# Changes in Veterans Health Administration Emergency Department Visits During Two Years of COVID-19

## TL;DR

This study found that emergency department visits by veterans decreased during the first two years of the COVID-19 pandemic, with a greater drop in emergent visits compared to non-emergent ones.

## Contribution

The study provides new insights into how the pandemic affected ED use in veterans, showing sustained decreases in emergent visits despite expectations of telehealth reducing non-emergent visits.

## Key findings

- Both emergent and non-emergent ED visits decreased during the first two years of the pandemic.
- Emergent visits showed a greater and more sustained decrease compared to non-emergent visits.
- By 2022, ED visits had not returned to pre-pandemic levels.

## Abstract

To better understand the impact of the COVID-19 pandemic on emergency department (ED) utilization, we examined two years of Veterans Health Administration (VHA) ED visits. Emergent and non-emergent ED visits were examined separately to understand the impact of systems-level changes in healthcare delivery.

In this retrospective, observational cohort study we examined ED visits in 111 EDs within the VHA from March 2018–February 2022. Primary outcome was the count of emergent and non-emergent ED visits, using incident rate ratios (IRR) with 95% confidence intervals (CI) to examine ED visits during the first two years of the COVID-19 pandemic in eight separate quarters, compared to two years of seasonally equivalent quarters before COVID-19.

Over the four-year period, US veterans made 8,057,011 ED visits, with 54.7% in the eight pre-COVID-19 quarters, and 45.3% in the first eight quarters during the COVID-19 pandemic. Both emergent and non-emergent visit counts decreased in each of the first eight quarters during COVID-19 when compared to their respective pre-COVID-19 baseline. The change in emergent visits ranged between −26.9% (March–May 2020; IRR 0.73, 95% CI 0.72–0.74) and −7.0% (June–August 2021; IRR 0.93, 95% CI 0.92–0.94). The change in non-emergent visits ranged between −33.0% (March–May 2020; IRR 0.67, 95% CI 0.67–0.67) and −5.7% (June–August 2021; IRR 0.94, 95% CI 0.94–0.95). After the first six months of the pandemic, emergent ED visits had a sustained greater decrease compared to non-emergent visits.

As of 2022, ED visits had not returned to pre-pandemic baselines, and our results suggest that emergent visits have sustained a greater decrease even in the second year of the pandemic compared to their respective, seasonally equivalent pre-pandemic quarters from March 2018–February 2020. The finding that emergent visits decreased more than non-emergent is notable given that system-level changes in care delivery, particularly a shift toward use of telehealth, would be expected to have a greater impact on non-emergent care. More work is needed to understand whether acute care is being forgone altogether, as well as the subsequent impact.