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The Impact of COVID-19 on a Large, Canadian Community Emergency Department.
West J Emerg Med. 2021 May 05; 22(3):572-579.WJ

Abstract

INTRODUCTION

As the COVID-19 pandemic unfolded, emergency departments (EDs) across the world braced for surges in volume and demand. However, many EDs experienced decreased demand even for higher acuity illnesses. In this study we sought to examine the change in utilization at a large Canadian community ED, including changes in patient demographics and presentations, as well as structural and administrative changes made in response to the pandemic.

METHODS

This retrospective observational study took place in Ontario, Canada, from March 17-June 30, 2020, during province-wide lockdowns in response to COVID-19. We used a control period of March 17-June 30 in 2018-2019. Differences between observed and expected values were calculated for total visits, Canadian Triage and Acuity Scale (CTAS) groups, and age groups using Fisher's exact test. Length of stay (LOS), physician initial assessment time (PIA), and top primary and admission diagnoses were also examined.

RESULTS

Patient visits fell to 66.3% of expected volume in the exposure period (20,901 vs 31,525, P<0.0001). CTAS-1 (highest acuity) patient volumes dropped to 86.8% of expected (P = 0.1964) while CTAS-5 (lowest acuity) patient volumes dropped to 32.4% of expected (P <0.0001). Youth (0-17), adult (18-64), and senior (65+) visits all decreased to 37.4%, 71.7%, and 72.9% of expected volumes, respectively (P <0.0001). Median PIA and median ED LOS both decreased (1.1 to 0.6 hours and 3.3 to 3.0 hours, respectively). The most common primary diagnosis in both periods was "other chest pain." Viral syndromes were more prevalent in the exposure period. The top admission diagnoses were congestive heart failure in the control period (4.8%) and COVID-19 in the study period (3.5%).

CONCLUSION

ED utilization changed drastically during COVID-19. Our ED responded with wide stakeholder engagement, spatial reorganization, and human resources changes informed by real-time data. Our experiences can help prepare for potential subsequent "waves" of COVID-19 and future pandemics.

Authors+Show Affiliations

Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada.Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada.Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada.Mackenzie Health, Department of Emergency Medicine, Richmond Hill, Ontario, Canada.University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada. University Health Network, Department of Emergency Medicine, Toronto, Ontario, Canada.University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada. University Health Network, Department of Emergency Medicine, Toronto, Ontario, Canada.Mackenzie Health, Department of Emergency Medicine, Richmond Hill, Ontario, Canada. University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada. McMaster University, Department of Family Medicine, Hamilton, Ontario, Canada.Mackenzie Health, Department of Emergency Medicine, Richmond Hill, Ontario, Canada. University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada. University Health Network, Department of Emergency Medicine, Toronto, Ontario, Canada.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

34125029

Citation

Lee, Daniel Dongjoo, et al. "The Impact of COVID-19 On a Large, Canadian Community Emergency Department." The Western Journal of Emergency Medicine, vol. 22, no. 3, 2021, pp. 572-579.
Lee DD, Jung H, Lou W, et al. The Impact of COVID-19 on a Large, Canadian Community Emergency Department. West J Emerg Med. 2021;22(3):572-579.
Lee, D. D., Jung, H., Lou, W., Rauchwerger, D., Chartier, L. B., Masood, S., Sathiaseelan, S., & Taher, A. K. (2021). The Impact of COVID-19 on a Large, Canadian Community Emergency Department. The Western Journal of Emergency Medicine, 22(3), 572-579. https://doi.org/10.5811/westjem.2021.1.50123
Lee DD, et al. The Impact of COVID-19 On a Large, Canadian Community Emergency Department. West J Emerg Med. 2021 May 5;22(3):572-579. PubMed PMID: 34125029.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Impact of COVID-19 on a Large, Canadian Community Emergency Department. AU - Lee,Daniel Dongjoo, AU - Jung,Hyejung, AU - Lou,Wendy, AU - Rauchwerger,David, AU - Chartier,Lucas B, AU - Masood,Sameer, AU - Sathiaseelan,Seyon, AU - Taher,Ahmed Khaled, Y1 - 2021/05/05/ PY - 2020/10/04/received PY - 2021/01/26/accepted PY - 2021/6/14/entrez PY - 2021/6/15/pubmed PY - 2021/7/2/medline SP - 572 EP - 579 JF - The western journal of emergency medicine JO - West J Emerg Med VL - 22 IS - 3 N2 - INTRODUCTION: As the COVID-19 pandemic unfolded, emergency departments (EDs) across the world braced for surges in volume and demand. However, many EDs experienced decreased demand even for higher acuity illnesses. In this study we sought to examine the change in utilization at a large Canadian community ED, including changes in patient demographics and presentations, as well as structural and administrative changes made in response to the pandemic. METHODS: This retrospective observational study took place in Ontario, Canada, from March 17-June 30, 2020, during province-wide lockdowns in response to COVID-19. We used a control period of March 17-June 30 in 2018-2019. Differences between observed and expected values were calculated for total visits, Canadian Triage and Acuity Scale (CTAS) groups, and age groups using Fisher's exact test. Length of stay (LOS), physician initial assessment time (PIA), and top primary and admission diagnoses were also examined. RESULTS: Patient visits fell to 66.3% of expected volume in the exposure period (20,901 vs 31,525, P<0.0001). CTAS-1 (highest acuity) patient volumes dropped to 86.8% of expected (P = 0.1964) while CTAS-5 (lowest acuity) patient volumes dropped to 32.4% of expected (P <0.0001). Youth (0-17), adult (18-64), and senior (65+) visits all decreased to 37.4%, 71.7%, and 72.9% of expected volumes, respectively (P <0.0001). Median PIA and median ED LOS both decreased (1.1 to 0.6 hours and 3.3 to 3.0 hours, respectively). The most common primary diagnosis in both periods was "other chest pain." Viral syndromes were more prevalent in the exposure period. The top admission diagnoses were congestive heart failure in the control period (4.8%) and COVID-19 in the study period (3.5%). CONCLUSION: ED utilization changed drastically during COVID-19. Our ED responded with wide stakeholder engagement, spatial reorganization, and human resources changes informed by real-time data. Our experiences can help prepare for potential subsequent "waves" of COVID-19 and future pandemics. SN - 1936-9018 UR - https://www.unboundmedicine.com/medline/citation/34125029/The_Impact_of_COVID_19_on_a_Large_Canadian_Community_Emergency_Department_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/34125029/ DB - PRIME DP - Unbound Medicine ER -