Association Between Screening for Suspected COVID-19 Cases and Outcomes of Patients Revisiting the Emergency Department

OBJECTIVES: Patients who revisit the emergency department (ED) shortly after discharge are a high-risk group for complications and death, and these revisits may have been seriously affected by the COVID-19 pandemic. Detecting suspected COVID-19 cases in EDs is resource intensive. We examined the associations of screening workload for suspected COVID-19 cases with in-hospital mortality and intensive care unit (ICU) admission during short-term ED revisits. STUDY DESIGN: We conducted a retrospective cohort study using electronic health record data from a tertiary teaching hospital. METHODS: We analyzed all 72-hour ED-revisiting patients at the Taipei Veterans General Hospital ED in Taiwan between January 27, 2020, and December 31, 2020. Screening workload for suspected COVID-19 cases was measured with the daily number of suspected COVID-19 cases. Multivariate logistic regression models were used after adjustment for patient characteristics to examine the associations of screening workload with in-hospital mortality and ICU admission. RESULTS: A total of 1107 patients were included. The mean number of daily suspected COVID-19 cases was 9.4. The rates of subsequent in-hospital mortality and ICU admission were 2.1% and 3.2%, respectively. The volume of daily suspected COVID-19 cases was significantly associated with increased subsequent in-hospital mortality (adjusted OR, 1.073 with each additional daily suspected COVID-19 case; P = .005). CONCLUSIONS: This is the first study to our knowledge to identify that screening for suspected COVID-19 cases in EDs can adversely affect patient outcomes during short ED revisits. Identifying this association could enable ED providers and policy makers to optimize emergency service delivery during an epidemic and help patients.