?:abstract
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Study Objectives: NYC Health + Hospitals/Elmhurst, a public hospital in Queens, NY, was one of the first and hardest hit hospitals in the COVID-19 pandemic Emergency department (ED) clinicians anecdotally began to note a rise in ED visit volumes near the end of February 2020, which quickly became an unprecedented surge before tapering to unprecedentedly low levels This study quantifies Elmhurst ED volumes throughout the pandemic, from early March to late May 2020, and compares them to the corresponding 2019 volumes In addition, rates of admission from the ED to the hospital are examined to help determine the severity of symptoms in patients who did present to the ED, especially as volumes declined Methods: Number of daily ED visits and daily admissions were obtained from the electronic medical record, EPIC, for the 12 weeks beginning the first Sunday of March 2020 (March 1-May 23, 2020) and the corresponding 12 weeks of 2019 (March 3-May 25, 2019) Daily ED visits were counted by the number of patients who registered to be seen during the 24-hour period Results: A sharply increasing trend in ED volumes began around March 10, 2020 and peaked on March 18, when the daily ED volume was 68% greater than on the corresponding Wednesday of 2019 A sharp decrease in ED volumes followed, leveling off around the week of April 12 Between April 12 and May 23, the average daily ED volume was 65% less than for the corresponding period in 2019 In addition, the daily percentage of ED visits admitted to the hospital began to rise around the fourth week of March 2020, peaking at 59% admitted on April 2 The admission rate trended down through April and May but remained notably higher than 2019: for example, between May 3 and May 23, 2020, the average daily admission rate was 22%, compared to 14% during the corresponding period in 2019, a statistically significant difference (p < 0 001) Conclusion: Although other sources have reported decreased ED volumes in some areas throughout the COVID-19 pandemic, it is important to note the two-stage response at the epicenter of the crisis Similar patterns might be observed if COVID-19 spreads to new areas or reappears as a second wave, or in the event of a different, future pandemic The speed and magnitude of the surge in ED volumes suggest that ED staff, testing capacity, and other resources can quickly be overwhelmed without advance preparation In addition, the striking decrease in ED volumes in April and May 2020 compared to 2019, not unlike patterns being seen across the country, raises concern about delays in care due to the public’s fear of seeking medical attention during the pandemic The markedly elevated rates of admission from the ED to the hospital during this time confirm that patients presenting to the ED have more severe symptoms on average, possibly due to delaying seeking care for mild or early symptoms of serious conditions [Formula presented]
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