The impact of the COVID-19 pandemic on patterns of attendance at emergency departments in two large London hospitals: an observational study

Michaela A.C. Vollmer, Sreejith Radhakrishnan, Mara D. Kont, Seth Flaxman, Samir Bhatt, Ceire Costelloe, Kate Honeyford, Paul Aylin, Graham Cooke, Julian Redhead, Alison Sanders, Helen Mangan, Peter J. White, Neil Ferguson, Katharina Hauck, Shevanthi Nayagam, Pablo N. Perez-Guzman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Hospitals in England have undergone considerable change to address the surge in demand imposed by the COVID-19 pandemic. The impact of this on emergency department (ED) attendances is unknown, especially for non-COVID-19 related emergencies. 

Methods: This analysis is an observational study of ED attendances at the Imperial College Healthcare NHS Trust (ICHNT). We calibrated auto-regressive integrated moving average time-series models of ED attendances using historic (2015–2019) data. Forecasted trends were compared to present year ICHNT data for the period between March 12, 2020 (when England implemented the first COVID-19 public health measure) and May 31, 2020. We compared ICHTN trends with publicly available regional and national data. Lastly, we compared hospital admissions made via the ED and in-hospital mortality at ICHNT during the present year to the historic 5-year average. 

Results: ED attendances at ICHNT decreased by 35% during the period after the first lockdown was imposed on March 12, 2020 and before May 31, 2020, reflecting broader trends seen for ED attendances across all England regions, which fell by approximately 50% for the same time frame. For ICHNT, the decrease in attendances was mainly amongst those aged < 65 years and those arriving by their own means (e.g. personal or public transport) and not correlated with any of the spatial dependencies analysed such as increasing distance from postcode of residence to the hospital. Emergency admissions of patients without COVID-19 after March 12, 2020 fell by 48%; we did not observe a significant change to the crude mortality risk in patients without COVID-19 (RR 1.13, 95%CI 0.94–1.37, p = 0.19). 

Conclusions: Our study findings reflect broader trends seen across England and give an indication how emergency healthcare seeking has drastically changed. At ICHNT, we find that a larger proportion arrived by ambulance and that hospitalisation outcomes of patients without COVID-19 did not differ from previous years. The extent to which these findings relate to ED avoidance behaviours compared to having sought alternative emergency health services outside of hospital remains unknown. National analyses and strategies to streamline emergency services in England going forward are urgently needed.

Original languageEnglish
Article number1008
JournalBMC Health Services Research
Issue number1
Early online date23 Sep 2021
Publication statusE-pub ahead of print - 23 Sep 2021

Bibliographical note

Funding Information: This research was supported by the NIHR Imperial Biomedical Research Centre (BRC), the NIHR Imperial Patient Safety Translational Research Centre, the NIHR funded Imperial/PHE HPRU for AMR/HCAIs, the NIHR funded Applied Research Collaboration, the NIHR HPRU in Modelling and Health Economics, a partnership between a partnership between Public Health England, Imperial College London, and LSHTM (NIHR200908), the Abdul Lateef Jameel Institute for Disease and Emergency Analytics (J-IDEA), and the MRC Centre for Global Infectious Disease Analysis. SF acknowledges funding from the EPSR (EP/V002910/1). PJW has received payment from Pfizer for teaching of mathematical modelling of infectious disease transmission and vaccination. The other authors declare they have no competing interests. The MRC Centre award (MR/R015600/1) is jointly funded by the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth and Development Office (FCDO) under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the European Union (EU). The views expressed are those of the authors and not necessarily those of the Department of Health and Social Care, NHS, NIHR or Public Health England.

Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Publisher Copyright: © The Author(s), 2021.

Citation: Vollmer, M.A.C., Radhakrishnan, S., Kont, M.D. et al. The impact of the COVID-19 pandemic on patterns of attendance at emergency departments in two large London hospitals: an observational study. BMC Health Serv Res 21, 1008 (2021).



  • Accident
  • And emergency
  • COVID-19
  • Emergency department


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