Universal SARS-CoV-2 Testing of Emergency Department Admissions Increases Emergency Department Length of Stay - 19/01/22
, David R. Peaper, MD, PhD b, Craig Rothenberg, MPH a, Marie L. Landry, MD b, c, e, L. Scott Sussman, MD c, Richard A. Martinello, MD c, d, f, Andrew Ulrich, MD a, Arjun K. Venkatesh, MD, MBA a
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Abstract |
Study objective |
Our institution experienced a change in SARS-CoV-2 testing policy as well as substantial changes in local COVID-19 prevalence, allowing for a unique examination of the relationship between SARS-CoV-2 testing and emergency department (ED) length of stay.
Methods |
This was an observational interrupted time series of all patients admitted to an academic health system between March 15, 2020, and September 30, 2020. Given testing limitations from March 15 to April 24, all patients receiving SARS-CoV-2 tests were symptomatic. On April 24, testing was expanded to all ED admissions. The primary and secondary outcomes were ED length of stay and number needed to test to obtain a positive, respectively.
Results |
A total of 70,856 patients were cared for in the EDs during the 7-month period. The testing change increased admission length of stay by 1.89 hours (95% confidence interval 1.39 to 2.38). The number needed to test was 2.5 patients and was highest yield on April 1, 2020, when the state positivity rate was 39.7%; however, the number needed to test exceeded 170 patients by Sept 1, 2020, at which point the state positivity rate was 0.5%.
Conclusion |
Although universal SARS-CoV-2 testing of ED admissions may meaningfully support mitigation and containment efforts, the clinical cost of testing all admissions amid low community positivity is notable. In our system, universal ED SARS-CoV-2 testing was associated with a 24% increase in admission length of stay alongside the detection of only 1 positive case every other day. Given the known harms and risks of ED boarding and crowding, solutions must be developed to support regular operational flow while balancing infection prevention needs.
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| Please see page 183 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Daniel A. Handel, MD, MBA. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: RS, AU, and AK conceived and designed the study. RS, CR, DP, and ML performed data collection and analysis. All authors interpreted the data. RS and AK drafted the manuscript, and all authors contributed substantially to its revision. AK takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. The authors report this article did not receive any outside funding or support. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 79 - N° 2
P. 182-186 - février 2022 Retour au numéro
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