Review of Emergency Department Utilization Before, During, and After the COVID-19 Pandemic

Background Emergency departments (EDs) are the entrance into hospitals for patients with high and low acuity complaints. Since the COVID-19 pandemic began in 2020, trends have changed regarding ED utilization. Objective This literature review aims to understand how ED utilization has changed following the COVID-19 pandemic. Reviewing present literature can identify what is currently known about the pandemic’s effect on patient usage of EDs. Methods To identify relevant literature, PubMed was searched for studies published between 2018 and 2024. Search terms used to identify articles include “emergency department visit decline,” “emergency department utilization,” “urgent care,” “covid,” “coronavirus,” and “pandemic.” In total, 60 articles were reviewed. Each article’s information was screened systemically based on relevance to ED trends before, during, and after the COVID-19 pandemic. Conclusions In 44 articles, ED visits decreased following the COVID-19 pandemic onset in 2020 compared to pre-pandemic data, showing decline ranging from 15.1% to 66.4%. Some literature identified greater decreases specifically for visits with less acute medical complaints.1 Additionally, literature identified a rebound increase in visits after the initial decline without utilization reaching pre-pandemic levels.2 Next Steps ED visits declined when the pandemic began in 2020 compared to pre-pandemic data on emergency visits. Some literature documents that ED utilization has not reached pre-pandemic levels, but most literature does not mention post-pandemic trends. Next steps include investigating data on emergency department visits and utilization in Detroit since the end of the COVID-19 public health emergency in May 2023.3 Citations 1. Baker O, Galbraith A, Thomas A, LeCates RF, Wharam JF. Impact of the COVID-19 pandemic on regular emergency department users. Am J Manag Care. 2024;30(5):230-236. doi:10.37765/ajmc.2024.89540 2. Kang S, Ahn TK, Seo YH, Suh YJ, Paik JH. Comparison of emergency department utilization trends between the COVID-19 pandemic and control period. Medicine (Baltimore). 2021;100(32):e26847. doi:10.1097/MD.0000000000026847 3. Silk BJ, Scobie HM, Duck WM, et al. COVID-19 Surveillance After Expiration of the Public Health Emergency Declaration - United States, May 11, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(19):523-528. Published 2023 May 12. doi:10.15585/mmwr.mm7219e1