Virtual care use prior to emergency department admissions during a stable COVID-19 period in Ontario, Canada

Background The increased use of telemedicine to provide virtual outpatient visits during the pandemic has led to concerns about potential increased emergency department (ED) admissions and outpatient service use prior to such admissions. We examined the frequency of virtual visits use prior to ED admissions and characterized the patients with prior virtual visit use and the physicians who provided these outpatient visits. Methods We conducted a retrospective, population-based, cross-sectional analysis using linked health administrative data in Ontario, Canada to identify patients who had an ED admission between July 1 and September 30, 2021 and patients with an ED admissions during the same period in 2019. We grouped patients based on their use of outpatient services in the 7 days prior to admission and reported their sociodemographic characteristics and healthcare utilization. Results There were 1,080,334 ED admissions in 2021 vs. 1,113,230 in 2019. In 2021, 74% of these admissions had no prior outpatient visits (virtual or in-person) within 7 days of admission, compared to 75% in 2019. Only 3% of ED admissions had both virtual and in-person visits in the 7 days prior to ED admission. Patients with prior virtual care use were more likely to be hospitalized than those without any outpatient care (13% vs 7.7.%). Interpretation The net amount of ED admissions and outpatient care prior to admission remained the same over a period of the COVID-19 pandemic when cases were relatively stable. Virtual care seemed to be able to appropriately triage patients to the ED and virtual visits replaced in-person visits ahead of ED admissions, as opposed to being additive.

Automated summary

This study aims to explore the potential impact of increased use of telemedicine on emergency department (ED) admissions and outpatient service use during the COVID-19 pandemic. Using retrospective analysis of health administrative data in Ontario, Canada, it was found that in 2021, 74% of ED admissions had no prior outpatient visits within 7 days of admission, compared to 75% in 2019. Only 3% of ED admissions had both virtual and in-person visits in the 7 days prior to admission. Patients with prior virtual care use were more likely to be hospitalized. In conclusion, virtual care can appropriately triage patients to the ED and replace in-person visits ahead of ED admissions, rather than adding to the number of visits.