The Impact of the COVID-19 Epidemic on Patterns of Attendance at Emergency Departments in Two Large London Hospitals: An Observational Study

Background Hospitals in England have undergone considerable change to address the surge in demand imposed by the COVID-19 epidemic. The impact of this on emergency department (ED) attendances is unknown, especially for non-COVID-19 related emergencies. Methods We calibrated auto-regressive integrated moving average time-series models of ED attendances to Imperial College Healthcare NHS Trust (ICHNT) using historic (2015–2019) data. Forecasted trends were compared to present year ICHNT data for the period between March 12 (when England implemented the first COVID-19 public health measure) and May 31. We compared ICHTN trends with publicly available regional and national data. Lastly, we compared emergency admissions and in-hospital mortality at ICHNT during the present year to a historic 5-year average. Results ED attendances at ICHNT decreased by 35%, in keeping with the trend for ED attendances across all England regions, which fell by approximately 50%. For ICHNT, the decrease in attendances was mainly amongst those aged < 65 years and those arriving by their own means (e.g. personal or public transport). Increasing distance from postcode of residence to hospital was a significant predictor of reduced attendances. Non-COVID related emergency admissions to hospital after March 12 fell by 48%; there was an indication of a non-significant increase in non-COVID-19 crude mortality risk (RR 1.13, 95%CI 0.94–1.37, p = 0.19). Conclusions Our study finds strong evidence that emergency healthcare seeking has drastically changed across the population in England. At ICHNT, we find that a larger proportion arrived by ambulance and that hospitalisation outcomes of non-COVID patients did not differ from previous years. The extent to which these findings relate to ED avoidance behaviours compared to having sought alternative emergency health services outside of hospital remains unknown. National analyses and strategies to streamline emergency services in England going forward are urgently needed.