Hospitals across the country are seeing significant drops in emergency department visits as more patients avoid them during the COVID-19 pandemic. Adventist Health Lodi (Calif.) Memorial, a 150-bed community hospital, decided to address those fears head-on and encourage patients who needed emergency care to come to the hospital's ED, according an article in NEJM Catalyst.
Hospital leaders, who wrote the article, said that ED visits to their facility cut in half between the first week of March and first week of April. California issued a shelter-in-place order March 19, the first U.S. state to do so.
Hospitals leaders realized people who needed emergency care were avoiding the hospital. One of the key indicators was that emergency medical services reported a drastic increase in cardiac arrests outside the hospital in March, compared to February, which suggests patients were waiting too long to seek cardiac care at the hospital, the authors wrote.
To address the issue, Adventist Health Lodi Memorial created a team that conducted 10 phone interviews with patients and five in-person interviews with providers to understand hospital usage. They gleaned several insights from the interviews, including that patients wanted to avoid the hospital because they believed it posed the greatest risk of exposure to the new coronavirus and that they were unaware of cleaning precautions and screening methods at the hospital.
In response, the hospital made two changes:
1. The hospital split the ED into respiratory pods, where patients with respiratory symptoms were evaluated, and non-respiratory pods, where patients without those symptoms were evaluated.
2. It used targeted messaging to communicate clear information about services and risks to patients, such as sending emails to existing patients letting them know the ED was open and using social media to inform patients about symptoms that constitute an emergency.
Though it is too early to evaluate the success of the interventions, the authors said that there was an improvement in the hospital’s ED volume in the first week after the changes were made, starting April 17.
"As we reopen the country, we may find that patients' fears of the healthcare environment extend beyond this immediate crisis," the authors wrote. "It will become increasingly important to engage the community in order to mitigate the public health risk of avoiding care for life-threatening illnesses."