Changes in emergency department utilisation in Germany before and during different phases of the COVID-19 pandemic, using data from a national surveillance system up to June 2021
BMC Public Health, vol. 23, pp. 799
Abstract
BACKGROUND: During the COVID-19 pandemic and associated public health and social measures, decreasing patient numbers have been described in various healthcare settings in Germany, including emergency care. This could be explained by changes in disease burden, e.g. due to contact restrictions, but could also be a result of changes in utilisation behaviour of the population. To better understand those dynamics, we analysed routine data from emergency departments to quantify changes in consultation numbers, age distribution, disease acuity and day and hour of the day during different phases of the COVID-19 pandemic. METHODS: We used interrupted time series analyses to estimate relative changes for consultation numbers of 20 emergency departments spread throughout Germany. For the pandemic period (16-03-2020 - 13-06-2021) four different phases of the COVID-19 pandemic were defined as interruption points, the pre-pandemic period (06-03-2017 - 09-03-2020) was used as the reference. RESULTS: The most pronounced decreases were visible in the first and second wave of the pandemic, with changes of - 30.0% (95%CI: - 32.2%; - 27.7%) and - 25.7% (95%CI: - 27.4%; - 23.9%) for overall consultations, respectively. The decrease was even stronger for the age group of 0-19 years, with - 39.4% in the first and - 35.0% in the second wave. Regarding acuity levels, consultations assessed as urgent, standard, and non-urgent showed the largest decrease, while the most severe cases showed the smallest decrease. CONCLUSIONS: The number of emergency department consultations decreased rapidly during the COVID-19 pandemic, without extensive variation in the distribution of patient characteristics. Smallest changes were observed for the most severe consultations and older age groups, which is especially reassuring regarding concerns of possible long-term complications due to patients avoiding urgent emergency care during the pandemic.
Authors 42
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Madlen Schranz corresponding
Robert Koch Institute · Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin
Affiliation as printed
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Public Health, Berlin, Germany. schranzm@rki.de
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany. schranzm@rki.de
Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Public Health, Berlin, Germany
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Affiliation as printed
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Affiliation as printed
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Affiliation as printed
Department for Methods Development, Research Infrastructure and Information Technology, Robert Koch Institute, Berlin, Germany
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Affiliation as printed
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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University Medical Center Hamburg-Eppendorf · Otto-von-Guericke-Universität Magdeburg
Affiliation as printed
Department of Trauma Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Affiliation as printed
Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Affiliation as printed
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Affiliation as printed
Department for Methods Development, Research Infrastructure and Information Technology, Robert Koch Institute, Berlin, Germany
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Affiliation as printed
). Emergency Department , University Hospital RTWH , Aachen , Germany
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Affiliation as printed
). Emergency Department , University Hospital RTWH , Aachen , Germany
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Affiliation as printed
). Department of Emergency Medicine , University Hospital Augsburg , Augs- burg , Germany
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Universitätsmedizin Göttingen · University of Göttingen
Affiliation as printed
). Interdisciplinary Emergency Department , University Medical Center Göt- tingen , Göttingen , Germany
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Universitätsmedizin Göttingen · University of Göttingen
Affiliation as printed
). Interdisciplinary Emergency Department , University Medical Center Göt- tingen , Göttingen , Germany
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University Hospital Schleswig-Holstein
Affiliation as printed
). Department for Emergency Medicine , University Medical Center Schleswig-Holstein , Kiel , Germany
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University Hospital Schleswig-Holstein
Affiliation as printed
). Emergency Department , University Hospital of Schleswig-Holstein , Cam- pus Lübeck , Lübeck , Germany
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Otto-von-Guericke-Universität Magdeburg
Affiliation as printed
). Emergency Department , Otto von Guericke University Magdeburg , Magdeburg , Germany
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Otto-von-Guericke-Universität Magdeburg
Affiliation as printed
). Emergency Department , Otto von Guericke University Magdeburg , Magdeburg , Germany
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Ludwig-Maximilians-Universität München
Affiliation as printed
). Central Emergency Department , Campus Großhadern , Ludwig-Maximil- ians University , München , Germany
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Affiliation as printed
). Emergency Department , Ostalb Hospital Aalen , Aalen , Germany
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Affiliation as printed
). Emergency Department , Hospital Aschaffenburg , Aschaffenburg , Germany
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Affiliation as printed
). Emergency Department , HELIOS Hospital Berlin-Buch , Berlin , Germany
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Humboldt-Universität zu Berlin
Affiliation as printed
Universität Berlin and Humboldt , Universität zu Berlin , Institute of Public Health , Berlin , Germany
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Humboldt-Universität zu Berlin
Affiliation as printed
Universität Berlin and Humboldt , Universität zu Berlin , Institute of Public Health , Berlin , Germany
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Robert Koch Institute · Humboldt-Universität zu Berlin
Affiliation as printed
Universität Berlin and Humboldt , Universität zu Berlin , Institute of Public Health , Berlin , Germany
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Humboldt-Universität zu Berlin
Affiliation as printed
Universität Berlin and Humboldt , Universität zu Berlin , Institute of Public Health , Berlin , Germany
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Humboldt-Universität zu Berlin
Affiliation as printed
Universität Berlin and Humboldt , Universität zu Berlin , Institute of Public Health , Berlin , Germany
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Humboldt-Universität zu Berlin
Affiliation as printed
Universität Berlin and Humboldt , Universität zu Berlin , Institute of Public Health , Berlin , Germany
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Humboldt-Universität zu Berlin
Affiliation as printed
Universität Berlin and Humboldt , Universität zu Berlin , Institute of Public Health , Berlin , Germany
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Humboldt-Universität zu Berlin
Affiliation as printed
Universität Berlin and Humboldt , Universität zu Berlin , Institute of Public Health , Berlin , Germany
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Humboldt-Universität zu Berlin
Affiliation as printed
Universität Berlin and Humboldt , Universität zu Berlin , Institute of Public Health , Berlin , Germany
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Affiliation as printed
Institute of Medical Informatics , Medical Faculty , RWTH Aachen University , Aachen , Germany
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Affiliation as printed
Institute of Medical Informatics , Medical Faculty , RWTH Aachen University , Aachen , Germany
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Robert Koch Institute · RWTH Aachen University
Affiliation as printed
Institute of Medical Informatics , Medical Faculty , RWTH Aachen University , Aachen , Germany
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Affiliation as printed
Institute of Medical Informatics , Medical Faculty , RWTH Aachen University , Aachen , Germany
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University Medical Center Hamburg-Eppendorf · Otto-von-Guericke-Universität Magdeburg
Affiliation as printed
Department of Trauma Surgery , Otto von Guericke University Magdeburg , Magdeburg , Germany
Department of Trauma Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Otto-von-Guericke-Universität Magdeburg
Affiliation as printed
Department of Trauma Surgery , Otto von Guericke University Magdeburg , Magdeburg , Germany
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Otto-von-Guericke-Universität Magdeburg
Affiliation as printed
Department of Trauma Surgery , Otto von Guericke University Magdeburg , Magdeburg , Germany
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Otto-von-Guericke-Universität Magdeburg
Affiliation as printed
Department of Trauma Surgery , Otto von Guericke University Magdeburg , Magdeburg , Germany
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Charité - Universitätsmedizin Berlin
Affiliation as printed
Charité - Universitätsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
Charité – Universitätsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
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Affiliation as printed
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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