Impact of the SARS-CoV-2 Pandemic on Emergency Department Presentations in an Integrated Health System

Abstract Objective To quantify the impact of the SARS-CoV-2 pandemic on emergency department volumes and patient presentations, and to evaluate changes in community mortality for the purpose of characterizing new patterns of emergency care utilization. Patients and Methods This is an observational cross-sectional study using electronic health records for emergency department visits in an integrated, multi-hospital system with academic and community practices across four states for visits between March 17 to April 21, 2019, and February 9 to April 21, 2020. We compared numbers and proportions of common and critical chief complaints and diagnoses, triage assessments, throughput, disposition, and selected hospital lengths of stay and out-of-hospital deaths. Results In the period of interest, emergency department visits decreased by nearly 50%. Total number of patients diagnosed with myocardial infarctions, stroke, appendicitis and cholecystitis decreased. The percentage of visits for mental health complaints increased. There was an increase in deaths, driven by out-of-hospital mortality. Conclusion Fewer patients presenting with acute and time-sensitive diagnoses suggests that patients are deferring care, this may be further supported by an increase in out of hospital mortality. Understanding which patients are deferring care and why will allow us to develop outreach strategies and ensure that those in need of rapid assessment and treatment will do so, preventing downstream morbidity and mortality.