior pandemics. Objectives This study describes pandemic related changes in adult and pediatric Emergency Department (ED) presentations, acuity, and hospitalization rates during the pandemic in a major metropolitan area. Methods The study was a cross-sectional analysis of ED visits occurring before and during the pandemic. Sites collected ED patient daily census, monthly ED patient acuity as the Emergency Severity Index (ESI) score, and disposition. Pre-pandemic ED visits occurring from January 1st, 2019, through December 31st, 2019, were compared to ED visits occurring during the pandemic from January 1st, 2020, through March 31st, 2021. The change in pre-pandemic and pandemic ED volume was demonstrated using 7-day moving average of proportions. Results The study enrolled 83.8% of the total ED encounters. Pandemic adult and pediatric visit volume decreased to as low as 44.7% (95% CI 43.1%–46.3%; p

Lau N., Patterson S., Kim S., Kim T.Y.

Abstract Objective: The objective of this study was to describe changes in emergency department volumes after statewide lockdown in a network of hospitals across the United States during the COVID-19 global pandemic. Methods: A retrospective study was performed utilizing data on daily volumes across multiple emergency departments from a centralized data warehouse from a private for-profit hospital system during the COVID-19 pandemic. The mean daily volumes of 148 emergency departments were evaluated across 16 states in relation to each state’s governmental statewide lockdown orders. Comparisons of the same period in the prior year were evaluated for percent changes in volumes. We also compared pre-lockdown to post-lockdown volumes. A separate analysis was made for the pediatric ED volumes. Results: The 2020 post-lockdown volumes compared to the same 2019 dates revealed a mean percent change of −43.09%. The overall post-lockdown volumes compared to the pre-lockdown volumes had a mean percent change of −45.00%. The pediatric data revealed a greater mean percentage change in volumes of −71.52% (post-lockdown compared to 2019) and −69.03% (post-lockdown compared to pre-lockdown). Conclusions: This study found an overall decrease in volumes among 148 emergency departments across 16 states when compared to the comparable period pre-global pandemic.

Scott A., Ansari W., Khan F., Chambers R., Benigno M., Di Fusco M., McGrath L., Malhotra D., Draica F., Nguyen J., Atkinson J., Atwell J.E.

Abstract Background Post-COVID conditions encompass a range of long-term symptoms after SARS-CoV-2 infection. The potential clinical and economic burden in the United States is unclear. We evaluated diagnoses, medications, healthcare use, and medical costs before and after acute COVID-19 illness in US patients at high risk of severe COVID-19. Methods Eligible adults were diagnosed with COVID-19 from April 1 to May 31, 2020, had ≥ 1 condition placing them at risk of severe COVID-19, and were enrolled in Optum’s de-identified Clinformatics® Data Mart Database for ≥ 12 months before and ≥ 13 months after COVID-19 diagnosis. Percentages of diagnoses, medications, resource use, and costs were calculated during baseline (12 months preceding diagnosis) and the post-acute phase (12 months after the 30-day acute phase of COVID-19). Data were stratified by age and COVID-19 severity. Results The cohort included 19,558 patients (aged 18–64 y, n = 9381; aged ≥ 65 y, n = 10,177). Compared with baseline, patients during the post-acute phase had increased percentages of blood disorders (16.3%), nervous system disorders (11.1%), and mental and behavioral disorders (7.7%), along with increases in related prescriptions. Overall, there were substantial increases in inpatient and outpatient healthcare utilization, along with a 23.0% increase in medical costs. Changes were greatest among older patients and those admitted to the intensive care unit for acute COVID-19 but were also observed in younger patients and those who did not require COVID-19 hospitalization. Conclusions There is a significant clinical and economic burden of post-COVID conditions among US individuals at high risk for severe COVID-19.

Hartmann-Boyce J., Highton P., Rees K., Onakpoya I., Suklan J., Curtis F., O'Mahoney L., Morris E., Kudlek L., Morgan J., Lynch R., Marpadga S., Seidu S., Khunti K.

Summary The COVID-19 pandemic triggered disruptions to health care and lifestyles that could conceivably impact diabetes management. We set out to identify the impact of disruptions caused by COVID-19 on clinical outcomes in people with diabetes. We performed a systematic review of the available literature in the MEDLINE and OVID databases from Jan 1, 2020, to June 7, 2023, and included 138 studies (n>1 000 000 people). All but five studies were judged to be at some risk of bias. All studies compared prepandemic with pandemic periods. All-cause mortality (six studies) and diabetes-related mortality (13 studies) showed consistent increases, and most studies indicated increases in sight loss (six studies). In adult and mixed samples, data generally suggested no difference in diabetic ketoacidosis frequency or severity, whereas in children and adolescents most studies showed increases with some due to new-onset diabetes (69 studies). Data suggested decreases in hospital admissions in adults but increases in diabetes-related admissions to paediatric intensive care units (35 studies). Data were equivocal on diabetic foot ulcer presentations (nine studies), emergency department admissions (nine studies), and overall amputation rates (20 studies). No studies investigated renal failure. Where reported, the impact was most pronounced for females, younger people, and racial and ethnic minority groups. Further studies are needed to investigate the longer-term impact of the pandemic and the on potential differential impacts, which risk further exacerbating existing inequalities within people with diabetes.

Piri S., Pangburn M., Çil E.B.

This paper examines the impact of information technology-based ridesharing platforms on hospitals' emergency department (ED) admissions. Employing a difference-in-differences design, we analyze patient-level data for 42 million ED visits in Florida. We find that the availability of ridesharing positively affects ED arrivals, indicating enhanced accessibility. Our analysis of the heterogeneous impact of ridesharing suggests the most significant effect applies to young, middle-aged, low-income, and non-critical patients. Additionally, we find a significant increase in ED service time for patients with less critical conditions and no change in visit length for critical patients. The rise in ED demand due to ridesharing entry can have two distinct implications. On the one hand, ridesharing entry addresses the access barrier when the patient's condition is non-critical, but ED usage is necessary. This is a positive impact of ridesharing services availability, especially since it helps low-income communities the most. Therefore, hospitals and ridesharing companies can collaborate to address the healthcare access challenge. On the other hand, ridesharing entry may exacerbate already overcrowded EDs by facilitating non-critical and unnecessary ED usage, which can be an adverse effect. In this case, effective patient triage to identify those with urgent needs may become even more essential after ridesharing entry.