The COVID-19 pandemic has disrupted currently held norms and best practices for women who require evaluations and interventions for Obstetrics and gynecology (Ob/Gyn) emergency care. The resulting paradigm shifts have demonstrated a reassessment of how Ob/Gyn emergency care is provided in an acute setting while avoiding potential short and long-term harm. The objective of this study is to retrospectively evaluate if patients self-selected to avoid Emergency Department (ED) visits for perceived minor complaints and if postponing such care increased morbidity. Patients accessing Ob/Gyn ED care during the Covid-19 "lockdown period" (group A) in New York State were compared with those during a similar time frame in 2019 (group B). Primary outcomes were the number of ED visits and admission diagnoses. Secondary outcomes were the number of surgeries and clinical acuity on presentation. There was a 72% reduction in the total number of ED visits in group A compared to group B. Although the majority of the visits were for abdominal pain and vaginal bleeding in both groups, among patients who presented with vaginal bleeding in group A, a significantly higher number was due to early pregnancy loss rather than non-pregnancy-related uterine bleeding. The number of visits for non-emergency visits such as vulvovaginitis and contraceptive management was significantly lower and absent respectively. There were 61.5% fewer cases requiring emergency surgery in group A, however, the case acuity remained high with many patients being clinically unstable at presentation. There was a nonsignificant trend of an increased number of surgeries for ectopic pregnancy and pregnancy loss in group A compared to group B. Non-emergency surgeries, and visits for pain control, wound infections or ileus were absent in group A. We conclude that the decline in the ED visits and total number of emergency surgeries during the “lockdown period “were secondary to patients’ choices. This decrease was more pronounced for minor indications; however, many patients with serious conditions had delayed ED visits until they were clinically unstable. Therefore a reassessment of how patients access Ob/Gyn care via ED is indicated, with the goal being to avoid visits for minor indications while preventing potential life-threatening complications.
| Published in | Journal of Gynecology and Obstetrics (Volume 9, Issue 2) |
| DOI | 10.11648/j.jgo.20210902.13 |
| Page(s) | 42-45 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2021. Published by Science Publishing Group |
COVID-19, Lockdown Period, Ob/Gyn Visits, Emergency Surgery
| [1] | Rui P., Kang K., National Hospital Ambulatory Medical Care Survey: 2017 emergency department summary tables. National Center for Health Statistics. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2017_ed_web_tables-508.pdf. http://hcupnet.ahrq.gov/HCUPnet.jsp. |
| [2] | Morganti-Gonzalez K, Baufman S, Blanchard J, Abir M, Iyer N, Smith A, et al. The Evolving Role of Emergency Departments in the United States. RAND RR 280-ACEP. Santa Monica, CA: Rand Corp; May, 2013. www.rand.org. |
| [3] | Ning Tang, MD, John Stein, MD, Renee Y. Hsia, MD, MSc, Judith H. Maselli, MSPH, and Ralph Gonzales, MD, MSPH. Trends and Characteristics of US Emergency Department Visits, 1997-2007. JAMA. 2010 Aug 11; 304 (6): 664–670. doi: 10.1001/jama.2010.1112. |
| [4] | Audrey J Weiss, PhD, Lauren M Wier, MPH, Carol Stocks, PhD, RN, and Janice. |
| [5] | Blanchard, MD, PhD. An Overview of Emergency Department Visits in the United States, 2011.: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. June 2014. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. |
| [6] | Wong LE, Hawkins JE, Langness S, Murrell KL, Iris P, Sammann A. Where are all the patients? Addressing Covid-19 fear to encourage sick patients to seek emergency care. NEJM Catalyst Innovations in Care Delivery 2020. Epub May 14, 2020. https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0193. |
| [7] | Kathleen P. Hartnett, PhD; Aaron Kite-Powell, MS; Jourdan DeVies, MS; Michael A. Coletta, MPH; Tegan K. Boehmer, PhD, Jennifer Adjemian, PhD, Adi V. Gundlapalli, MD, PhD; National Syndromic Surveillance Program Community of Practice. CDC. Impact of the COVID-19 Pandemic on Emergency Department Visits — United States, January 1, 2019–May 30, 2020. |
| [8] | US national Library of Medicine. Centrai Trial. g ov. The Impact of the Covid-19 Outbreak on Emergency Room Attendances of Surgical Patients. |
| [9] | Jorge H. Nuñez, Andrea Sallent, Kushal Lakhani, Ernesto Guerra-Farfan, Nuria Vidal, Seper Ekhtiari, and Joan Minguel. Impact of the COVID-19 Pandemic on an Emergency Traumatology Service: Experience at a Tertiary Trauma Centre in Spain. NCBI, 2020 Jul; 51 (7): 1414–1418. |
| [10] | Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020 Feb 7. |
| [11] | World Health Organization (WHO). Novel Coronavirus (2019- nCoV) situation reports. 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports (02 April 2020). |
| [12] | Mohammad Hassan A. Noureldine, Elliot Pressman, Paul R. Krafft, Mark S. Greenberg, Siviero Agazzi, Harry van Loveren, Puya Alikhani. Impact of the COVID-19 Pandemic on Neurosurgical Practice at an Academic Tertiary Referral Center: A Comparative Study. 2020 Jul; 139: e872-e876. |
| [13] | Molly M. Jeffery, PhD; Gail D’Onofrio, MD, MS; Hyung Paek, MD; et al. Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US. JAMA Intern Med. 2020; 180 (10): 1328-1333. |
| [14] | Rosenbaum L. The untold toll: the pandemic’s effects on patients without COVID-19. N Engl J Med. 2020; 382 (24): 2368-2371. |
| [15] | De Filippo O, D’Ascenzo F, Angelini F, et al. Reduced rate of hospital admissions for ACS during COVID-19 outbreak in Northern Italy. N Engl J Med. 2020; 383: 88-89. |
| [16] | Jeffery MM, D’Onofrio GD, Paek Y, et al. Trends in ED Visits and Hospital Admissions During COVID-19 Pandemic. American College of cardiology. Aug 05, 2020. |
APA Style
Sepideh Mehri, Robert Berg, Iffath Abbasi Hoskins. (2021). Impact of the Coronavirus Pandemic on Emergency Department (ED) Visits for Ob/Gyn Care. Journal of Gynecology and Obstetrics, 9(2), 42-45. https://doi.org/10.11648/j.jgo.20210902.13
ACS Style
Sepideh Mehri; Robert Berg; Iffath Abbasi Hoskins. Impact of the Coronavirus Pandemic on Emergency Department (ED) Visits for Ob/Gyn Care. J. Gynecol. Obstet. 2021, 9(2), 42-45. doi: 10.11648/j.jgo.20210902.13
AMA Style
Sepideh Mehri, Robert Berg, Iffath Abbasi Hoskins. Impact of the Coronavirus Pandemic on Emergency Department (ED) Visits for Ob/Gyn Care. J Gynecol Obstet. 2021;9(2):42-45. doi: 10.11648/j.jgo.20210902.13
Share This Article
Twitter
Linked In
Facebook
Copy
Download@article{10.11648/j.jgo.20210902.13,
author = {Sepideh Mehri and Robert Berg and Iffath Abbasi Hoskins},
title = {Impact of the Coronavirus Pandemic on Emergency Department (ED) Visits for Ob/Gyn Care},
journal = {Journal of Gynecology and Obstetrics},
volume = {9},
number = {2},
pages = {42-45},
doi = {10.11648/j.jgo.20210902.13},
url = {https://doi.org/10.11648/j.jgo.20210902.13},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20210902.13},
abstract = {The COVID-19 pandemic has disrupted currently held norms and best practices for women who require evaluations and interventions for Obstetrics and gynecology (Ob/Gyn) emergency care. The resulting paradigm shifts have demonstrated a reassessment of how Ob/Gyn emergency care is provided in an acute setting while avoiding potential short and long-term harm. The objective of this study is to retrospectively evaluate if patients self-selected to avoid Emergency Department (ED) visits for perceived minor complaints and if postponing such care increased morbidity. Patients accessing Ob/Gyn ED care during the Covid-19 "lockdown period" (group A) in New York State were compared with those during a similar time frame in 2019 (group B). Primary outcomes were the number of ED visits and admission diagnoses. Secondary outcomes were the number of surgeries and clinical acuity on presentation. There was a 72% reduction in the total number of ED visits in group A compared to group B. Although the majority of the visits were for abdominal pain and vaginal bleeding in both groups, among patients who presented with vaginal bleeding in group A, a significantly higher number was due to early pregnancy loss rather than non-pregnancy-related uterine bleeding. The number of visits for non-emergency visits such as vulvovaginitis and contraceptive management was significantly lower and absent respectively. There were 61.5% fewer cases requiring emergency surgery in group A, however, the case acuity remained high with many patients being clinically unstable at presentation. There was a nonsignificant trend of an increased number of surgeries for ectopic pregnancy and pregnancy loss in group A compared to group B. Non-emergency surgeries, and visits for pain control, wound infections or ileus were absent in group A. We conclude that the decline in the ED visits and total number of emergency surgeries during the “lockdown period “were secondary to patients’ choices. This decrease was more pronounced for minor indications; however, many patients with serious conditions had delayed ED visits until they were clinically unstable. Therefore a reassessment of how patients access Ob/Gyn care via ED is indicated, with the goal being to avoid visits for minor indications while preventing potential life-threatening complications.},
year = {2021}
}
TY - JOUR T1 - Impact of the Coronavirus Pandemic on Emergency Department (ED) Visits for Ob/Gyn Care AU - Sepideh Mehri AU - Robert Berg AU - Iffath Abbasi Hoskins Y1 - 2021/03/26 PY - 2021 N1 - https://doi.org/10.11648/j.jgo.20210902.13 DO - 10.11648/j.jgo.20210902.13 T2 - Journal of Gynecology and Obstetrics JF - Journal of Gynecology and Obstetrics JO - Journal of Gynecology and Obstetrics SP - 42 EP - 45 PB - Science Publishing Group SN - 2376-7820 UR - https://doi.org/10.11648/j.jgo.20210902.13 AB - The COVID-19 pandemic has disrupted currently held norms and best practices for women who require evaluations and interventions for Obstetrics and gynecology (Ob/Gyn) emergency care. The resulting paradigm shifts have demonstrated a reassessment of how Ob/Gyn emergency care is provided in an acute setting while avoiding potential short and long-term harm. The objective of this study is to retrospectively evaluate if patients self-selected to avoid Emergency Department (ED) visits for perceived minor complaints and if postponing such care increased morbidity. Patients accessing Ob/Gyn ED care during the Covid-19 "lockdown period" (group A) in New York State were compared with those during a similar time frame in 2019 (group B). Primary outcomes were the number of ED visits and admission diagnoses. Secondary outcomes were the number of surgeries and clinical acuity on presentation. There was a 72% reduction in the total number of ED visits in group A compared to group B. Although the majority of the visits were for abdominal pain and vaginal bleeding in both groups, among patients who presented with vaginal bleeding in group A, a significantly higher number was due to early pregnancy loss rather than non-pregnancy-related uterine bleeding. The number of visits for non-emergency visits such as vulvovaginitis and contraceptive management was significantly lower and absent respectively. There were 61.5% fewer cases requiring emergency surgery in group A, however, the case acuity remained high with many patients being clinically unstable at presentation. There was a nonsignificant trend of an increased number of surgeries for ectopic pregnancy and pregnancy loss in group A compared to group B. Non-emergency surgeries, and visits for pain control, wound infections or ileus were absent in group A. We conclude that the decline in the ED visits and total number of emergency surgeries during the “lockdown period “were secondary to patients’ choices. This decrease was more pronounced for minor indications; however, many patients with serious conditions had delayed ED visits until they were clinically unstable. Therefore a reassessment of how patients access Ob/Gyn care via ED is indicated, with the goal being to avoid visits for minor indications while preventing potential life-threatening complications. VL - 9 IS - 2 ER -
Information
Email: