Factors reducing inappropriate attendances to emergency departments before and during the COVID-19 pandemic: A multicentre study

Abstract

Introduction: Inappropriate attendances (IAs) to emergency departments (ED) create an unnecessary strain on healthcare systems. With decreased ED attendance during the COVID-19 pandemic, this study postulates that there are less IAs compared to before the pandemic and identifies factors associated with IAs. Methods: We performed a retrospective review of 29,267 patient presentations to a healthcare cluster in Singapore from 7 April 2020 to 1 June 2020, and 36,370 patients within a corresponding period in 2019. This time frame coincided with local COVID-19 lockdown measures. IAs were defined as patient presentations with no investigations required, with patients eventually discharged from the ED. IAs in the 2020 period during the pandemic were compared with 2019. Multivariable logistic regression was performed to identify factors associated with IAs. Results: There was a decrease in daily IAs in 2020 compared to 2019 (9.91±3.06 versus 24.96±5.92, P<0.001). IAs were more likely with self-referrals (adjusted odds ratio [aOR] 1.58, 95% confidence interval [CI] 1.50–1.66) and walk-ins (aOR 4.96, 95% CI 4.59–5.36), and those diagnosed with non-specific headache (aOR 2.08, 95% CI 1.85–2.34), or non-specific low back pain (aOR 1.28, 95% CI 1.15–1.42). IAs were less likely in 2020 compared to 2019 (aOR 0.67, 95% CI 0.65–0.71) and older patients (aOR 0.79 each 10 years, 95% CI 0.78–0.80). Conclusion: ED IAs decreased during COVID-19. The pandemic has provided a unique opportunity to examine factors associated with IAs. Keywords: COVID-19, emergency department, inappropriate attendance, utilisation