Impact of the COVID-19 pandemic on South Australia’s emergency departments: evidence from two lockdowns
Laura M. Boyle
A B , Mark Mackay C , Nigel Bean B D and Matthew Roughan B D
A Mathematical Sciences Research Centre, School of Mathematics and Physics, Queen’s University Belfast, Northern Ireland, UK.
B Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, The University of Melbourne, Vic., Australia.
C UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia. Email: mark.mackay@unisa.edu.au
D School of Mathematical Sciences, The University of Adelaide, SA, Australia. Email: nigel.bean@adelaide.edu.au; matthew.roughan@adelaide.edu.au
E Corresponding author. Email: laura.m.boyle@outlook.com
Australian Health Review 45(5) 533-539 https://doi.org/10.1071/AH20366
Submitted: 22 December 2020 Accepted: 24 February 2021 Published: 20 May 2021
Journal Compilation © AHHA 2021 Open Access CC BY
Abstract
Objective This study assessed the impact of the COVID-19 pandemic on emergency departments (EDs) in South Australia, measured by changes in the number and casemix of patients in the system over time.
Methods Data from the South Australia Emergency Department Dashboard, updated every 30 min, were analysed for the period 4 October–21 December 2020. The Dashboard reports live counts of the number and type of patients in each of the six adult metropolitan public EDs in Adelaide, South Australia.
Results There was a significant difference in the mean daily average occupied ED capacity before and during two distinct increases in COVID-19 cases in South Australia. An increase in COVID-19 cases coincided with a decrease in patients in EDs (Pearson’s r = –0.93 and –0.67; P < 0.001 for both). Presentations in Australasian Triage Scale (ATS) Categories 2–5 decreased during these periods, whereas ATS Category 1 stayed constant. Mental health patients continued to present to the ED, despite the overall drop in ED presentations.
Conclusions During the two periods of COVID-19 case growth in South Australia, there was a significant drop in the number of patients presenting to the major public EDs and a change in the casemix of patients over time.
What is known about the topic? EDs in Australia often operate at or over capacity, with frequent reports of ambulance ramping, access block and long waiting times. There have been reports internationally of significant declines in ED presentations throughout the COVID-19 pandemic.
What does this paper add? This paper uses a novel publicly available data source that is available in real time to contribute a new perspective from South Australia, which has experienced two distinct periods of strict restrictions and lockdown. The research showed that the number of mental health presentations remained consistently high, despite a significant overall decline in ED occupancy.
What are the implications for practitioners? This study demonstrates that South Australians are accessing emergency medical treatment differently in response to the COVID-19 pandemic. In the context of an overall decline in presentation numbers, the number of mental health-related presentations has not changed significantly, suggesting that this trend should be closely monitored. The findings corroborate the national concern that unwell people have avoided accessing emergency medical care during the pandemic, leading to worse outcomes and increased need for healthcare resources at a later date. It will be important to monitor and quickly detect further changes in ED usage using real-time data as the pandemic evolves, as well as in any future significant health crises.
Keywords: health systems, hospitals, health services research, COVID-19, Australia, emergency department presentations, emergency treatment, medical care.
References
[1] Australian Institute of Health and Welfare (AIHW). Australia’s health 2014. Catalogue no. AUS 178. Canberra: AIHW; 2014.[2] Australian Institute of Health and Welfare. 8.8 Emergency departments: at the front line. In Australia’s health series no. 14, cat. no. AUS 178. 2014. Available at: https://www.aihw.gov.au/getmedia/1bfbff5c-d3db-40c8-8a48-310269825fcd/8_8-emergency-dept.pdf.aspx [verified December 2020].
[3] Australasian College for Emergency Medicine. Media release: Overcrowding, bed block and ambulance ramping must not be the new ‘normal’ for hospital emergency departments. 28 June 2019. Available at: https://acem.org.au/getmedia/731be577-f8ba-44d5-94f2-c6cc58254401/201906-SA-overcrowding2 [verified December 2020].
[4] World Health Organization (WHO). Listings of WHO’s response to COVID-19. 2020. Available at: https://www.who.int/news/item/29-06-2020-covidtimeline [verified March 2021].
[5] MacIntyre CR, Heslop DJ. Public health, health systems and palliation planning for COVID-19 on an exponential timeline. Med J Aust 2020; 212 440–442.e1.
| 32319114PubMed |
[6] Australian Government Department of Health. Physical distancing for coronavirus (COVID-19). 2020. Available at: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/how-to-protect-yourself-and-others-from-coronavirus-covid-19/social-distancing-for-coronavirus-covid-19 [verified December 2020].
[7] Australian Government Department of Health. Coronavirus (COVID-19) in Australia – Pandemic Health Intelligence Plan. 2020. Available at: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/easing-of-coronavirus-covid-19-restrictions/coronavirus-covid-19-in-australia-pandemic-health-intelligence-plan [verified December 2020].
[8] Australian Bureau of Statistics (ABS). Weekly payroll jobs and wages in Australia, week ending 14 November 2020. Canberra: ABS; 2020.
[9] Lifeline. Lifeline media releases: COVID-19 impact activates first national emergency appeal in Lifeline’s 57 year history. Available at: https://www.lifeline.org.au/resources/news-and-media-releases/media-releases/ [verified December 2020].
[10] Newby JM, O’Moore K, Tang S, Christensen H, Faasse K. Acute mental health responses during the COVID-19 pandemic in Australia. PLoS One 2020; 15 e0236562
| Acute mental health responses during the COVID-19 pandemic in Australia.Crossref | GoogleScholarGoogle Scholar | 32722711PubMed | 32722711PubMed |
[11] World Health Organization (WHO). COVID-19 disrupting mental health services in most countries, WHO survey. 2020. Available at: https://www.who.int/news/item/05-10-2020-covid-19-disrupting-mental-health-services-in-most-countries-who-survey [verified December 2020].
[12] Australian Institute of Health and Welfare. New report shows impact of COVID-19 on cancer screening. 2020. Available at: https://www.aihw.gov.au/news-media/media-releases/2020/october/new-report-shows-impact-of-covid-19-on-cancer-scre [verified December 2020].
[13] Kam AW, Chaudhry SG, Gunasekaran N, White AJR, Vukasovic M, Fung AT. Fewer presentations to metropolitan emergency departments during the COVID-19 pandemic. Med J Aust 2020; 213 370–1.
| Fewer presentations to metropolitan emergency departments during the COVID-19 pandemic.Crossref | GoogleScholarGoogle Scholar | 32946589PubMed | 32946589PubMed |
[14] Jeffrey MM, D’Onofrio G, Paek H, Platts-Mills TF, Soares WE, Hoppe JA, Genes N, Nath B, Melnick ER. Trends in emergency department visits and hospital admissions in health care systems in 5 states in the first months of the COVID-19 pandemic in the US. JAMA Intern Med 2020; 180 1328–33.
[15] Thornton J. Covid-19: A&E visits in England fall by 25% in week after lockdown. BMJ 2020; 369 m1401
| Covid-19: A&E visits in England fall by 25% in week after lockdown.Crossref | GoogleScholarGoogle Scholar | 32253175PubMed |
[16] Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis 2020; 20 533–4.
| An interactive web-based dashboard to track COVID-19 in real time.Crossref | GoogleScholarGoogle Scholar | 32087114PubMed | 32087114PubMed |
[17] R Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation; 2019. Available at: https://www.R-project.org/
[18] Benneyan JC, Lloyd RC, Plsek PE. Statistical process control as a tool for research and healthcare improvement. Qual Saf Health Care 2003; 12 458–64.
| Statistical process control as a tool for research and healthcare improvement.Crossref | GoogleScholarGoogle Scholar | 14645763PubMed | 14645763PubMed |
[19] Scrucca L. qcc: an R package for quality control charting and statistical process control. R News 2004; 4 11–7.
[20] Berecki-Gisolf J. Victorian emergency departments during COVID-19: overall presentations down but assault and DIY injuries up. The Conversation, 11 August 2020. Available at: https://theconversation.com/victorian-emergency-departments-during-covid-19-overall-presentations-down-but-assault-diy-injuries-up-144071 [verified December 2020].
[21] ABC News. Cancer screening, heart attack and stroke presentations down in Victoria during coronavirus pandemic. ABC News, 11 September 2020. Available at: https://www.abc.net.au/news/2020-09-11/victoria-coronavirus-drop-in-stroke-heart-attack-cancer-screens/12654588 [verified December 2020].
[22] ESC Press Office. Fear of COVID-19 keeping more than half of heart attack patients away from hospitals. European Society of Cardiology, 3 June 2020. Available at: https://www.escardio.org/The-ESC/Press-Office/Press-releases/Fear-of-COVID-19-keeping-more-than-half-of-heart-attack-patients-away-from-hospitals [verified December 2020].
[23] Australian Government Department of Health. What you need to know about coronavirus (COVID-19). 2021. Available at: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/what-you-need-to-know-about-coronavirus-covid-19#how-to-seek-medical-attentio [verified December 2020].
[24] Australian Government Department of Health. COVID-19 National Health Plan – supporting the mental health of Australians through the coronavirus pandemic. 2020. Available at: https://www.health.gov.au/resources/publications/covid-19-national-health-plan-supporting-the-mental-health-of-australians-through-the-coronavirus-pandemic [verified December 2020].
[25] Toner L, Koshy AN, Hamilton GW, Clark D, Farouque O, Yudi MB. Acute coronary syndromes undergoing percutaneous coronary intervention in the COVID-19 era: comparable case volumes but delayed hospital presentation. Eur Heart J Qual Care Clin Outcomes 2020; 6 225–6.
| Acute coronary syndromes undergoing percutaneous coronary intervention in the COVID-19 era: comparable case volumes but delayed hospital presentation.Crossref | GoogleScholarGoogle Scholar | 32379888PubMed | 32379888PubMed |
[26] Lim A, Gupta N, Lim A, Hong W, Walker K. Description of the effect of patient flow, junior doctor supervision and pandemic preparation on the ability of emergency physicians to provide direct patient care. Aust Health Rev 2020; 44 741–7.
| Description of the effect of patient flow, junior doctor supervision and pandemic preparation on the ability of emergency physicians to provide direct patient care.Crossref | GoogleScholarGoogle Scholar | 32862832PubMed | 32862832PubMed |
