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{ "pk": 14617, "title": "The Impact of COVID-19 on a Large, Canadian Community Emergency Department", "subtitle": null, "abstract": "Introduction: \nAs 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.\nMethods:\n 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.\nResults:\n 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%).\nConclusion:\n 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.", "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 care systems" }, { "word": "Emergency Departments" }, { "word": "emergency department utilisation" }, { "word": "triage" }, { "word": "planning" }, { "word": "management" }, { "word": "Emergency Department Management" } ], "section": "Endemic Infections", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/0xk8j1fj", "frozenauthors": [ { "first_name": "Daniel Dongjoo", "middle_name": "", "last_name": "Lee", "name_suffix": "", "institution": "Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada\nDalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada", "department": "None" }, { "first_name": "Hyejung", "middle_name": "", "last_name": "Jung", "name_suffix": "", "institution": "Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada", "department": "None" }, { "first_name": "Wendy", "middle_name": "", "last_name": "Lou", "name_suffix": "", "institution": "Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada", "department": "None" }, { "first_name": "David", "middle_name": "", "last_name": "Rauchwerger", "name_suffix": "", "institution": "Mackenzie Health, Department of Emergency Medicine, Richmond Hill, Ontario, Canada", "department": "None" }, { "first_name": "Lucas", "middle_name": "B.", "last_name": "Chartier", "name_suffix": "", "institution": "University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada\nUniversity Health Network, Department of Emergency Medicine, Toronto, Ontario, Canada", "department": "None" }, { "first_name": "Sameer", "middle_name": "", "last_name": "Masood", "name_suffix": "", "institution": "University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada\nUniversity Health Network, Department of Emergency Medicine, Toronto, Ontario, Canada", "department": "None" }, { "first_name": "Seyon", "middle_name": "", "last_name": "Sathiaseelan", "name_suffix": "", "institution": "Mackenzie Health, Department of Emergency Medicine, Richmond Hill, Ontario, Canada \nUniversity of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada\nMcMaster University, Department of Family Medicine, Hamilton, Ontario, Canada", "department": "None" }, { "first_name": "Ahmed", "middle_name": "Khaled", "last_name": "Taher", "name_suffix": "", "institution": "Mackenzie Health, Department of Emergency Medicine, Richmond Hill, Ontario, Canada \nUniversity of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada\nUniversity Health Network, Department of Emergency Medicine, Toronto, Ontario, Canada", "department": "None" } ], "date_submitted": "2020-10-05T00:00:21+05:30", "date_accepted": "2020-10-05T00:00:21+05:30", "date_published": "2021-05-05T23:51:02+05:30", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/14617/galley/7457/download/" } ] }