People continue to avoid the emergency department, particularly for less-urgent care, a trend that may stick beyond the COVID-19 pandemic, experts forecast.
ED volumes have been the slowest to rebound compared with total admissions and surgeries across hospitals, many of which are still reporting a decline in June year-over-year results—about 20%—largely due to fewer lower-acuity visits.
If less-complex care is redirected to more appropriate, cost-effective settings, COVID-19 has unintentionally solved a vexing problem: keeping non-urgent cases out of the ED. That could prove important as hospital executives redesign their EDs to prevent COVID-19 transmissions.
But if care is being forgone altogether, physicians are concerned that patients will become sicker and outcomes will deteriorate.
ED admissions are also an important referral source for hospitals. If health systems do not adequately prepare alternative care pathways, they will likely lose market share.
”We saw people, with COVID-19 and without, coming into the ED who were very ill,” said Dr. Vik Reddy, chief medical officer of Wellstar Kennestone Hospital and Wellstar Windy Hill Hospital in the Atlanta area, noting that some patients delayed care for a couple of days after suffering a heart attack or appendicitis, which could lead to a longer recovery and worse outcomes. “The good news is that we’re seeing that trend reverse this time around. It was scary in March when we knew that people weren’t coming into the ED for heart attacks.”
During the pandemic’s initial peak in April, ED visits across hospitals nationwide declined 42% from a mean of 2.1 million per week to 1.2 million, according to an analysis by the National Syndromic Surveillance Program. In the 10 weeks following declaration of the COVID-19 national emergency, ED visits fell 23% for heart attacks, 20% for strokes and 10% for hyperglycemic crises, NSSP data show.
As of the end of May, there were 26% fewer ED visits compared with the same period in 2019.
The national figures align with Georgia-based Wellstar Health System, which recently completed a 263,000-square-foot emergency department for its Kennestone Hospital in Marietta. Wellstar’s ED visits were down nearly 50% in April compared with its historical volumes, and they continue to lag around 20% as low-acuity cases have dropped off, Reddy said.
Wellstar has expanded the hours of its pediatrics and urgent-care facilities as well as its reach via telehealth, which explains some of the decline. That also allowed the system to retain patients and downstream care. The rest may be explained by individuals’ fear of being exposed to COVID-19 in the ED, financial distress, extended wait times, or a sense of civic responsibility to avoid using healthcare services that others may need more.