Comparative Analysis of Emergency Department Utilization Patterns During the COVID-19 International Pandemic: Frequent Users vs General Population
Recommended Citation
Shih D, Hawatian K, Page B, Rammal JK, Miller J, Klausner H, Stokes-Buzzelli S. Comparative Analysis of Emergency Department Utilization Patterns During the COVID-19 International Pandemic: Frequent Users vs General Population. Ann Emerg Med 2024; 84(4):S28-S29.
Document Type
Conference Proceeding
Publication Date
10-1-2024
Publication Title
Ann Emerg Med
Abstract
Study Objectives: Frequent emergency department (ED) users present specific challenges in that they often have a medical complaint whether acute or chronic that warrants investigation in addition to complex psychosocial factors. Our hospital has identified frequent users in a program previously described, Community Resources for Emergency Department Overuse (CREDO), who may have complex medical and social needs. The COVID-19 pandemic caused increased stressors on the medical system, decreasing efficiency and access along with diminished social support. This study aimed to evaluate the impact of the effects of a global pandemic on frequent users, specifically the CREDO population with respect to ED utilization. Methods: This was a retrospective observational analysis of patients aged 18 years or older, from a single center tertiary care inner city hospital, who presented to the ED during two periods: July 2018-July 2019 (pre-COVID) and July 2022-July 2023 (post-COVID). CREDO patients were a subset of frequent users with 10 or more ED visits within the last year, identified through a banner in the electronic health record with a care plan of individualized treatment recommendations. Outcomes included ED length of stay (LOS) and rates of leaving without completing services (LWCS), which included against medical advice (AMA) and left before being seen (LWBS) dispositions. A banner notified providers of recommendations to expedite care in patients. The analysis includes descriptive and univariate statistical comparisons, reporting standard deviation [SD] and 95% confidence intervals (CI) where appropriate. Results: Analysis included 89,768 general adult and 3,690 CREDO patient encounters pre-COVID and 73,994 general adult and 3,740 CREDO patient encounters post-COVID. [SD1] CREDO patients pre- and post-COVID were mostly Black (86% and 79%, respectively), male (72% and 78%), with an average age of 52 and 49 years. LOS were compared during both timeframes. Pre-COVID, CREDO patients had a mean LOS of 431 [332] versus 420 [357] minutes in the general population (difference 11, 95% CI 1 to -22 minutes, p=0.056). Post-COVID, CREDO patients had a mean LOS of 528 [496] versus 674 [697] minutes for general patients (difference -147, 95% CI -130 to -163 minutes, p<0.001). The pre-COVID rate of LWCS in the CREDO group was 11.8% versus 35.1% post-COVID (p<0.001), whereas the LWCS rate for the general population was 6.7% pre-COVID and 14.8% post-COVID (p<0.001). Post-COVID, CREDO patients had 3.4 times the odds (95% CI 3.1 – 3.6, p<0.001) of leaving LWCS compared to all other patients. Conclusion: Post-pandemic, the ED faced longer boarding times and nursing shortages, resulting in increased LOS for both groups. Although LOS was generally longer post-COVID, the increase was less pronounced for CREDO patients. Healthcare providers streamlined care for CREDO patients using the banner, mitigating resource pressure. However, the decreased LOS among CREDO patients post-COVID was also influenced by their increased LWCS rate. Although the association between these factors and LOS cannot be definitively determined from the available data, it remains a plausible contributing factor. The use of the CREDO banner is effective in managing patient flow after COVID-19, however, further analysis is needed to fully understand the impact of factors such as LWCS on LOS and patient outcomes among CREDO patients.
Volume
84
Issue
4
First Page
S28
Last Page
S29
