The threat of COVID-19 impacting on a quaternary healthcare service: a retrospective cohort study of administrative data
Dr Leanne Saxon
Associate Professor Steve TongFull Bio
Dr Tim Fazio
Dr Elly McNamara
The Royal Melbourne Hospital
“The coronavirus disease 2019 (COVID-19) pandemic has affected hospitals in varied ways. The usual business of providing care to patients without COVID-19 has altered and the pattern of presentations and admissions has changed. In general, as the number of COVID-19 cases rose, the reported decrease in overall number of emergency presentations has ranged from 49% in the UK up to 88% in Italy. Unanticipated and indirect impacts on hospital services occurred even in regions with relatively few reported COVID-19 cases.
Before July 2020, Australia had been relatively spared. As of June 30, 2020, there had been 8,023 COVID-19 cases and 104 deaths among a population of 25 million. In the second-largest jurisdiction of Victoria, there had been 2,159 cases. The Victorian government declared a state of emergency on March 16 and shut down all non-essential activity. Health services were instructed to suspend non-urgent surgery to maintain surge capacity. The federal government introduced widened criteria for telehealth consultation rebates to encourage the use of telehealth.
The Australian context provides a unique opportunity to examine the effects of the threat of COVID-19 on healthcare use. Using hospital administrative data from the Royal Melbourne Hospital, one of Victoria’s largest hospitals and epicentre for the COVID-19 pandemic, we determined changes in the number, type, and severity of emergency presentations, hospital admissions, and hospital outpatient visits, during the first half of 2020 compared with the preceding five years, 2015-2019. An understanding of changes can improve planning, public health messaging, and resource management for future surges.” (excerpt from publication)
- raise concern that during the initial threat of COVID-19, and even after it abated, there has been a marked reduction in presentations to hospitals, and indicators of increased severity in those presenting.
- indicate it is imperative for public health authorities to improve community messaging regarding the importance of seeking timely care. Targeting vulnerable groups who already have barriers to accessing care is especially important.
- suggest hospitals should prepare for an increase in workload after the pandemic, not only from patients who had elective procedures deferred but from patients who avoided care during the initial threat of COVID-19.
(excerpt from publication)
Saxon L*, McNamara, E*, Bond K, Campbell BCV, Douglass J, Dutch MJ, Grigg L, Douglas Johnson D, Knott JC, Koye JN, Putland M, Read DJ, Smith B, Thomson BNJ, Williamson DBA, Tong SYC, Fazio TN * joint first authors “The threat of COVID-19 impacting on a quaternary healthcare service: a retrospective cohort study of administrative data” BMJ Open, under review 2020