{"pk":14385,"title":"Who Stayed Home Under Safer-at-Home? Impacts of COVID-19 on Volume and Patient-Mix at an Emergency Department","subtitle":null,"abstract":"Introduction:\n To describe the impact of COVID-19 on a large, urban emergency department (ED) in Los Angeles, California, we sought to estimate the effect of the novel coronavirus 2019 (COVID-19) and “safer-at-home” declaration on ED visits, patient demographics, and diagnosis-mix compared to prior years.\nMethods:\n We used descriptive statistics to compare ED volume and rates of admission for patients presenting to the ED between January and early May of 2018, 2019, and 2020.\nResults:\n Immediately after California’s “safer-at-home” declaration, ED utilization dropped by 11,000 visits (37%) compared to the same nine weeks in prior years. The drop affected patients regardless of acuity, demographics, or diagnosis. Reductions were observed in the number of patients reporting symptoms often associated with COVID-19 and all other complaints. After the declaration, higher acuity, older, male, Black, uninsured or non-Medicaid, publicly insured, accounted for a disproportionate share of utilization.\nConclusion:\n We show an abrupt, discontinuous impact of COVID-19 on ED utilization with a slow return as safer-at-home orders have lifted. It is imperative to determine how this reduction will impact patient outcomes, disease control, and the health of the community in the medium and long terms.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"emergency department, safety net, GIS, causal inference, vulnerable populations"}],"section":"Endemic Infections","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1kv121qg","frozenauthors":[{"first_name":"Chun Nok","middle_name":"","last_name":"Lam","name_suffix":"","institution":"University of Southern California, Keck School of Medicine, Department of Emergency Medicine, Los Angeles, California","department":"None"},{"first_name":"Sarah","middle_name":"","last_name":"Axeen","name_suffix":"","institution":"University of Southern California, Keck School of Medicine, Department of Emergency Medicine, Los Angeles, California; USC Schaeffer Center for Health Policy and Economics, Los Angeles, California","department":"None"},{"first_name":"Sophie","middle_name":"","last_name":"Terp","name_suffix":"","institution":"University of Southern California, Keck School of Medicine, Department of Emergency Medicine, Los Angeles, California; USC Schaeffer Center for Health Policy and Economics, Los Angeles, California","department":"None"},{"first_name":"Elizabeth","middle_name":"","last_name":"Burner","name_suffix":"","institution":"University of Southern California, Keck School of Medicine, Department of Emergency Medicine, Los Angeles, California","department":"None"},{"first_name":"Dan","middle_name":"A.","last_name":"Dworkis","name_suffix":"","institution":"University of Southern California, Keck School of Medicine, Department of Emergency Medicine, Los Angeles, California","department":"None"},{"first_name":"Sanjay","middle_name":"","last_name":"Arora","name_suffix":"","institution":"University of Southern California, Keck School of Medicine, Department of Emergency Medicine, Los Angeles, California; USC Schaeffer Center for Health Policy and Economics, Los Angeles, California","department":"None"},{"first_name":"Michael","middle_name":"","last_name":"Menchine","name_suffix":"","institution":"University of Southern California, Keck School of Medicine, Department of Emergency Medicine, Los Angeles, California","department":"None"}],"date_submitted":"2020-07-23T18:59:37-04:00","date_accepted":"2020-07-23T18:59:37-04:00","date_published":"2021-02-08T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/14385/galley/7385/download/"}]}