Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.
PLoS One. 2024 Nov 1;19(11):e0311901. doi: 10.1371/journal.pone.0311901. eCollection 2024.
Access to and use of urgent and emergency care in the United Kingdom's National Health Service reduced during COVID-19 related lockdowns but demand reportedly increased since then. We investigated the impact of COVID-19 on urgent and emergency health care services activity in an eastern England population of 1.1 million.
We used health care activity data from a municipal health department, recorded at the level of discrete events (such as visits to hospital or ambulance calls) to compare system activity between 2018-2020 (pre-COVID), 2020-2021 (lockdown) and 2021-2023 (post-lockdown), carrying out interrupted time series analyses to describe changes in activity.
Daily emergency department (ED) attendances were 10% (95% confidence interval 9-12%) lower during the lockdown period, and 7% (6-8%) higher in the post-lockdown period than pre-COVID. Attendances arriving by ambulance were 13% (12-14%) lower post-lockdown than pre-COVID, while attendances of arrivals by other means were 17% (16-19%) higher. Post-lockdown, overall attendances were continually reducing. ED waiting times were 45% (44-47%) longer in the post-lockdown period compared to the pre-COVID period and continued to increase post-lockdown. There was a 15% (14-16%) reduction in daily ambulance dispatches post-lockdown versus pre-COVID. Ambulance arrivals with delayed handover to hospital care exceeding 60 minutes increased by 17% (16-18%) post-lockdown versus pre-COVID, and probability of delay showed a continuously upward trend post-lockdown of 20% (19-21%) per year.
Patients are facing long waits in EDs to be admitted to hospital, discharged or transferred. This results in delays in ambulances handing over patients and attending to other calls, which may explain decreasing rates of ambulance dispatches. Potential solutions are likely to involve enhancing the flow through and discharge of patients from hospital, and a whole systems approach which considers the capacity of the local health and care infrastructure, including intermediate care and social care.
在与 COVID-19 相关的封锁期间，英国国民保健制度（NHS）中紧急和紧急护理的可及性和使用减少，但此后需求据报有所增加。我们调查了 COVID-19 对英格兰东部一个 110 万人口的紧急和紧急医疗保健服务活动的影响。
我们使用市政卫生部门的医疗保健活动数据，按离散事件（如去医院就诊或救护车呼叫）记录，以比较 2018-2020 年（COVID-19 前）、2020-2021 年（封锁期间）和 2021-2023 年（封锁后）之间的系统活动，进行中断时间序列分析以描述活动变化。
封锁期间，每日急诊部（ED）就诊人数减少 10%（95%置信区间 9-12%），封锁后比 COVID-19 前增加 7%（6-8%）。封锁后通过救护车到达的就诊人数比 COVID-19 前减少 13%（12-14%），而其他方式到达的就诊人数增加 17%（16-19%）。封锁后，整体就诊人数持续减少。与 COVID-19 前相比，封锁后 ED 的等待时间延长了 45%（44-47%），并且在封锁后继续增加。与 COVID-19 前相比，封锁后每日救护车出动次数减少了 15%（14-16%）。封锁后，救护车交接至医院护理时间超过 60 分钟的情况增加了 17%（16-18%），与 COVID-19 前相比，延迟的可能性呈持续上升趋势，每年增加 20%（19-21%）。
患者在急诊部等待住院、出院或转院的时间较长。这导致救护车交接患者和处理其他呼叫的时间延迟，这可能解释了救护车出动率下降的原因。潜在的解决方案可能涉及增强患者从医院的流动和出院，以及考虑当地卫生和保健基础设施（包括中级保健和社会保健）能力的整体系统方法。
