The Impact of COVID-19 on an Irish Emergency Department (ED): Unlocking the Factors influencing Decision to Attend the ED in a Repeated Measure, Cross-sectional Study

Background: Emergency Department (ED) crowding is a global public health crisis which has been compounded by the COVID-19 pandemic. The collateral damage of SARS-CoV-2 is a serious concern in the Emergency Medicine (EM) community, specifically in relation to delayed care increasing morbidity and mortality in attendances unrelated to COVID-19. The objectives of this study are to describe the profile of patients attending an Irish ED prior to, and during the pandemic, and to investigate the factors influencing ED utilisation in this cohort. Methods: This was a repeated measure, cross-sectional study with recruitment at three time-points prior to the onset of COVID-19 in December 2019 (n=47) and February 2020 (n=57) and post-Lockdown 1 in July 2020 (n=70). At each time-point all adults presenting over a 24h period were eligible for inclusion. Clinical data were collected via electronic records and a questionnaire provided information on demographics, healthcare utilisation, service awareness and factors influencing the decision to attend the ED. Results: The demographic and clinical profile of patients across time-points was comparable in terms of age (p=0.904), gender (p=0.584) and presenting complaint (p=0.556). Median length of stay in the ED decreased from 7.25h (IQR 4.18-11.22) in February to 3.86h (IQR 0.41-9.14) in July (p≤0.005) and differences were observed in disposition (p≤0.001). COVID-19 influenced decision to attend the ED for 31% of patients with 9% delaying presentation. Post-lockdown, patients were less likely to attend the ED for reassurance (p≤0.005), for a second opinion (p≤0.005) or to see a specialist (p≤0.05). Conclusions: This study illustrates the importance of addressing capacity and flow in the wider hospital and within community services. Sustainable system-wide solutions are required to tackle ED crowding and COVID-19 may have provided further evidence that the solutions lie largely outside of the ED. These findings provide useful information for hospitals with regard to pandemic preparedness and also have wider implications for planning of future health service delivery.