Impact of COVID-19 on Patient Populations in the Emergency Department in Flint, Michigan

ABSTRACT

Study Objectives: As the COVID-19 pandemic continues, it is necessary to elucidate its impact on services in the emergency department (ED). The research project aims to identify and analyze changes in medical presentations and disease severity within the ED at Hurley Medical Center (HMC) in Flint, Michigan due to the COVID-19 pandemic. Methods: The present study is a retrospective chart review on HMC’s ED encounters focusing on adults 18 years and above in Flint/Genesee County in Michigan. Data collected for the study was obtained from patient charts from February 1, 2019 to July 31, 2019 and from February 1, 2020 to July 31, 2020. Data from 2019 versus 2020 was analyzed using a combination of independent t-test, chi-square analysis, and regression modeling. Results: There were a total of 59,345 visits analyzed within the study;33,648 ED visits within the study were in 2019 compared to 25,697 visits in 2020. There was a significant difference in patient sex between 2019 and 2020 with a larger percentage of males presenting in 2020 vs 2019 (p<0.001). Furthermore, the ICD-10 diagnosis differed between 2019 and 2020 with significant increase in the percentage of infectious disease, COVID-19, generalized symptoms, pneumonia, respiratory failure/insufficiency/arrest, patients with socioeconomic factors, mental health, nausea/vomiting, patients with history or family history of chronic disease, disorders of lipid metabolism, and myocardial infarction presentations in 2020 compared to 2019. Dispositions also significantly differed in 2020 compared to 2019 with more patients receiving admission or dying in the ED (p<0.001). Patients who presented to the ED often presented with more severe illness in 2020 as reflected in increased length of stay in 2020 (p=0.01) and increased case-medical-index (p<0.001). Conclusion: The COVID-19 pandemic significantly reduced the total number of ED visits to HMC in Flint, Michigan in 2020, when compared to the same time period in 2019. Notably, patients were more likely to have a longer length-of-stay, present with more severe illness, and more likely to be admitted or pass away in the ED when compared to the same time period in 2019. Analysis also revealed that visits for respiratory diagnoses and other life-threatening conditions like myocardial infarction increased, whereas less life-threatening/acute conditions like sprains, urinary tract infections, and sexually transmitted infections decreased. Interestingly as well, the pandemic drove statistically significant increased visits for mental health and socioeconomic factors. Limitations include analyzing 6 months of data as opposed to the whole calendar year and the use of broad ICD-10 code categories. It is also important to note that diagnosis codes were analyzed versus what the patient subjectively presented for, so there is a gray area between being able to elucidate what motivated the patient to come to the ED and verus what was analyzed in this project as patient’s ICD-10 diagnoses. [Formula presented] [Formula presented] [Formula presented] [Formula presented] [Formula presented]