Evidence map›Paper›PMID 39485775›Full record

ArticlePloS one2024

Changes in urgent and emergency care activity associated with COVID-19 lockdowns in a sub-region in the East of England: Interrupted times series analyses.

Zillur Rahman Shabuz, Max Bachmann, Rachel Cullum, Amanda Burke, Charlotte Emily Louise Jones, Oby Otu Enwo, Alice M Dalton, Julii Brainard, Michael Saunders, Nicholas Steel

Abstract read
In one paragraph

Article in PloS one, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Zillur Rahman ShabuzNorwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.
Max BachmannNorwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.ORCID 0000-0003-1770-3506
Rachel CullumNorwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.ORCID 0009-0008-8989-2389
Amanda BurkeNorwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.ORCID 0000-0002-7905-8947
Charlotte Emily Louise JonesNorwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.ORCID 0009-0004-9791-0760
Oby Otu EnwoNorwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.ORCID 0000-0003-4287-7145
Alice M DaltonNorwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.
Julii BrainardNorwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.ORCID 0000-0002-5272-7995
Michael SaundersNorwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.ORCID 0000-0001-9109-6164
Nicholas SteelNorwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAccess to and use of urgent and emergency care in the United Kingdom's National Health Service reduced during COVID-19 related lockdowns but demand reportedly increased since then. We investigated the impact of COVID-19 on urgent and emergency health care services activity in an eastern England population of 1.1 million.

methodsWe used health care activity data from a municipal health department, recorded at the level of discrete events (such as visits to hospital or ambulance calls) to compare system activity between 2018-2020 (pre-COVID), 2020-2021 (lockdown) and 2021-2023 (post-lockdown), carrying out interrupted time series analyses to describe changes in activity.

resultsDaily emergency department (ED) attendances were 10% (95% confidence interval 9-12%) lower during the lockdown period, and 7% (6-8%) higher in the post-lockdown period than pre-COVID. Attendances arriving by ambulance were 13% (12-14%) lower post-lockdown than pre-COVID, while attendances of arrivals by other means were 17% (16-19%) higher. Post-lockdown, overall attendances were continually reducing. ED waiting times were 45% (44-47%) longer in the post-lockdown period compared to the pre-COVID period and continued to increase post-lockdown. There was a 15% (14-16%) reduction in daily ambulance dispatches post-lockdown versus pre-COVID. Ambulance arrivals with delayed handover to hospital care exceeding 60 minutes increased by 17% (16-18%) post-lockdown versus pre-COVID, and probability of delay showed a continuously upward trend post-lockdown of 20% (19-21%) per year.

conclusionPatients are facing long waits in EDs to be admitted to hospital, discharged or transferred. This results in delays in ambulances handing over patients and attending to other calls, which may explain decreasing rates of ambulance dispatches. Potential solutions are likely to involve enhancing the flow through and discharge of patients from hospital, and a whole systems approach which considers the capacity of the local health and care infrastructure, including intermediate care and social care.

Indexed as

COVID-19Emergency Service, HospitalInterrupted Time Series AnalysisAdultAgedAmbulancesAmbulatory CareEmergency Medical ServicesEnglandFemaleHealth Services AccessibilityHumansMaleMiddle AgedSARS-CoV-2

Identifiers

PMID39485775
PMCPMC11530045

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.