Barriers to emergency department usage during the COVID-19 pandemic

Joshua D Niforatos; Alexander Chaitoff; Alexander R Zheutlin; Max M Feinstein; Ali S Raja

doi:10.1002/emp2.12316

Barriers to emergency department usage during the COVID-19 pandemic

J Am Coll Emerg Physicians Open. 2020 Nov 12;1(6):1261-1268. doi: 10.1002/emp2.12316. eCollection 2020 Dec.

Authors

Joshua D Niforatos¹, Alexander Chaitoff², Alexander R Zheutlin³, Max M Feinstein⁴, Ali S Raja⁵

Affiliations

¹ Department of Emergency Medicine The Johns Hopkins School of Medicine Baltimore Maryland USA.
² Department of Internal Medicine Brigham and Women's Hospital Boston Massachusetts USA.
³ Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah USA.
⁴ Department of Anesthesiology Perioperative and Pain Medicine Icahn School of Medicine at Mount Sinai New York New York USA.
⁵ Department of Emergency Medicine Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA.

Abstract

Objective: The objective of this study was to determine the public's likelihood of being willing to use an emergency department (ED) for urgent/emergent illness during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: An institutional review board-approved, cross-sectional survey of a non-probability sample from Amazon Mechanical Turk was administered May 24-25, 2020. Change in self-reported willingness to use an ED before and during the pandemic (primary outcome) was assessed via McNemar's test; COVID-19 knowledge and perceptions were secondary outcomes.

Results: There were 855 survey participants (466 [54.5%] male; 699 [81.8%] White; median age 39). Proportion reporting likelihood to use the ED pre-pandemic (71% [604/855]) decreased significantly during the pandemic (49% [417/855]; P < 0.001); those unlikely to visit the ED increased significantly during the pandemic (41% [347/855] vs 22% [417/855], P < 0.001). Participants were unlikely to use the ED during the pandemic if they were unlikely to use it pre-pandemic (adjusted odds ratio, 4.55; 95% confidence interval, 3.09-6.7) or correctly answered more COVID-19 knowledge questions (adjusted odds ratio, 1.37; 95% confidence interval, 1.17-1.60). Furthermore, 23.4% (n = 200) of respondents believed the pandemic was not a serious threat to society. Respondents with higher COVID-19 knowledge scores were more likely to view the pandemic as serious (odds ratio, 1.57; 95% confidence interval, 1.36-1.82).

Conclusions: This survey study investigated the public's willingness to use the ED during the COVID-19 pandemic. Only 49% of survey respondents were willing to visit the ED during a pandemic if they felt ill compared with 71% before the pandemic.