Trends in presentations to a private emergency department during the first and second waves of the COVID-19 pandemic in Australia
Nisal Punchihewa
A E F , David Rankin B , Michael Ben-Meir A , Lisa Brichko A C D and Ian Turner A
A Emergency Department, Cabrini Health, Melbourne, Vic., Australia. Email: mbenmeir@cabrini.com.au; lisabrichko@cabrini.com.au, iturner@cabrini.com.au
B Department of Clinical Informatics, Cabrini Health Malvern, Melbourne, Vic., Australia. Email: drankin@cabrini.com.au
C Alfred Hospital Emergency and Trauma Centre, Melbourne, Vic., Australia.
D School of Public Health and Preventative Medicine, Monash University, Melbourne, Vic., Australia.
E Present address: Monash Medical Centre, Melbourne, Vic., Australia.
F Corresponding author. Email nisal.punchihewa@gmail.com
Australian Health Review 45(6) 690-695 https://doi.org/10.1071/AH21185
Submitted: 30 May 2021 Accepted: 27 July 2021 Published: 3 December 2021
Journal Compilation © AHHA 2021 Open Access CC BY
Abstract
Objective The COVID-19 pandemic in Australia coincided with an early trend of reduced visits to the emergency department (ED), but to determine which patients presented less requires closer evaluation. Identifying which patient groups are presenting less frequently will provide a better understanding of health care utilisation behaviours during a pandemic and inform healthcare providers of the potential challenges in managing these groups.
Methods This single-centre retrospective study examined trends in presentations in 2020 to a private, mixed paediatric and adult ED in an inner city suburb within the state of Victoria that treats both COVID-19 and non-COVID-19 patients. The 2019 dataset was used as a reference baseline for comparison. All analyses were performed using baseline characteristics and triage data.
Results The total number of visits to the ED dropped from 24 775 in 2019 to 22 754 in 2020, representing an overall reduction of 8%. Significant reductions in daily presentations and admissions from the ED were observed in the months immediately following the peak of the two COVID-19 waves in the state of Victoria. Visits by those in the 0- to 17-year age group, triage categories 4 and 5 and musculoskeletal presentations were also reduced for most of 2020. Gastrointestinal/abdominal and urological/renal presentations were reduced immediately after the first COVID-19 wave, whereas infectious diseases visits were reduced during and after the second COVID-19 wave.
Conclusions These findings add to the growing body of evidence regarding emergency care underutilisation during the COVID-19 pandemic. Reduced private ED presentations were observed overall and in paediatric patients, lower acuity triage categories, musculoskeletal, abdominal/gastrointestinal and urological/renal presentations during the first wave, whereas infectious disease cases were reduced during the second wave.
What is known about the topic? During the first and second waves of COVID-19 in Victoria, ED visits were reduced in the public sector across all diagnostic categories and all triage categories. The effect of the COVID-19 pandemic on private ED attendance is less well known.
What does this paper add? Total visits to the private ED during the first and second waves of COVID-19 were reduced across all major diagnostic categories except cardiac presentations. During this same period, visits for triage categories 4 and 5 were significantly reduced.
What are the implications for practitioners? ED underutilisation during the initial two waves of the COVID-19 pandemic is apparent in both the private and public sector. Patients should be encouraged not to delay seeking urgent medical care during the pandemic.
Keywords: COVID-19, pandemic, delayed diagnosis, reduced visits, emergency care, emergency department, private, public health.
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