Emergency department presentations during the COVID-19 pandemic in Queensland (to June 2021): interrupted time series analysis

Objectives: To assess emergency department (ED) presentation numbers in Queensland during the coronavirus disease 2019 (COVID-19) pandemic to mid-2021, a period of relatively low COVID-19 case numbers. Design: Interrupted time series analysis. Setting: All 105 Queensland public hospital EDs. Main outcome measures: Numbers of ED presentations during the COVID-19 lockdown period (11 March 2020 – 30 June 2020) and the period of easing restrictions (1 July 2020 – 30 June 2021), compared with pre-pandemic period (1 January 2018 – 10 March 2020), overall (daily numbers) and by Australasian Triage Scale (ATS; daily numbers) and selected diagnostic categories (cardiac, respiratory, mental health, injury-related conditions) and conditions (stroke, sepsis) (weekly numbers). Results: During the lockdown period, the mean number of ED presentations was 19.4% lower (95% confidence interval, –20.9% to –17.9%) than during the pre-pandemic period (predicted mean number: 5935; actual number: 4786 presentations). The magnitudes of the decline and the time to return to predicted levels varied by ATS category and diagnostic group; changes in presentation numbers were least marked for ATS 1 and 2 (most urgent) presentations, and for presentations with cardiac conditions or stroke. Numbers remained below predicted levels during the 12-month post-lockdown period for ATS 5 (least urgent) presentations and presentations with mental health problems, respiratory conditions, or sepsis. Conclusions: The COVID-19 pandemic and related public restrictions were associated with profound changes in health care use. Pandemic plans should include advice about continuing to seek care for serious health conditions and health emergencies, and support alternative sources of care for less urgent health care needs.