Impact on emergency and elective hospital-based care in Scotland over the first 12 months of the pandemic: interrupted time-series analysis of national lockdowns

Author:

Shah Syed Ahmar1ORCID,Mulholland Rachel H1,Wilkinson Samantha1,Katikireddi Srinivasa Vittal2,Pan Jiafeng3,Shi Ting1ORCID,Kerr Steven1,Agrawal Uktarsh4ORCID,Rudan Igor1,Simpson Colin R15,Stock Sarah J1,Macleod John6,Murray Josephine-LK7,McCowan Colin4,Ritchie Lewis8,Woolhouse Mark1,Sheikh Aziz1

Affiliation:

1. Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH16 4UX UK

2. MRC/CSO Social & Public Health Sciences Unit, University of Glasgow G3 7HR, Glasgow, UK

3. Department of Mathematics and Statistics, University of Strathclyde, Glasgow, G1 1XH UK

4. School of Medicine, University of St. Andrews, St Andrews, KY16 9TF UK

5. School of Health, Wellington Faculty of Health, Victoria University of Wellington, PO Box 600,Wellington 6140 New Zealand

6. The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, BS1 2NT, UK

7. Public Health Scotland, Glasgow, G2 6QE UK

8. Academic Primary Care, University of Aberdeen School of Medicine and Dentistry, Aberdeen, AB24 3FX UK

Abstract

Objectives COVID-19 has resulted in the greatest disruption to National Health Service (NHS) care in its over 70-year history. Building on our previous work, we assessed the ongoing impact of pandemic-related disruption on provision of emergency and elective hospital-based care across Scotland over the first year of the pandemic. Design We undertook interrupted time-series analyses to evaluate the impact of ongoing pandemic-related disruption on hospital NHS care provision at national level and across demographics and clinical specialties spanning the period 29 March 2020–28 March 2021. Setting Scotland, UK. Participants Patients receiving hospital care from NHS Scotland. Main outcome measures We used the percentage change of accident and emergency attendances, and emergency and planned hospital admissions during the pandemic compared to the average admission rate for equivalent weeks in 2018–2019. Results As restrictions were gradually lifted in Scotland after the first lockdown, hospital-based admissions increased approaching pre-pandemic levels. Subsequent tightening of restrictions in September 2020 were associated with a change in slope of relative weekly admissions rate: –1.98% (–2.38, –1.58) in accident and emergency attendance, –1.36% (–1.68, –1.04) in emergency admissions and –2.31% (–2.95, –1.66) in planned admissions. A similar pattern was seen across sex, socioeconomic status and most age groups, except children (0–14 years) where accident and emergency attendance, and emergency admissions were persistently low over the study period. Conclusions We found substantial disruption to urgent and planned inpatient healthcare provision in hospitals across NHS Scotland. There is the need for urgent policy responses to address continuing unmet health needs and to ensure resilience in the context of future pandemics.

Funder

Medical Research Council

Publisher

SAGE Publications

Subject

General Medicine

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