The impact of the COVID-19 pandemic and governor mandated stay at home order on emergency department super utilizers

• Published in: The American journal of emergency medicine Vol. 48; pp. 114 - 119
• Main Authors: Alwood, Shannon, Musso, Mandi W., Jones, Glenn N., Mosley, Joel, Wippel, Brittany, Theriot, Lauren, Hamer, Diana
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2021; Elsevier Limited
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Coronaviruses; COVID-19; COVID-19 - prevention & control; Emergency department; Emergency department utilization; Emergency medical care; Emergency medical services; Emergency Service, Hospital - trends; Facilities and Services Utilization - trends; Female; Government Regulation; Governors; Health care policy; Health Policy; Health Services Accessibility - trends; High utilizer; Humans; Louisiana; Male; Medical Overuse - trends; Medical records; Middle Aged; Pandemics; Patient Acceptance of Health Care - statistics & numerical data; Patients; Regression analysis; Retrospective Studies; Severe acute respiratory syndrome coronavirus 2; Shelter in place; State Government; Super utilizer; Time series; Trends; Young Adult; Louisiana; United States > US; COVID-19; Super utilizer; Emergency department; High utilizer; Emergency department utilization
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2021.04.022

Despite the trend of rising Emergency Department (ED) visits over the past decade, researchers have observed drastic declines in number of ED visits due to the COVID-19 pandemic. The purpose of the current study was to examine the impact of the COVID-19 pandemic and governor mandated Stay at Home Order on ED super utilizers.
This was a retrospective chart review of patients presenting to the 12 emergency departments of the Franciscan Mission of Our Lady Hospital System in Louisiana between January 1, 2018 and December 31, 2020. Patients who were 18 years of age or older and had four ED visits within a one-year period (2018, 2019, or 2020) were classified as super-utilizers. We examined number and category of visits for the baseline period (January 2018 – March 2020), the governor's Stay at Home Order, and the subsequent Reopening Phases through December 31, 2020.
The number of visits by super utilizers decreased by over 16% when the Stay at Home Order was issued. The average number of visits per week rose from 1010.63 during the Stay at Home Order to 1198.09 after the Stay at Home Order was lifted, but they did not return to Pre-COVID levels of approximately 1400 visits per week in 2018 and 2019. When categories of visits were examined, this trend was found for emergent visits (p < 0.001) and visits related to injuries (p < 0.001). Non-emergent visits declined during the Stay at Home Order compared to the baseline period (p < 0.001), and did not increase significantly during reopening compared to the Stay at Home Order (p = 0.87). There were no changes in number of visits for psychiatric purposes, alcohol use, or drug use during the pandemic.
Significant declines in emergent visits raise concerns that individuals who needed ED treatment did not seek it due to COVID-19. However, the finding that super utilizers with non-emergent visits continued to visit the ED less after the Stay at Home Order was lifted raises questions for future research that may inform policy and interventions for inappropriate ED use.