Impact of COVID-19 on accident and emergency attendances and emergency and planned hospital admissions in Scotland: an interrupted time-series analysis

Objectives Following the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and the subsequent global spread of the 2019 novel coronavirus disease (COVID-19), health systems and the populations who use them have faced unprecedented challenges. We aimed to measure the...

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Veröffentlicht in:Journal of the Royal Society of Medicine 2020-11, Vol.113 (11), p.444-453
Hauptverfasser: Mulholland, Rachel H, Wood, Rachael, Stagg, Helen R, Fischbacher, Colin, Villacampa, Jaime, Simpson, Colin R, Vasileiou, Eleftheria, McCowan, Colin, Stock, Sarah J, Docherty, Annemarie B, Ritchie, Lewis D, Agrawal, Utkarsh, Robertson, Chris, Murray, Josephine LK, MacKenzie, Fiona, Sheikh, Aziz
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container_end_page 453
container_issue 11
container_start_page 444
container_title Journal of the Royal Society of Medicine
container_volume 113
creator Mulholland, Rachel H
Wood, Rachael
Stagg, Helen R
Fischbacher, Colin
Villacampa, Jaime
Simpson, Colin R
Vasileiou, Eleftheria
McCowan, Colin
Stock, Sarah J
Docherty, Annemarie B
Ritchie, Lewis D
Agrawal, Utkarsh
Robertson, Chris
Murray, Josephine LK
MacKenzie, Fiona
Sheikh, Aziz
description Objectives Following the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and the subsequent global spread of the 2019 novel coronavirus disease (COVID-19), health systems and the populations who use them have faced unprecedented challenges. We aimed to measure the impact of COVID-19 on the uptake of hospital-based care at a national level. Design The study period (weeks ending 5 January to 28 June 2020) encompassed the pandemic announcement by the World Health Organization and the initiation of the UK lockdown. We undertook an interrupted time-series analysis to evaluate the impact of these events on hospital services at a national level and across demographics, clinical specialties and National Health Service Health Boards. Setting Scotland, UK. Participants Patients receiving hospital care from National Health Service Scotland. Main outcome measures Accident and emergency (A&E) attendances, and emergency and planned hospital admissions measured using the relative change of weekly counts in 2020 to the averaged counts for equivalent weeks in 2018 and 2019. Results Before the pandemic announcement, the uptake of hospital care was largely consistent with historical levels. This was followed by sharp drops in all outcomes until UK lockdown, where activity began to steadily increase. This time-period saw an average reduction of −40.7% (95% confidence interval [CI]: −47.7 to −33.7) in A&E attendances, −25.8% (95% CI: −31.1 to −20.4) in emergency hospital admissions and −60.9% (95% CI: −66.1 to −55.7) in planned hospital admissions, in comparison to the 2018–2019 averages. All subgroup trends were broadly consistent within outcomes, but with notable variations across age groups, specialties and geography. Conclusions COVID-19 has had a profoundly disruptive impact on hospital-based care across National Health Service Scotland. This has likely led to an adverse effect on non-COVID-19-related illnesses, increasing the possibility of potentially avoidable morbidity and mortality. Further research is required to elucidate these impacts.
doi_str_mv 10.1177/0141076820962447
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We aimed to measure the impact of COVID-19 on the uptake of hospital-based care at a national level. Design The study period (weeks ending 5 January to 28 June 2020) encompassed the pandemic announcement by the World Health Organization and the initiation of the UK lockdown. We undertook an interrupted time-series analysis to evaluate the impact of these events on hospital services at a national level and across demographics, clinical specialties and National Health Service Health Boards. Setting Scotland, UK. Participants Patients receiving hospital care from National Health Service Scotland. Main outcome measures Accident and emergency (A&amp;E) attendances, and emergency and planned hospital admissions measured using the relative change of weekly counts in 2020 to the averaged counts for equivalent weeks in 2018 and 2019. Results Before the pandemic announcement, the uptake of hospital care was largely consistent with historical levels. This was followed by sharp drops in all outcomes until UK lockdown, where activity began to steadily increase. This time-period saw an average reduction of −40.7% (95% confidence interval [CI]: −47.7 to −33.7) in A&amp;E attendances, −25.8% (95% CI: −31.1 to −20.4) in emergency hospital admissions and −60.9% (95% CI: −66.1 to −55.7) in planned hospital admissions, in comparison to the 2018–2019 averages. All subgroup trends were broadly consistent within outcomes, but with notable variations across age groups, specialties and geography. Conclusions COVID-19 has had a profoundly disruptive impact on hospital-based care across National Health Service Scotland. This has likely led to an adverse effect on non-COVID-19-related illnesses, increasing the possibility of potentially avoidable morbidity and mortality. Further research is required to elucidate these impacts.</description><identifier>ISSN: 0141-0768</identifier><identifier>EISSN: 1758-1095</identifier><identifier>DOI: 10.1177/0141076820962447</identifier><identifier>PMID: 33012218</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>COVID-19 - epidemiology ; COVID-19 - therapy ; Emergency Service, Hospital - trends ; Female ; Humans ; Interrupted Time Series Analysis ; Male ; Organizational Innovation ; Patient Admission - statistics &amp; numerical data ; Patient Admission - trends ; SARS-CoV-2 ; Scotland ; State Medicine</subject><ispartof>Journal of the Royal Society of Medicine, 2020-11, Vol.113 (11), p.444-453</ispartof><rights>The Royal Society of Medicine</rights><rights>The Royal Society of Medicine 2020 The Royal Society of Medicine</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c434t-5a7b50edec93bc01b9eb6ec52ef85465bd7446811bfdcd0541e94ec77ae837363</citedby><cites>FETCH-LOGICAL-c434t-5a7b50edec93bc01b9eb6ec52ef85465bd7446811bfdcd0541e94ec77ae837363</cites><orcidid>0000-0003-4453-623X ; 0000-0001-8277-420X ; 0000-0003-1020-3373</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686524/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686524/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,21798,27901,27902,43597,43598,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33012218$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mulholland, Rachel H</creatorcontrib><creatorcontrib>Wood, Rachael</creatorcontrib><creatorcontrib>Stagg, Helen R</creatorcontrib><creatorcontrib>Fischbacher, Colin</creatorcontrib><creatorcontrib>Villacampa, Jaime</creatorcontrib><creatorcontrib>Simpson, Colin R</creatorcontrib><creatorcontrib>Vasileiou, Eleftheria</creatorcontrib><creatorcontrib>McCowan, Colin</creatorcontrib><creatorcontrib>Stock, Sarah J</creatorcontrib><creatorcontrib>Docherty, Annemarie B</creatorcontrib><creatorcontrib>Ritchie, Lewis D</creatorcontrib><creatorcontrib>Agrawal, Utkarsh</creatorcontrib><creatorcontrib>Robertson, Chris</creatorcontrib><creatorcontrib>Murray, Josephine LK</creatorcontrib><creatorcontrib>MacKenzie, Fiona</creatorcontrib><creatorcontrib>Sheikh, Aziz</creatorcontrib><title>Impact of COVID-19 on accident and emergency attendances and emergency and planned hospital admissions in Scotland: an interrupted time-series analysis</title><title>Journal of the Royal Society of Medicine</title><addtitle>J R Soc Med</addtitle><description>Objectives Following the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and the subsequent global spread of the 2019 novel coronavirus disease (COVID-19), health systems and the populations who use them have faced unprecedented challenges. We aimed to measure the impact of COVID-19 on the uptake of hospital-based care at a national level. Design The study period (weeks ending 5 January to 28 June 2020) encompassed the pandemic announcement by the World Health Organization and the initiation of the UK lockdown. We undertook an interrupted time-series analysis to evaluate the impact of these events on hospital services at a national level and across demographics, clinical specialties and National Health Service Health Boards. Setting Scotland, UK. Participants Patients receiving hospital care from National Health Service Scotland. Main outcome measures Accident and emergency (A&amp;E) attendances, and emergency and planned hospital admissions measured using the relative change of weekly counts in 2020 to the averaged counts for equivalent weeks in 2018 and 2019. Results Before the pandemic announcement, the uptake of hospital care was largely consistent with historical levels. This was followed by sharp drops in all outcomes until UK lockdown, where activity began to steadily increase. This time-period saw an average reduction of −40.7% (95% confidence interval [CI]: −47.7 to −33.7) in A&amp;E attendances, −25.8% (95% CI: −31.1 to −20.4) in emergency hospital admissions and −60.9% (95% CI: −66.1 to −55.7) in planned hospital admissions, in comparison to the 2018–2019 averages. All subgroup trends were broadly consistent within outcomes, but with notable variations across age groups, specialties and geography. Conclusions COVID-19 has had a profoundly disruptive impact on hospital-based care across National Health Service Scotland. This has likely led to an adverse effect on non-COVID-19-related illnesses, increasing the possibility of potentially avoidable morbidity and mortality. 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We aimed to measure the impact of COVID-19 on the uptake of hospital-based care at a national level. Design The study period (weeks ending 5 January to 28 June 2020) encompassed the pandemic announcement by the World Health Organization and the initiation of the UK lockdown. We undertook an interrupted time-series analysis to evaluate the impact of these events on hospital services at a national level and across demographics, clinical specialties and National Health Service Health Boards. Setting Scotland, UK. Participants Patients receiving hospital care from National Health Service Scotland. Main outcome measures Accident and emergency (A&amp;E) attendances, and emergency and planned hospital admissions measured using the relative change of weekly counts in 2020 to the averaged counts for equivalent weeks in 2018 and 2019. Results Before the pandemic announcement, the uptake of hospital care was largely consistent with historical levels. This was followed by sharp drops in all outcomes until UK lockdown, where activity began to steadily increase. This time-period saw an average reduction of −40.7% (95% confidence interval [CI]: −47.7 to −33.7) in A&amp;E attendances, −25.8% (95% CI: −31.1 to −20.4) in emergency hospital admissions and −60.9% (95% CI: −66.1 to −55.7) in planned hospital admissions, in comparison to the 2018–2019 averages. All subgroup trends were broadly consistent within outcomes, but with notable variations across age groups, specialties and geography. Conclusions COVID-19 has had a profoundly disruptive impact on hospital-based care across National Health Service Scotland. This has likely led to an adverse effect on non-COVID-19-related illnesses, increasing the possibility of potentially avoidable morbidity and mortality. 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source MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; SAGE Complete; PubMed Central; Alma/SFX Local Collection
subjects COVID-19 - epidemiology
COVID-19 - therapy
Emergency Service, Hospital - trends
Female
Humans
Interrupted Time Series Analysis
Male
Organizational Innovation
Patient Admission - statistics & numerical data
Patient Admission - trends
SARS-CoV-2
Scotland
State Medicine
title Impact of COVID-19 on accident and emergency attendances and emergency and planned hospital admissions in Scotland: an interrupted time-series analysis
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