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New Orleans hospital provides microcosm of COVID-19's effects on ED volumes

Non-COVID-19 deaths are on the rise, most likely linked to a decrease in deferred care.

Jeff Lagasse, Associate Editor

The COVID-19 pandemic is creating a lot of hardships for the nation's hospitals, and one hospital in New Orleans is providing a window into how the coronavirus is affecting emergency department volumes. A Health Affairs analysis of the Epic electronic health records at University Medical Center, within the Louisiana Children's Medical Center network in New Orleans, Louisiana, shows that ED encounters were down a full 50% in April compared to April 2019.

That's a stark contrast to the safety net hospital's ICU, which saw a surge to about 65% capacity, much higher than the 40% average recorded a year ago.

WHAT'S THE IMPACT?

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It was April that saw the most precipitous drop in ED volume. In both 2019 and 2020, from January through April, the ED averaged about 5,300 patients per week, and while the numbers for mid-March 2020 were in line with that average – 5,658 patients walked through the ED doors in mid-March – by the second week of April that number had fallen off to just over 2,500.

Breaking down the numbers by ailment shows that this drop in ED encounters was consistent among those complaining of abdominal pain, chest pain and headache. Those three complaints are associated with the most severe pathologies seen in the ED.

Sadly, the numbers are in line with a recent American College of Emergency Physicians poll showing that nearly one-third of adults avoided seeking medical care due to their COVID-19 concerns. A separate poll from Gallup finds 42% of adults are "very concerned" about being exposed to the coronavirus while seeking emergency care.

Even patients with more serious or even life-threatening conditions are avoiding ED care, resulting in a 38% reduction in visits to the catheter lab for certain types of severe heart attacks. And a Yale analysis published in The Washington Post found that non-COVID-19 deaths are on the rise.

Meanwhile, a recent Cigna study indicated patients have deferred treatments for seven different acute clinical conditions, including acute coronary syndromes and transient ischemic attacks.

One possible way to address this, as detailed by Health Affairs, is to review the language in high-level messaging campaigns to vulnerable populations on personal protection. Knowledge gaps for risk factors and warning signs of strokes, for example, could be bridged with better communication, potentially resulting in fewer non-COVID-19 deaths.

More education is also needed on the risk-benefit analysis of seeking care once stay-at-home orders are lifted, authors said.

THE LARGER TREND

April was a record-setting month for healthcare, and not in a good way, with steep volume and revenue declines, along with stagnant expenses. Despite $50 billion in funding allocated through the CARES Act, operating EBITDA margins fell to -19%. They fell 174%, or 2,791 basis points, compared to the same period last year, and 118% compared to March. This shows a steady and dramatic decline, as EBITDA margins were as high as 6.5% in April.

Volumes were down – way down. Operating room minutes fell 61% compared to April 2019, which is more than triple the declines seen in March. Discharges fell 30% over that time, while emergency department visits fell 43%. Surgery room volumes saw the biggest declines, which was expected, given the halting of elective procedures.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com