Latest study highlights impact of COVID-19 pandemic on emergency department visits in British Columbia

A brand new study showing the impact of the COVID-19 pandemic and mitigation strategies used to administer the virus on emergency department (ED) visits in British Columbia will help with future planning. The study is published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.221516.

“Evaluation of the results of the pandemic and associated measures can provide a historical account and inform health care service planning for each postpandemic recovery and mitigation of potential consequences of restrictions for future pandemics,” write scientists from the British Columbia Centre for Disease Control (BCCDC) and Vancouver Coastal Health, Vancouver, British Columbia. “Insights from this study may also trigger further research on the drivers of the changes and inform strategies for emergency care.”

Previous studies have assessed the impact of the pandemic on ED visits, but few have checked out the health reasons for these visits.

To know the impact of the pandemic in response to health visit type over the primary 3 years of the pandemic, scientists checked out data from 30 emergency departments and greater than 10.7 million visits across British Columbia from January 2016 to December 2022. Using modeling, they estimated what usual patterns of ED visits would have been compared with actual visits in the course of the pandemic. The smallest variety of ED visits were in April and December 2020, reflecting the results of the strong virus mitigation measures, and visits returned to pre-pandemic levels in May 2021.

After accounting for seasonal and annual trends in ED visits, the April and December dips saw a 42% and 19% reduction, respectively, in comparison with what can be expected within the absence of the pandemic. The most important reductions were for respiratory issues (35%), with a 48% drop in December 2020, which might normally have been peak season for respiratory illnesses. Visits for mental health concerns and substance misuse had the smallest reductions.

By age group, the most important reductions in visits were in children younger than 10 years, accounting for nearly one-third of the decrease in visits.

By taking a look at the time window that captured a lot of the pandemic period, we were capable of tell a fuller story by showing not only the short-term impacts, but additionally longer-term impacts. It was particularly interesting to see those longer-term patterns for youngsters’s visits and visits related to respiratory and ears, nose, and throat symptoms, which, after returning to normal in 2021, went on to surpass the expected levels in 2022.”

Dr. Kate Smolina, interim scientific director, BCCDC Data and Analytic Services and Knowledge Translation and senior writer of the paper

In summer 2021, there was a considerable increase in visits, possibly related to the intense heat in June in British Columbia in addition to opioid-related overdoses.

The authors hope that the information might be useful in helping manage health care resources. “There was an enormous drop in volumes within the emergency department originally of the pandemic, but we have now ultimately returned to pre-pandemic growth of volumes,” says Dr. Eric Grafstein, chief medical information officer and regional emergency department head at Vancouver Coastal Health and Windfall Health Care. “This return toward normal emergency department volumes will help with future understanding of the impact of pandemics on health care needs.”

“More studies on the drivers of those trends is not going to only aid in higher planning of emergency department capability for future public health emergencies, but may also inform strategies to assist the general public make decisions about looking for emergency care. The statistical modelling approach may be further developed into surveillance tools to watch health care services use and plan for surge capability,” conclude the authors.

In a related editorial https://www.cmaj.ca/lookup/doi/10.1503/cmaj.231156, Dr. Catherine Varner, deputy editor, CMAJ, and an emergency physician in Toronto, says until acute care capability is increased, Canadian hospitals will proceed to face severe emergency department overcrowding. With hospitals steadily exceeding 100% bed occupancy, she proposes several steps to assist mitigate the burden on emergency department patients and staff. These include implementing demand-driven overcapacity protocols when overcrowding is compromising care, extending hours for in-hospital consults and procedures, increasing access to urgent but nonemergency testing and other interventions, and ensuring safety of staff and patients by embedding security and mental health professionals trained in de-escalation in emergency departments.