The impact of SARS-CoV-2 on emergency health care in a referral acute-care center in northern Italy: Allegra Ferrari. (25th October 2022)

• Record Type: Journal Article
• Authors: Ferrari, A; Parente, F; Iudica, G; Porretto, M; Simonetta, D; Minet, C; Mosca, S; Panatto, D; Orsi, A; Icardi, G
• Is Part Of: European journal of public health. Volume 32(2022)Supplement 3
• Publication Date: 2022-10-25
• Subjects: Epidemiology -- Europe -- Periodicals; Public health -- Europe -- Periodicals; 362.109405
• DOI: 10.1093/eurpub/ckac129.540
• Languages: English
• ISSNs: 1101-1262

Abstract

Abstract: : To assess how SARS-CoV-2 has changed the demand for in-person health care, we retrospectively analyzed data on access to the emergency department (ED) of San Martino Hospital, the referral acute-care center in the Liguria region (Northwest Italy). 181, 699 records of patients diagnosed with an ICD-9 code between 2019 and 2021 were considered. In comparison to pre-pandemic levels, following the introduction of social distancing measures, the median number of ED visits declined by 41.4% in 2020 and by 28.1% in 2021. The period of maximum drop in access (-58.6%) corresponded to the 2020 11-12th calendar weeks and coincided with the highest rates of COVID-like illness - defined as either ILI or LRTI cases - identified through an operator-dependent syndromic surveillance system (+340%; 19.5% of total ED attendances). In terms of relative impact, in 2020 and 2021 non-urgent ED codes decreased (by 6.7% and 7.3%) and both urgent and emergency ED codes increased (by 4.8% and 3.8% the former; 5.5% and 8.8% the latter), even so, the absolute number of ED access fell drastically for all codes. Urgent codes, in particular, experienced the most severe decrease, shifting from a pre-pandemic value of 25, 009 to 18, 826 in 2020 and 19, 528 in 2021. With regards to diagnosis, in 2020, respiratory infections saw the highest increase (+3.3%) while traumas and eye diseases saw the highest decrease (-1.1% and -3.8%, respectively). This trend reversed in 2021 during which respiratory infections decreased (-2.2%) and traumas increased (+2.2%). Despite the admissions of males and the elderly being routinely lower, these categories experienced the greatest increase in access for respiratory infections: +3.9% and +10.1% in 2020; +2.8% and +7.4% in 2021. While reduction of non-urgent ED visits indicates that the high pre-pandemic access levels may have been avoidable, the significant decline in non-COVID-19 urgent accesses potentially points to an increase in delayed and missed care. Key messages: During the COVID-19 pandemic – possibly due to fear and underestimation of symptoms – there was an overall reduction in ED accesses that potentially points to an increase in delayed or missed care. The reduction in non-urgent attendances indicates that high pre-pandemic accesses may have been avoidable and that a reduction in unnecessary ED visits is an attainable goal for healthcare systems.