The effect of COVID-19 on the characteristics of adult emergency department visits: A retrospective cohort tertiary hospital experience in Riyadh

An Updated Scoping Review of Factors Associated with Length of Stay in Emergency Department

Background

The Emergency Department (ED) is important to the hospital healthcare system. However, increasing patient visits to the ED have increased the length of stay (LOS), which contributes to overcrowding, resource constraints, and decreased quality of care. Factors affecting LOS are complex and involve patient characteristics, hospital operations, and health system policies.

Purpose

This review aimed to explore the factors influencing ED LOS.

Methods

This study employed a scoping review with the PRISMA-ScR approach, analyzing articles from PubMed, Scopus, Taylor & Francis, and EBSCOhost databases published between 2022 and 2025. The keywords used were Emergency department patients OR ED patients OR Hospital admissions OR Emergency visits AND Length of stay OR hospital stay AND Predictor OR Factor. The quality appraisal of the articles was assessed using the Joanna Briggs Institute critical evaluation tool. Data were analyzed using descriptive qualitative and thematic analysis.

Results

Factors influencing LOS in the ED were categorized into five main categories: (1) Patient characteristics (advanced age, male gender, comorbidities, and specific clinical conditions such as sepsis and blood diseases); (2) Time and environmental factors (nighttime, weekend, and winter visits); (3) Hospital and health system factors (hospital type, bed capacity, insurance status, and triage severity); (4) Diagnostic and treatment processes (waiting times for radiology and laboratory examinations, delays in specialist consultations, and limited inpatient beds); and (5) Patient arrival mode (arriving by ambulance or referred from another hospital).

Conclusion

Longer LOS in the ED is influenced by various multidimensional factors that interact with each other. To reduce patient stays in the ED, efforts to optimize triage, improve diagnostic efficiency, and strengthen coordination between hospital units are needed. Evidence-based strategies such as digitizing medical records and predictive analytics can help improve service efficiency and reduce ED congestion.

Evaluation of In-Hospital and Community-Based Healthcare Utilization and Costs During the Coronavirus 2019 (COVID-19) Pandemic in Alberta, Canada: A Population-Based Descriptive Study

Background

Assessing the financial burden of COVID-19 is important for planning health services and resource allocation to inform future pandemic response.

Objectives

This study examines the changing dynamics in healthcare utilization patterns and costs from a public healthcare perspective during the COVID-19 pandemic in Alberta, Canada.

Design

Population-based descriptive study.

Methods

All adult patients over the age of 18 years who had a laboratory-confirmed COVID-19 diagnosis in Alberta, Canada from March 1, 2020 to December 15, 2021. We described demographic information and community- and hospital-based healthcare utilization and costs. We compared changes in each outcome throughout the first four waves of the pandemic.

Results

Among 255,037 patients, hospitalization incurred significantly higher costs (N = 20,603; aRR = 755.51; marginal cost: $21,738.17 CAD; P < .01). Wave 2 recorded the highest cost for Emergency Department (ED) visits (aRR = 1.10; marginal cost: $79.19 CAD; P < .01). Compared to Wave 1, Waves 2-4 all recorded significantly lower costs for out-patient visits. Wave 2's in-patient cost for patients that required ICU admission was significantly lower than Wave 1 (aRR = 0.75; marginal cost: -$24,142.47 CAD; P = .02).

Conclusion

COVID-19 exerted a heavy toll on healthcare services, and the dynamics of this continue to evolve. Utilization of ED and in-patient services were particularly high. Severe infections requiring hospitalization and ICU admission are more expensive than non-hospitalized and non-ICU hospital admits. Future studies should clarify specific factors, such as sociodemographic determinants, that contribute to evolving patterns of health services consumption and changing trends in cost to holistically inform responses to future pandemics.

Substance Use Disorder Admission Rates Before and After the Lockdown in a Large Addiction Center in Saudi Arabia: A Retrospective Cohort Study

Objective: This study aimed to examine the potential changes in substance use disorder (SUD) admission rates before and after the lockdown in a major addiction center in Saudi Arabia. Method: This retrospective cohort study extracted data from Al-Amal Hospital Electronic Health Record in the city of Dammam, Eastern region of Saudi Arabia. A total of 2,426 cases included in the analysis for patients who received services from the SUD treatment programs from 1/1/2015 to 31/12/2021. Results: Before the pandemic, there was a consistent increase in the admission rates for patients with substance use disorder. The highest proportion of increase were among unemployed, young, newly admitted patients. During lockdown, there was nearly a 70% reduction in SUDs-related admission rate. The age group 18-25 was seven-times more likely to be admitted for SUD after the lockdown. Amphetamine-related admissions were two times more likely to be admitted after the lockdown (Odds ratio (OR) 2.04; confidence interval (CI) 95%[1.64, 2.54]). Conclusions: There was nearly 70% reduction in SUDs admission rates during the lockdown. After the lockdown, a significant proportional increase in amphetamine use disorder admissions was observed mostly among the patients age group 18-24 with a history of a previous admissions. Determining populations at risk for high health care utilization is crucial in building a comprehensive and effective prevention strategy. Therefore, the need to adopt coordinated strategies and innovative, comprehensive approaches to benefit individuals with SUD is imperative to face the increased rate of SUD related admissions.

Excess Deaths During the COVID-19 Pandemic in Southern Iran: Estimating the Absolute Count and Relative Risk Using Ecological Data

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic led to increased mortality rates. To assess this impact, this ecological study aimed to estimate the excess death counts in southern Iran.

METHODS

The study obtained weekly death counts by linking the National Death Registry and Medical Care Monitoring Center repositories. The P-score was initially estimated using a simple method that involved calculating the difference between the observed and expected death counts. The interrupted time series analysis was then used to calculate the mean relative risk (RR) of death during the first year of the pandemic.

RESULTS

Our study found that there were 5571 excess deaths from all causes (P-score=33.29%) during the first year of the COVID-19 pandemic, with 48.03% of these deaths directly related to COVID-19. The pandemic was found to increase the risk of death from all causes (RR, 1.26; 95% confidence interval [CI], 1.19 to 1.33), as well as in specific age groups such as those aged 35-49 (RR, 1.21; 95% CI, 1.12 to 1.32), 50-64 (RR, 1.38; 95% CI, 1.28 to 1.49), and ≥65 (RR, 1.29; 95% CI, 1.12 to 1.32) years old. Furthermore, there was an increased risk of death from cardiovascular diseases (RR, 1.17; 95% CI, 1.11 to 1.22).

CONCLUSIONS

There was a 26% increase in the death count in southern Iran during the COVID-19 pandemic. More than half of these excess deaths were not directly related to COVID-19, but rather other causes, with cardiovascular diseases being a major contributor.

Demand for emergency services during the COVID-19 pandemic and disease burden: a case study in Portugal

Background

The COVID-19 pandemic brought changes in the pattern of care use. A significant increase in the volume of emergencies was expected. However, a significant decrease was observed worldwide.

Methods

An observational, analytical and cross-sectional study of all records of emergency episodes of patients aged 18 years or older admitted to the emergency services of the University of Porto Hospital Centre (2018-2022) were analysed.

Results

During the pandemic, a significant reduction in emergency episode admissions (up to 40% during lockdowns), an increase in pre-emergency services, and discharges from Infectious Diseases and Internal Medicine was observed. The discharges from General Practice and General Practice and Family Medicine were residual.

Conclusion

The lower use and type of use of emergency services during the COVID-19 pandemic had a negative impact on the disease burden. This could be prevented in future pandemics through the development of strategies to promote confidence in the use of health resources and establishing contingency plans for virtual assistance.

The Impact of the Second Wave of the COVID-19 Pandemic on Non-COVID Hospital Care in a Tertiary Hospital in Spain

In 2020, Spain ranked fourth among European countries with the highest excess mortality due to COVID-19 disease. This study evaluates the impact of the COVID-19 pandemic on non-COVID patients in a tertiary hospital during the second pandemic wave in Spain (22 June 2020-6 December 2020). Data from Virgen del Rocío University Hospital in Seville during that timeframe were compared with the data from the same period in the preceding two years (2018-2019). Between-group comparisons were performed using the Chi-squared test, Student's t-test, or Mann-Whitney U tests, as appropriate. A total of 63,137 non-COVID patients were included in this study. During the second pandemic wave, a 19% decrease was observed in the annual number of non-COVID admissions overall (18,260 vs. 22,439, p < 0.001), but a 10% increase in the proportion of emergency admissions (60.6% vs. 54.93%, p < 0.001), a higher severity level of patients (1.79 vs. 1.72, p < 0.001), a longer in-hospital stay (7.02 vs. 6.74 days, p < 0.001), a 26% increase in non-COVID mortality (4.9% vs. 3.9%, p < 0.001), and a 50% increase in global mortality (5.9 vs. 3.9, p < 0.001) were also observed. In terms of both medical and surgical diagnoses, a significant reduction in the number of admissions and an increase in in-hospital mortality were observed. These results demonstrate the significant impact of the pandemic on hospital care, similar to what was previously observed during the initial wave in the same hospital. Our findings emphasize the need to include non-COVID patients when assessing the broad impact of the pandemic on healthcare, beyond its direct effects on COVID-19 patients.

The impact of COVID-19 epidemic on emergency department visits of older patients in Taiwan

BACKGROUND

The number of emergency department (ED) visits has significantly declined since the COVID-19 pandemic. In Taiwan, an aged society, it is unknown whether older adults are accessing emergency care during the COVID-19 epidemic. Therefore, this study aimed to investigate the impact of COVID-19 on the ED visits and triage, admission, and intensive care unit (ICU) hospitalization of the geriatric population in a COVID-19-dedicated medical center throughout various periods of the epidemic.

METHODS

A retrospective chart review of ED medical records from April 9 to August 31, 2021 were conducted, and demographic information was obtained from the hospital's computer database. The period was divided into pre-, early-, peak-, late-, and post-epidemic stages. For statistical analysis, one-way analysis of variance followed by multiple comparison tests (Bonferroni correction) were used.

RESULTS

A statistically significant decrease in the total number of patients attending the ED was noted during the peak-, late-, and post-epidemic stages. In the post-epidemic stage, the number of older patients visiting ED was nearly to that of the pre-epidemic stage, indicating that older adults tend to seek care at the ED earlier than the general population. Throughout the entire epidemic period, there was no statistically significant reduction in the number of the triage 1& 2 patients seeking medical attention at the emergency department. In the entire duration of the epidemic, there was no observed reduction in the admission of elderly patients to our hospital or ICU through the ED. However, a statistically significant decrease was observed in the admission of the general population during the peak epidemic stage.

CONCLUSIONS

During the peak of COVID-19 outbreak, the number of ED visits was significantly affected. However, it is noteworthy that as the epidemic was gradually controlled, the older patients resumed their ED visits earlier that the general population as indicated by the surge in their number. Additionally, in the patient group of triage 1& 2, which represents a true emergency, the number did not show a drastic change.

Impact of COVID-19 Vaccination on General Surgical Emergencies in Al-Qassim Region, Saudi Arabia: A Single-Center Retrospective Chart Review

Background This study sought to determine the COVID-19 pandemic and vaccination's effects on the number of patients presenting with emergent surgical illnesses or requiring emergency general surgical procedures. We compared the number of presenting cases and surgical emergencies before the pandemic, in 2019, and during the pandemic, before and after the COVID-19 vaccination's introduction. Method This observational retrospective chart review was conducted at a tertiary hospital in Al-Qassim, Saudi Arabia. The data were retrospectively collected for three periods (July 1 to September 30) in 2019, 2020, and 2021 using a data collection sheet for demographic data, visit date, comorbidities, emergency procedure type, COVID-19 test result, length of hospitalization, ICU admission status, and surgical case mortality. Results The study included 152 participants with a mean age of 36.1 (SD: 16) years, and 69.7% of them were male. Common surgical conditions were identified as acute appendicitis (49.3%), skin abscesses and pilonidal sinus (21.7%), and diabetic foot (9.2%) across all three years. The most frequent (48.7%) surgical procedure was appendectomy. A decrease in surgical emergencies rate was observed during the year 2020, as compared to 2019 and 2021. The general surgery emergency rate was highest in 2021 among patients admitted for procedures post-vaccination (38.8%). Conclusion Common surgical emergencies were most frequent in 2021, after the COVID-19 vaccine's introduction. Future research areas include the impact of the pandemic on delays or the severity and complication of surgical or medical cases.

Perceived Difficulties and Learning Needs Among Acute Care Ward Nurses Providing End-of-Life Care During the COVID-19 Pandemic: Comparison by Years of Clinical Experience

Background

In the daily routine of acute care wards, where priority is given to patients with severe illnesses and those who require urgent care, working with and supporting the decision making of terminally ill patients can be challenging.

Methods

This study aimed to clarify the perceived difficulties of and learning needs among acute care ward nurses providing end-of-life care during the COVID-19 pandemic. In order to perform analyses by years of clinical experience, we conducted semi-structured interviews with both novice and experienced nurses. Participants were nurses working in the acute care ward of hospitals in the Kansai area.

Results

We interviewed 31 nurses who agreed to cooperate, including 18 novice/advanced beginner nurses and 13 proficient/expert nurses. Perceived difficulties were categorized into four main groups for novice/advanced beginner nurses: , , , and . Perceived difficulties were categorized into four main groups for proficient/expert nurses: , , , and . Perceived learning needs were categorized into three main groups for novice/advanced beginner nurses: , , and . Perceived learning needs were categorized into three main groups for proficient/expert nurses: , , and .

Conclusion

Novice/advanced beginner nurses felt anxiety and confusion, and were overwhelmed with how to care for terminal patients. Proficient/expert nurses were able to think about how to make patients and their families feel better, and were able to think specifically about post-mortem care. Many proficient/expert nurses were thinking not only about patient care but also about patients' room environment and how to spend time with their families. They sought learning opportunities regarding angel care, including methods of teaching it and basic techniques for performing it, and realized that information sharing within wards, chain of command within the hospital, information exchange with other hospitals, and inter-hospital collaboration were all important during COVID-19 pandemic.

The Effect of COVID-19 in a University Hospital Neurosurgery Clinic Comparison to Prepandemic Period: A Retrospective Study with 6 months of Data

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic affected all countries' health systems and people's lifestyles. In this study, we aimed to investigate its effects in a university hospital neurosurgery clinic.

METHODS

The 2019 year's 6 months' data as a prepandemic period compared to the 2020 year's same period as a pandemic date. Demographic data were collected. Operations were divided into seven groups: tumor, spinal, vascular, cerebrospinal fluid disorders, hematoma, local, and minor surgery, respectively. We classified the hematoma cluster into subgroups to evaluate the etiology: epidural, acute subdural, subarachnoid hemorrhage, intracerebral hemorrhage, depressed skull fractures, and others. Patients' COVID-19 test results were collected.

RESULTS

Total operations decreased from 972 to 795 (Δ18.2%) during the pandemic. All groups, except minor surgery cases, decreased compared to the prepandemic period. Also, vascular procedures for females increased during the pandemic period. While focusing on the hematoma subgroups, there was decreasing in epidural and subdural hematomas, depressed skull fractures, and total case numbers; an increase in subarachnoid hemorrhage and intracerebral hemorrhage. Overall mortality significantly increased to 9.6% from 6.8% during the pandemic (P = 0.033). Eight (1.0%) of 795 patients were COVID-19-positive; three of them died. Neurosurgery residents and academicians were unsatisfied with decreased number of operations, training, and research productivity.

CONCLUSIONS

The pandemic and restrictions affected negatively the health system and people's access to healthcare. Our retrospective observational study aimed to evaluate these effects and take lessons for the next similar situations. People's access to health care should be considered when lockdown restrictions.

How Significant Are Xpert Xpress SARS-CoV-2 Test Findings When Only an N2 Gene Is Detected?

The rapid identification of patients infected with COVID-19 during the SARS-CoV-2 pandemic is critical to operating emergency rooms effectively. Xpert Xpress SARS-CoV-2 (Xpert) assays are increasingly being used in the rapid screening of COVID-19. We evaluated the clinical performance of Xpert by comparing findings with those of qRT-PCR evaluations and included the clinical features of patients visiting the emergency department. Positive results with Xpert testing (n = 370) were compared with qRT-PCR findings, demonstrating a 91.9% intertest agreement. We reviewed the subsequent COVID-19 test results and SARS-CoV-2 infection histories for individuals showing discrepancies in Xpert and qRT-PCR testing and determined whether the findings were true-positive or false-positive. The true-positive rate for Xpert testing was 95.4% (353/370); the remaining 17 samples (4.6%) were false-positive. All false-positive data for Xpert testing showed N2 signals amplified to Ct values of ≥40 with no E gene signals. Rapid Xpert testing is highly sensitive and shows a good performance overall in challenging situations, such as an emergency room. However, we considered the possibility of false-positive Xpert results given an N2 gene signal only, especially given high Ct values. We recommend interpreting test data with caution and considering retesting over time.

Epidemiology of Traffic Injuries before, during and 1 Year after the COVID-19 Pandemic Restrictions: National Findings from the Saudi Red Crescent Authority

Background

Road traffic injuries are a leading cause of death in Saudi Arabia. Studies have examined the impact of the COVID-19 pandemic on traffic injuries treated in healthcare institutions, but its impact on patients seeking emergency medical transport for traffic injuries remains unclear.

Objective

This study aimed to determine changes in traffic injuries' distribution and outcomes among patients seeking emergency medical transport before, during, and after the COVID-19 restrictions were imposed in Saudi Arabia.

Methods

This is a nationwide retrospective study of all injuries reported to the Saudi Red Crescent Authority (SRCA) between January 1st, 2020, and May 31st, 2021. The cases in the study were categorized based on the following three time periods: (1) Pre-restriction (January 1 to March 23, 2020), (2) restriction (March 24 to June 21, 2020), and (3) post-restriction (June 22, 2020, to May 31, 2021).

Results

A total of 142,763 cases of traffic-related injuries were recorded at the SRCA during the study period: pre-restriction, 27,811 (19.5%); restriction, 14,414 (10.1%); post-restriction, 100,538 (70.4%). Males accounted for most cases throughout the study period, but a significant increase in the number of females was observed in the post-restriction period compared with the first two timeframes (12.2% vs. 3.4% and 3.4%, respectively; P < 0.01). During the restriction period, the rate of mortality was the highest, and rollover crashes were significantly higher (18.2% vs. 14.0% and 14.6%; P < 0.01). Overall, pedestrians were almost three times more likely to die following injuries than occupants or drivers (OR = 2.7).

Conclusions

Further prevention programs to reduce traffic injuries are needed to improve traffic safety and improve population health.