Article Text
PDF
Abstract
Background The impact of a pandemic on unplanned hospital attendance has not been extensively examined. The aim of this study is to report the nationwide consequences of the COVID-19 pandemic on unplanned hospital attendances in Denmark for 7 weeks after a ‘shelter at home’ order was issued.
Methods We merged data from national registries (Civil Registration System and Patient Registry) to conduct a study of unplanned (excluding outpatient visits and elective surgery) hospital-based healthcare and mortality of all Danes. Using data for 7 weeks after the ‘shelter at home’ order, the incidence rate of unplanned hospital attendances per week in 2020 was compared with corresponding weeks in 2017–2019. The main outcome was hospital attendances per week as incidence rate ratios. Secondary outcomes were general population mortality and risk of death in-hospital, reported as weekly mortality rate ratios (MRRs).
Results From 2 438 286 attendances in the study period, overall unplanned attendances decreased by up to 21%; attendances excluding COVID-19 were reduced by 31%; non-psychiatric by 31% and psychiatric by 30%. Out of the five most common diagnoses expected to remain stable, only schizophrenia and myocardial infarction remained stable, while chronic obstructive pulmonary disease exacerbation, hip fracture and urinary tract infection fell significantly. The nationwide general population MRR rose in six of the recorded weeks, while MRR excluding patients who were COVID-19 positive only increased in two.
Conclusion The COVID-19 pandemic and a governmental national ‘shelter at home’ order was associated with a marked reduction in unplanned hospital attendances with an increase in MRR for the general population in two of 7 weeks, despite exclusion of patients with COVID-19. The findings should be taken into consideration when planning for public information campaigns.
- emergency department
- healthcare quality improvement
- health services research
- mortality (standardized mortality ratios)
Data availability statement
Data may be obtained from a third party and are not publicly available. According to Danish law, data cannot be shared. However, the data sources are available for other researchers pending approval from the Danish Health Data Authority.
This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
https://bmj.com/coronavirus/usageStatistics from Altmetric.com
- emergency department
- healthcare quality improvement
- health services research
- mortality (standardized mortality ratios)
Data availability statement
Data may be obtained from a third party and are not publicly available. According to Danish law, data cannot be shared. However, the data sources are available for other researchers pending approval from the Danish Health Data Authority.
Footnotes
SBB and MF are joint first authors.
Twitter @BieBogh
Contributors All authors made a substantial contribution to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work. MBr, SBB and MF conceived the study. MBr, SBB, RYH and MF designed the study. SBB and MF processed and analysed the data and all authors were involved in interpretation of the data. RYH and CAG provided an international approach to findings. MBe, SPJ, SBB, DPH, KRO and LCT designed the statistical analysis plan. SKN, SH, MRK, LEL, TL, MBS, HL, RYH, CAG, MBr, MF, PH and HGJ interpreted the findings from the emergency department. LF, EFC, JS, DPH, KEB and SM interpreted the findings from associated fields of medicine. MBr, SBB and MF drafted the paper and all authors revised it critically for important intellectual content. All authors gave the final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MBr is the guarantor for the paper and accepts full responsibility for the work and/or the conduct of the study, had access to the data and controlled the decision to publish.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.