Emergency Department Utilization within a Rural Health System during Early COVID-19 Pandemic

Abstract

Background: Stay-at-home orders were issued during March 2020 to contain the spread of COVID-19. We sought to understand the impact of COVID-19 on emergency care utilization within one rural health system. Methods: This studied a retrospective cohort of patients presenting to system emergency departments (EDs). Primary outcome was ED volume. Secondary outcomes were admission rate for stroke, acute coronary syndrome (ACS), and critical illness states. A report was generated for all ED visits during study period March 19–May 31, 2020, and reference period: March 19–May 31, 2019. For the primary outcome, a regression model was used. Mixed-effects logistic and linear models were used for evaluating differences in rates for secondary outcomes. Results: There was a decrease in weekly volume (−609 ±57, p < 0.001). There was an increase in admission rate for sepsis (OR 1.43 [95% CI 1.18–1.72]), stroke (OR 1.54 [95% CI 1.11–2.12]), and overall critical illness presentation (OR 1.59 [95% CI 1.41–1.8]). There were higher rates of vasopressor use (OR 1.91 [95% CI 1.56–2.33]) and inpatient mortality (OR 1.49 [95% CI 1.09–2.05]). There were 37 cases of COVID-19. Conclusions: ED volume decreased by 40% with evidence of greater severity of illness in the setting of low COVID-19 disease burden. Efforts should be developed to reassure the public of the importance and safety of timely hospital care during future pandemics. Hospital staffing models should anticipate greater severity of illness despite lower patient volume.