ER volumes dropped 42% in April due to pandemic

Dive Brief:

  • The number of emergency room visits nationally was 42% lower during the week of April 12-18​ than it was over the same period a year earlier, according to new data from the Centers for Disease Control and Prevention. Patients younger than 14, females, and those in the Northeast region contributed to the largest declines in visits.
  • ER visits have since increased, although the most recent complete week, May 24-30, still remained 26% lower compared to the corresponding week in 2019, according to the report published Wednesday.
  • Some of the highest ER visit declines occurred in COVID-19 hotspot regions, including New York and New Jersey. The CDC said this suggests the pandemic altered the use of the ER by the public.

Dive Insight:

Patients are starting to return to hospitals they largely avoided during the pandemic for delayed elective care, though some early reports show much slower volume rebounds in visits to emergency rooms than other departments.

A study from Transunion Healthcare that surveyed 500 hospitals found that during the week of May 10-16, outpatient visits were down 31% and inpatient volumes were down 20% compared to pre-COVID-19 levels. Emergency visits were down 40%, though older patients are leading the pack in returning to ERs.

The new CDC report lends additional demographic information, finding that ER visits declined for every age group, with the largest proportional declines in visits from children under 10 (72%) and those 11 to 14 (71%).

In the 2019 comparison period, 12% of all ER visits were from children under 10, compared with 6% during the early pandemic period.

The CDC report also looked at which diagnostic categories at ERs saw upticks, though the results were limited by missing specific diagnostic codes in 20% of visits.

The number of visits to ERs that resulted in a diagnosis associated with lower respiratory disease, pneumonia and difficulty breathing during the early pandemic accounted for the highest proportions of diagnoses.

The number of visits for conditions including nonspecific chest pain and heart attacks decreased, suggesting that some people could be delaying care for conditions that might result in additional mortality if left untreated, according to the report.

The CDC also noted that patients who use ERs as a safety net, particularly because they lack access to primary care, might be disproportionately affected from avoiding treatment because of infection risk concerns in those settings.

So much so that health messages reinforcing the importance of immediately seeking care for symptoms of serious conditions are needed, the CDC said.

The American Hospital Association on May 16 launched an ad campaign on network and cable TV along with online platforms to let the public know that even during an ongoing public health crisis, hospitals and health systems are still available to provide other medical care.

The CDC still recommends continued use of virtual visits and triage help lines before going to ERs to minimize the spread of COVID-19 while addressing public concerns about virus exposure at hospitals during a pandemic.

But hospitals are still facing depleted volumes and revenues and remain eager to bring patients back in for care that can’t be delivered remotely.

To address those fears about returning to medical settings, the CDC suggests following its infection control recommendations.

Hospitals should implement temperature screening to help identify infected people, though asymptomatic or pre-symptomatic patients may not show symptoms, it said, along with maintaining separate, well-ventilated triage areas for patients with and without signs and symptoms of COVID-19.

Health systems should also consider policies requiring everyone entering the facility to wear a face covering regardless of symptoms, an approach consistent with recommendations to the general public advising them to wear a cloth face covering whenever they must leave their home, the CDC said.