The impact of COVID-19 on an Irish Emergency Department (ED): a cross-sectional study exploring the factors infuencing ED utilisation prior to and during the pandemic from the patient perspective

Background: The collateral damage of SARS-CoV-2 is a serious concern in the Emergency Medicine (EM) community,  specifcally in relation to delayed care increasing morbidity and mortality in attendances unrelated to COVID-19. The  objectives of this study are to describe the profle of patients attending an Irish ED prior to, and during the pandemic,  and to investigate the factors infuencing ED utilisation in this cohort. Methods: This was a cross-sectional study with recruitment at three time-points prior to the onset of COVID-19 in  December 2019 (n=47) and February 2020 (n=57) and post-Lockdown 1 in July 2020 (n=70). At each time-point all  adults presenting over a 24h period were eligible for inclusion. Clinical data were collected via electronic records and  a questionnaire provided information on demographics, healthcare utilisation, service awareness and factors infu?encing the decision to attend the ED. Data analysis was performed in SPSS and included descriptive and inferential  statistics. Results: The demographic and clinical profle of patients across time-points was comparable in terms of age  (p=0.904), gender (p=0.584) and presenting complaint (p=0.556). Median length of stay in the ED decreased from  7.25h (IQR 4.18–11.22) in February to 3.86h (IQR 0.41–9.14) in July (p≤0.005) and diferences were observed in dispo?sition (p≤0.001). COVID-19 infuenced decision to attend the ED for 31% of patients with 9% delaying presentation.  Post-lockdown, patients were less likely to attend the ED for reassurance (p≤0.005), for a second opinion (p≤0.005)  or to see a specialist (p≤0.05). Conclusions: Demographic and clinical presentations of ED patients prior to the frst COVID-19 lockdown and dur?ing the reopening phase were comparable, however, COVID-19 signifcantly impacted health-seeking behaviour and  operational metrics in the ED at this phase of the pandemic. These fndings provide useful information for hospitals  with regard to pandemic preparedness and also have wider implications for planning of future health service delivery