Investigating changes in care patterns and lessons learned during COVID-19 pandemic - an exploratory, convergent mixed method study at two university emergency departments in Germany.

backgroundThe COVID-19 pandemic posed particular challenges for medical staff in emergency departments (ED). With the end of the pandemic declared by the WHO, the focus shifted to the pandemic preparedness of EDs. The present study aims to identify changes in care patterns in emergency care during the COVID-19 pandemic and derive lessons learned for future health crises.

methodsAn exploratory, convergent mixed method design was conducted. Qualitative data were collected through semi-structured interviews with ED staff. The focus was on their perspectives and perceived experiences of changes in work routines as well as lessons learned during the COVID-19 pandemic. The data were analyzed using thematic analysis. In parallel, routine data from ED patients were descriptively analyzed to examine differences in ED utilization, care pattern and patient flow during the COVID-19 pandemic compared to 2019. Group comparisons and mixed-effects models were used to identify changed patterns and their respective drivers.

resultsSixteen interviews and 56,842 patient records were analyzed. Overall, a decline in patient numbers was observed during the COVID-19 pandemic as well as changes in length of stay, referrals to ICU and in-hospital mortality compared to 2019. But rapid adjustments required and the accompanying flood of information led to an increased workload. Medical care in the ED was shaped by two overarching dilemmas: (1) Providing optimal care while conserving resources, (2) Delivering optimal treatment in compliance with hygiene guidelines. A shift in self-perception – from helpers to endangerers – had to be newly integrated into role understanding and patient care. To enhance the preparedness of the ED for future pandemics, six key areas have been identified: (1) Avoid Information overload and improve communication, (2) Staff safety and emotional support, (3) Early detection of infections, (4) Hygienic distancing, (5) Resource management in patient care, (6) Efficient discharge management.

conclusionsTo enhance the pandemic preparedness of EDs, an interdisciplinary approach was identified as crucial. This involves a combination of organizational adaptations, effective communication pathways, and emotional support for medical staff for advancing response capacity, resilience, and operational adaptability amidst future pandemics. REGISTRATION: www.drks.de DRKS00023117. Registered 21/09/2020.