Louisiana State University Health Sciences Center Emergency Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA 70808, United States of America.
Louisiana State University Health Sciences Center Emergency Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA 70808, United States of America; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA 70808, United States of America.
Am J Emerg Med. 2021 Oct;48:114-119. doi: 10.1016/j.ajem.2021.04.022. Epub 2021 Apr 20.
Despite the trend of rising Emergency Department (ED) visits over the past decade, researchers have observed drastic declines in number of ED visits due to the COVID-19 pandemic. The purpose of the current study was to examine the impact of the COVID-19 pandemic and governor mandated Stay at Home Order on ED super utilizers.
This was a retrospective chart review of patients presenting to the 12 emergency departments of the Franciscan Mission of Our Lady Hospital System in Louisiana between January 1, 2018 and December 31, 2020. Patients who were 18 years of age or older and had four ED visits within a one-year period (2018, 2019, or 2020) were classified as super-utilizers. We examined number and category of visits for the baseline period (January 2018 - March 2020), the governor's Stay at Home Order, and the subsequent Reopening Phases through December 31, 2020.
The number of visits by super utilizers decreased by over 16% when the Stay at Home Order was issued. The average number of visits per week rose from 1010.63 during the Stay at Home Order to 1198.09 after the Stay at Home Order was lifted, but they did not return to Pre-COVID levels of approximately 1400 visits per week in 2018 and 2019. When categories of visits were examined, this trend was found for emergent visits (p < 0.001) and visits related to injuries (p < 0.001). Non-emergent visits declined during the Stay at Home Order compared to the baseline period (p < 0.001), and did not increase significantly during reopening compared to the Stay at Home Order (p = 0.87). There were no changes in number of visits for psychiatric purposes, alcohol use, or drug use during the pandemic.
Significant declines in emergent visits raise concerns that individuals who needed ED treatment did not seek it due to COVID-19. However, the finding that super utilizers with non-emergent visits continued to visit the ED less after the Stay at Home Order was lifted raises questions for future research that may inform policy and interventions for inappropriate ED use.
尽管在过去十年中，急诊科（ED）就诊人数呈上升趋势，但由于 COVID-19 大流行，研究人员观察到急诊科就诊人数急剧下降。本研究的目的是研究 COVID-19 大流行和州长强制的居家令对 ED 超级利用者的影响。
这是对路易斯安那州弗朗西斯坎使命圣母医院系统的 12 个急诊科在 2018 年 1 月 1 日至 2020 年 12 月 31 日期间就诊的患者进行的回顾性图表审查。18 岁或以上且在一年内（2018 年、2019 年或 2020 年）有四次 ED 就诊的患者被归类为超级利用者。我们检查了基线期（2018 年 1 月至 2020 年 3 月）、州长的居家令以及随后到 2020 年 12 月 31 日的重新开放阶段的就诊次数和类别。
发布居家令后，超级利用者的就诊次数减少了 16%以上。居家令期间每周就诊次数从 1010.63 次增加到居家令解除后的 1198.09 次，但并未恢复到 2018 年和 2019 年每周约 1400 次的 COVID 前水平。当检查就诊类别时，这一趋势在紧急就诊（p < 0.001）和与伤害相关的就诊（p < 0.001）中均有发现。与基线期相比，居家令期间非紧急就诊次数减少（p < 0.001），与居家令期间相比，重新开放期间非紧急就诊次数并未显著增加（p = 0.87）。在大流行期间，因精神问题、酒精使用或药物使用而就诊的次数没有变化。
紧急就诊次数的显著下降引起了人们的关注，即因 COVID-19 需要接受 ED 治疗的人没有寻求治疗。然而，居家令解除后，非紧急就诊的超级利用者继续到 ED 就诊的次数减少，这引发了人们对未来研究的质疑，这些研究可能会为不当使用 ED 提供信息并制定相关政策和干预措施。
