Big fall in numbers attending hospital emergency departments in England

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Ambulance arriving at A&E

There have been big reductions in people attending hospital A&E departments in England since the COVID-19 pandemic began, according to a new report.

The report looked in detail at the number of people attending Accident and Emergency (A&E) departments in two hospitals in Imperial College Healthcare NHS Trust, as well as at the wider picture across English hospitals.

The researchers found there was a 35 percent reduction in the number of people going to A&E at the Imperial College Healthcare hospitals, compared with what would be expected based on historical trends.

“The altered use of emergency department services by the public is a very worrying development that has to be addressed urgently.” Dr Michaela Vollmer Report author

Across London, there was a 50 per cent decrease and nationally a 53 percent decrease in people attending A&E. In addition, non-COVID-19 admissions from A&E at the two Imperial College Healthcare hospitals declined by 48% compared to previous years.

At Imperial College Healthcare, the reduction in visits to A&E was mainly in those aged under 65. There was an increase in the proportion of people arriving by ambulance, which can potentially be explained by some people having delayed seeking hospital treatment until their condition became more severe.

At Imperial College Healthcare NHS Trust, emergency attendances were down 60 percent for acute coronary syndromes, 26 percent for strokes, 52 percent for obstetric emergencies and 21 percent for perinatal emergencies. Cancer-related emergency visits were down 47 percent.

Attendances for injuries were down 64 percent and the researchers suggest that this could in part be a result of fewer injuries occurring as people left the house less and travelled less, as a result of lockdown measures being imposed.

The health care system in England has been highly affected by the surge in demand due to patients afflicted by COVID-19. The report reviewed anonymised individual level administrative records of patients attending emergency department services and compared current data (between March 12 and May 31) with historic data (between 2015 and 2019).

The researchers analysed the impact of the COVID-19 pandemic on care seeking behaviour. They analysed attendance, admissions, mode of arrival, distance from patient residence to hospital and primary diagnosis after admission at St Mary’s and Charing Cross hospitals, part of Imperial College Healthcare NHS Trust.

The researchers urge for national level research on factors causing reduced attendances to emergency department services, and for strategies to revert the negative trends observed.

Report author Dr Michaela Vollmer said: “The spread of the COVID-19 pandemic has highly affected the emergency-care seeking behaviour of patients in England. The altered use of emergency department services by the public is a very worrying development that has to be addressed urgently.”

Dr Paolo Perez-Guzman, another author of the report, added: “We find strong indications of decreased emergency department attendances to Imperial College Healthcare NHS Trust and the rest of England, especially amongst younger sectors of the population. Factors underpinning these negative trends and strategies to reverse them warrant urgent investigation.”

The work is presented in the latest report from the WHO Collaborating Centre for Infectious Disease Modelling within the MRC Centre for Global Infectious Disease Analysis,Jameel Institute (J-IDEA), Imperial College London.

Since the emergence of the new coronavirus (COVID-19) in December 2019, the Imperial College COVID-19 Response Team has adopted a policy of immediately sharing research findings on the developing pandemic.

Report 29: Impact of COVID-19 on emergency department attendance is available on the MRC Centre for Global Infectious Disease Analysis COVID-19 reports web page



Dr Sabine L. van Elsland

Dr Sabine L. van Elsland
School of Public Health

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Laura Gallagher

Laura Gallagher
Communications Division

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Tel: +44 (0)20 7594 6701

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