Hospital ED visits still down 26% following declines stemming from COVID-19, CDC reports

• Hospital ED visits remain one-quarter below normal, according to the latest data.
• Children and women are more likely to avoid EDs.
• Hospitals should encourage community residents to seek emergency care when needed.

Hospital emergency department (ED) volumes by the end of May were still 26% lower than a year earlier, according to new federal survey data.

The Centers for Disease Control and Prevention (CDC) analyzed data through May 30 from the National Syndromic Surveillance Program (NSSP), which includes electronic data from hospitals in 47 states, comprising about 73% of ED visits.

Among the findings on how the coronavirus pandemic and subsequent shutdowns affected ED visits:

• By the week of May 24–30, visits remained 26% below same week in 2019.
• The lowest number of visits occurred the week of April 12–18.
• Weekly ED visits decreased by a mean 42% March 31-April 27.
• The largest decline in visits was by children younger than 11 (72%).
• A similar decline was found for children 11–14 (71%).
• Visits declined by 37% among males and 45% among females.

“The striking decline in ED visits nationwide, with the highest declines in regions where the pandemic was most severe in April 2020, suggests that the pandemic has altered the use of the ED by the public,” the CDC authors wrote. “Persons who use the ED as a safety net because they lack access to primary care and telemedicine might be disproportionately affected if they avoid seeking care because of concerns about the infection risk in the ED.”

The collapse of ED use during the pandemic and ensuing state-ordered shutdowns echoed recent industry research, including the finding that ED use remains the biggest laggard in hospital operations recovery, according to a revenue cycle analysis by TransUnion Healthcare.

Nearly one-third of American adults (29%) said they have delayed or avoided medical care because they are concerned about contracting COVID-19, according to a recent poll by Morning Consult and the American College of Emergency Physicians (ACEP).

“Waiting to see a doctor if you think you’re having a medical emergency could be life threatening,” said William Jaquis, MD, president of ACEP. “While it’s important to stay home and follow social distancing guidelines, it’s critical to always know when to go to the emergency department.”

The CDC report also found that declines in ED visits varied sharply by geography. The largest declines occurred in the Northeast and in the region that includes New Jersey and New York.

That finding quantified the observations of hospital executives and industry analysts in recent interviews. They said patients in areas that were heavily hit by the virus appeared to most strongly associate hospitals with the illness and had the greatest fear of using such facilities.

Conditions affected by the decline in ED visits

The peak pandemic period also had major changes in the types of conditions for which patients came to the ED.

The diagnostic categories with the largest reductions, for all age groups, included:

• Abdominal pain and other digestive or abdominal signs and symptoms
• Musculoskeletal pain
• Essential hypertension

In women and girls, large declines in visits also occurred for urinary tract infections, with a 19,833 decrease in mean weekly visits.

During the early pandemic period, ED visits for “exposure, encounters, screening, or contact with infectious disease” represented the largest increase in conditions treated, with a mean weekly increase of 18,834 cases.

Hospital urged to address the situation

The CDC said hospitals and health systems should address public concern about exposure to COVID-19 in the ED by adhering to infection control recommendations, such as immediately screening every person for fever and symptoms of COVID-19 and maintaining separate, well-ventilated triage areas for patients with and without signs and symptoms of COVID-19.

Additionally, the CDC urged hospitals to ramp up messaging about the importance of immediately seeking care for serious conditions for which ED visits cannot be avoided.

Expanded access to triage telephone lines could help patients rapidly decide whether they need to go to an ED for symptoms of COVID-19 infection or for other urgent conditions, the CDC noted.

For conditions that do not require immediate care or in-person treatment, the CDC recommended health systems continue to expand the use of virtual visits during the pandemic.