Retrospective Analysis of the Effects of the COVID-19 Pandemic on the Emergency Department Walk-Out Rate in an Acute Care Community Hospital During the USA National Lockdown

Background There are currently no data available that compares the volume and the walk-out rate of patients who presented to the emergency department (ED) before and after the coronavirus disease 2019 (COVID-19) peak pandemic period during the USA national lockdown. Objective EDs measure metrics such as walk-out rate (WOR), which is reflected in leaving against medical advice (AMA), elopement, left after triage (LAFT), and left without being seen (LWBS). In this study, we sought to determine the effects of the COVID-19 pandemic on the ED WOR. Methods A retrospective analysis was used to assess the overall ED census and the walk-out rate for three community EDs during the March to June 2020 national lockdown. This period was compared to the same period for 2019. Results The walk-out rate during the COVID-19 pandemic was inversely proportional to the overall ED census. While overall ED visits decreased by 26% to 42% during the period of March to June 2020 as compared to March to June 2019, the patient walk-out rates increased from 25% to 65%. Conclusion The national lockdown during the COVID-19 pandemic created a paradoxical finding with a decrease in ED census but an increase in ED walk-out rates. This decline in census and increase in WOR raises concern that patients avoid going to the hospitals to seek medical attention because the concern of contracting the virus prevails, resulting in increased walkouts. With this retrospective study, we can anticipate that future newly discovered emerging diseases causing national lockdowns will result in a high probability of avoidance of emergency care.