A descriptive analysis of the impact of COVID-19 on Emergency Department attendance and visit characteristics in Singapore

Introduction: It is yet to be understood how COVID-19 impacted utilisation of Emergency Department (ED) services in Singapore. This study aimed to describe the changes in attendance of a single ED and corresponding patient visit characteristics and outcomes before and during the COVID-19 period.Methods: In a single-centre retrospective cohort study, we used descriptive statistics to compare ED attendance, patient demographics and visit characteristics during the COVID-19 period (1 January – 28 June 2020) and its corresponding historical period in 2019 (2 January – 30 June 2019).Results: Mean ED attendance decreased from 342 visits/day in the pre-COVID-19 period, to 297 visits/day in the COVID-19 period. This was accompanied by reductions in P1 visits and presentations in nearly every ICD-10-CM diagnosis category except for respiratory-related diseases. We also noted a shift in ED patient case-mix from ‘Non-fever’ cases to ‘Fever’ cases, likely giving rise to two distinct trough-to-peak visit patterns during the pre-Circuit Breaker and Circuit Breaker period. Average ED admission rate during the Circuit Breaker period (48.3%) was higher as compared to pre-Circuit Breaker period (40.7%), however average daily admission remained stable.Conclusion: The COVID-19 pandemic caused a reduction in SGH ED attendances amongst patients with low-acuity conditions and those with highest priority for emergency care. This raises concern about treatment-seeking delays and possible impact on health outcomes. Our data provides insights that may be useful for ED crowd management planning in the post-COVID-19 era. There should be cautious use of ED admission rate as a metric in evaluating ED performance during an outbreak.