Emergency Department Utilization Following Statewide Stay at Home Orders During the Novel Coronavirus (COVID-19) Pandemic

ABSTRACT

Study Objective: With COVID-19 cases and fatalities increasing nationally, health officials implemented policies and restrictions to keep the positivity rate in check. In California, a statewide stay at home order was issued on March 19, 2020 and again on December 7, 2020. The objective of this study was to assess the impact each stay at home order had on ED utilization. Methods: We conducted a multi-center, retrospective study among adult patients (≥18 years) presenting to two emergency departments (urban level 1 trauma center and suburban academic hospital with combined annual census of ∼80,000). We compared ED utilization over a two-week period both prior to and following each statewide stay at home order (March and December, 2020), as well as similar periods in 2019. We calculated the percent change in ED volume and admissions for each. Results: Prior to the first stay at home order, there were only 70 confirmed COVID-19 cases in the county, compared to 94,169 cases prior to the subsequent stay at home order. Compared to 2019, ED volume and admissions during the two-week period following the initial stay at home order decreased by 30.7% and 28.4%, respectively. Following the second stay at home order, ED volume was only down 12.4% from 2019, while admissions were up 4.4%. Similarly, compared to the two week period prior to the initial stay at home order, ED volume and admissions decreased by 22.8% and 14.0% in the following 2-week period, respectively. However, ED volume and admissions remained similar following the second stay at home order, with an increase by 0.8% in ED visits and 1.6% increase in admissions between the two weeks before and after the order began. Conclusion: This study of ED utilization trends during the COVID-19 pandemic demonstrated that ED volume and admissions decreased dramatically during the initial stay at home order. However, despite the large differences in the number county-wide positive cases, ED utilization and admissions were largely unaffected by the second stay at home order.