Threat of COVID-19 impacting on a quaternary healthcare service: a retrospective cohort study of administrative data
Deborah A Williamson,
Mark Putland,
Bruce CV Campbell,
Digsu N Koye,
Timothy N Fazio,
Benjamin Smith,
Leeanne Grigg,
Douglas Johnson,
Jonathan C Knott,
Jo Douglass,
Elissa McNamara,
Leanne Saxon,
Katherine Bond,
Martin J Dutch,
David J Read,
Benjamin NJ Thomson,
Steven YC Tong
Affiliations
Deborah A Williamson
Infectious Diseases, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
Mark Putland
Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria 3000, Australia
Bruce CV Campbell
Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
Digsu N Koye
The Royal Melbourne Hospital, Melbourne, Victoria, Australia
Timothy N Fazio
Department of General Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
Benjamin Smith
Columbia University, New York, New York, USA
Leeanne Grigg
Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
Douglas Johnson
9 Departments of General Medicine and Infectious Diseases, The Royal Melbourne Hospital, Parkville, Victoria, Australia
Jonathan C Knott
Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
Jo Douglass
The Royal Melbourne Hospital, Melbourne, Victoria, Australia
Elissa McNamara
Department of General Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
Leanne Saxon
Melbourne Academic Centre for Health, Parkville, Victoria, Australia
Katherine Bond
5 Department of Microbiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Martin J Dutch
Centre for Integrated Critical Care Research, University of Melbourne, Melbourne, Victoria, Australia
David J Read
Trauma and Colorectal Units, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
Benjamin NJ Thomson
University of Melbourne Department of Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
Steven YC Tong
Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
Objectives The threat of a pandemic, over and above the disease itself, may have significant and broad effects on a healthcare system. We aimed to describe the impact of the SARS-CoV-2 pandemic (during a relatively low transmission period) and associated societal restrictions on presentations, admissions and outpatient visits.Design We compared hospital activity in 2020 with the preceding 5 years, 2015–2019, using a retrospective cohort study design.Setting Quaternary hospital in Melbourne, Australia.Participants Emergency department presentations, hospital admissions and outpatient visits from 1 January 2015 to 30 June 2020, n=896 934 episodes of care.Intervention In Australia, the initial peak COVID-19 phase was March–April.Primary and secondary outcome measures Separate linear regression models were fitted to estimate the impact of the pandemic on the number, type and severity of emergency presentations, hospital admissions and outpatient visits.Results During the peak COVID-19 phase (March and April 2020), there were marked reductions in emergency presentations (10 389 observed vs 14 678 expected; 29% reduction; p<0.05) and hospital admissions (5972 observed vs 8368 expected; 28% reduction; p<0.05). Stroke (114 observed vs 177 expected; 35% reduction; p<0.05) and trauma (1336 observed vs 1764 expected; 24% reduction; p<0.05) presentations decreased; acute myocardial infarctions were unchanged. There was an increase in the proportion of hospital admissions requiring intensive care (7.0% observed vs 6.0% expected; p<0.05) or resulting in death (2.2% observed vs 1.5% expected; p<0.05). Outpatient attendances remained similar (30 267 observed vs 31 980 expected; 5% reduction; not significant) but telephone/telehealth consultations increased from 2.5% to 45% (p<0.05) of total consultations.Conclusions Although case numbers of COVID-19 were relatively low in Australia during the first 6 months of 2020, the impact on hospital activity was profound.
