Potential to be more effective: Reduction in lower urgency emergency department presentations during the COVID-19 period in New South Wales, Australia

Abstract

Objective: Diverting lower urgency ED presentations to more suitable healthcare is a key goal of several healthcare systems. During the early stages of the COVID-19 pandemic in 2020, there was a substantial drop in ED presentations in New South Wales (NSW), potentially because of lower risk of illness and injury through social restrictions, or ED avoidance for lower urgent care. The present study aimed to better understand the impact of social restrictions during the pandemic on ED presentations, to inform potential shifts to alternative modes of care in emergency medicine. Methods: We conducted a quasi-experimental study of public ED presentations in NSW. We compared changes in weekly ED presentation counts by urgency, during and after the period of tightest social restrictions in contrast to the baseline period. Expected weekly counts were estimated using segmented quasi-Poisson regression, accounting for age and seasonality. Results: Lower urgency presentations fell more than mid-high urgency presentations, both during and after the period of tightest social restrictions. Lower urgency presentations reduced 30.9% compared to the baseline period during tightest restrictions, in contrast to 20.9% reduction for mid-high urgency presentations. Lower urgency presentations remained 14.4% lower after the tightest restrictions compared to the baseline period, whereas mid-high urgency presentations returned to usual levels. Conclusions: This finding suggests that reducing lower urgency ED presentation beyond the COVID-19 pandemic maybe feasible, by supporting alternative, more appropriate sources of care.