Effect of COVID-19 Surge Mitigation on Emergency Department Visits for Patients at High Risk for Opioid Overdose

ABSTRACT

Study Objectives: Multiple reports in the US and worldwide demonstrate substantial decreases in ED utilization for serious conditions during the early surge mitigation phase of the COVID-19 crisis. In Ohio, governmental surge mitigation measures were instituted very early, beginning March 3, 2020, prior to its first reported case. Importantly, these recommendations prompted multiple hospital system wide initiatives to prevent “unnecessary” COVID and non-COVID ED and hospital utilization. However, these strategies may have decreased ED visits for more emergent conditions, causing underutilization of needed resources by high-risk ED populations. Opioid overdose (OD) is a leading cause of accidental death in the US and the effect of early surge mitigation on the population at high risk for opioid overdose death is unknown. The purpose of this study was to determine the effect of early COVID-19 mitigation measures on ED visits for patients at high risk for opioid overdose. Methods: This study was performed in a major urban Midwestern hospital system with IRB approval. We previously created an algorithm using the electronic health record (EHR, Epic systems) to identify patients presenting to the ED with a high risk of a subsequent opioid. The number of patients from March 1, 2020 to June 30, 2020 (COVID-19 mitigation phase) were compared to patients presenting from March 1, 2019 to June 30, 2019. Total ED visits during that time were also determined. Statistical comparison was by Fisher’s exact test. Results: There were 31,809 ED visits during the COVID-19 mitigation phase compared to 44,297 in 2019, a 29% decrease. We identified 188 patients at high risk for subsequent opioid OD during the COVID-19 mitigation phase compared to 206 during the control period. This represents a significant increase in the percentage of ED visits by high-risk patients for subsequent opioid OD during the COVID-19 mitigation phase (0.59% of ED visits vs. 0.46% of ED visits, p=0.018). Conclusion: The number of patients presenting to the ED at high risk for subsequent opioid OD was not affected by the COVID-19 mitigation measures, resulting in a relative increase in the percentage of high-risk patients seen during that time. Future determination of the effect of surge mitigation strategies on linkage to care and treatment resources available during that time will be important to develop strategies to ensure appropriate resources are in place for these high-risk patients for future pandemic preparedness.