Changing temporal trends in patient volumes in a pediatric emergency department during a COVID-19 pandemic lockdown: a retrospective cohort study.

Abstract

Objective: Emergency department (ED) teams have had to adjust limited staffing resources to meet the fluctuating levels of patient volume and acuity during the COVID-19 pandemic.  Historically, Mondays have had the highest reported ED volumes. We are unaware of any studies reporting on the change of this Monday effect during the COVID-19 pandemic.     Methods: This retrospective, observational study of a single pediatric ED compared a pandemic lockdown period (3/23/2020-11/1/2020) with a seasonally comparative period (3/25/2019-11/3/2019). We compared the mean number of patients who arrived on Monday versus any other specific weekday (Tuesday, Wednesday, Thursday, or Friday) and the aggregate of other weekdays (Tuesday to Friday) for both study periods. Secondary analyses investigated overall mean volumes, admission rates, and differences in triage acuity levels.  Results: There were 31,377 and 18,098 patients in the comparative and pandemic periods.  The mean number of ED visits on Mondays in the comparative period was significantly more than any other weekday and the aggregate of weekdays (latter p<0.001). In contrast, there were no significant differences in the mean number of ED visits on Mondays in the pandemic period relative to any other weekday and the aggregate of weekdays (all p>0.05). The pandemic period had significantly lower mean volumes, higher admission rates, and more patients with higher acuity levels.  Conclusion: The previously experienced Monday effect of increased relative ED patient volumes was not seen during the pandemic period. This change has operational implications for scheduling ED staffing resources. Larger database studies are needed to determine the generalizability of these findings.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

No. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Eastern Virginia Medical School IRB. This research project was exempted from our institutional review board given that it was deemed not to be human subjects research (IRB #20-12-NH-0281)

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Data Availability

All relevant data are within the manuscript and its Supporting Information files.

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