Social distancing measures have been instrumental in slowing the spread of the coronavirus pandemic. However, they have also had an unintentional consequence that’s endangering the very lives they’re designed to protect. Too many people are now avoiding hospitals and emergency departments (EDs), even when experiencing life-threatening conditions. Many experts worry that these care delays represent a public health threat as deadly as COVID-19 itself.
As a result, ED and urgent care volumes have plunged in many parts of the country, and doctor’s offices have similarly seen decreased visits by their patients. A June 2020 report by Moody’s Investor Services found that ED and urgent care volumes have not bounced back at the same rate as inpatient and ambulatory surgery visits. In April 2020, ED and urgent care volumes were down 50% to 60% compared to the previous year. By May, visits had recovered somewhat but still lagged 35% to 50% behind 2019 volumes.[i]
This is alarming because the morbidity and mortality of avoiding emergency care are incredibly high. Patients with heart attacks, strokes, and acute surgical emergencies, like appendicitis, risk dying at home if they wait to seek help. And the longer patients delay care for serious acute conditions or worsening of chronic conditions, the more likely they are to suffer complications, extended hospital stays, and prolonged recovery periods.
Theo Koury, MD
To reassure the public, EDs and hospitals are using a range of methods to promote both patient and provider safety. Many teams have reconfigured their department flow for maximum infection control by establishing separate waiting rooms, drive-up care areas, and even outdoor tent clinics for patients with COVID symptoms. Also, providers are leveraging an expansion in telehealth, which allows patients and clinicians to interact while limiting in-person physical contact. Not only is telehealth being used by office-based physicians, many ED teams are using videoconferencing to triage patients, register them, and take their histories. In some cases, ED patients may be assessed, treated, and discharged entirely by telehealth with zero in-person contact.
Some hospitals are taking telehealth a step further by integrating virtual visits with in-person ones. For example, a patient might begin an ED or urgent care visit via videoconference by clicking a button on the health system website. This connects the patient to a triage provider, who assesses their condition and navigates them to the most appropriate level of care, whether it’s a telehealth visit, a primary care referral, an urgent care clinic, or an in-person ED visit. The triage provider also extends a “warm handoff” to the receiving team so that care can begin immediately when the patient arrives. This model helps patients quickly access appropriate care while limiting unnecessary face-to-face contact.
The fact that patients don’t feel safe visiting EDs and hospitals during a public health emergency is cause for alarm. As healthcare providers, it’s our responsibility to provide and assure the public of the safe, effective care available for all medical conditions. What's more, we need to make sure patients know how to access the range of care that’s available.
If you or a loved one are experiencing a chronic or acute healthcare condition, please don't wait to seek care. Your health is top priority for me, my medical colleagues, and our hospitals and health systems. Wherever and whenever you need us, we’re ready for you.
[i] Shinkman, R. Moody's: US healthcare system rebounds from COVID-19 in May, but a bumpy road lies ahead. Health Care Dive. Published June 19, 2020. https://www.healthcaredive.com/news/moodys-us-healthcare-system-rebounds-from-COVID-19-in-may-but-a-bumpy-ro/580152/