Status of Patient Flow in the Emergency Department of Kathmandu Medical College Before and After the National Level Lockdown for Pandemic

Background: Emergency visits during pandemic also comprise the patients with various complains other than symptoms of COVID.  It is prudent to identify the variation of non- COVID-19 cases (cases that do not have fever or cough or travel history or contact history or health professional) that visit emergency department during pandemic and their outcome for proper division of resources including human resources during pandemic. Methods: This is a cross sectional study done in emergency department of Kathmandu Medical College Teaching Hospital (KMCTH) Data were collected from the record book from 24th March 2020 to 21st July 2020 (lockdown period) and four months prior to 24th March. The variation in emergency admissions, demographic profile, outcome of the patients, departments admitting the patients and place of admission was evaluated. Results: Total of 6944 cases were seen during the pre-lockdown period and 2503 cases during the lockdown period, which is 63.95% less than the pre-lockdown era. The number of cases that were admitted from the ER during the lockdown had fallen by 67.5% from the pre-lockdown era. Likewise, the patients admitted in ward, high care, ICU had decreased by 76%, 49%, 64% respectively compared to pre-lockdown period. However, the rate of admissions in intensive care unit had risen from 32.58% to 35.73% during lockdown. There was decrease in injury, poisoning or certain consequences of external causes and external causes of morbidity and mortality by 57.5% and 52% respectively. Conclusion: The overall rate of admissions was low both for the COVID.  However, the admission in intensive care units increased during the lockdown period which gives the idea that people were only visiting hospital when their symptoms were worse.