Supplementary Material for: Emergency Department and COVID-19 Pandemic Stress Test: A Comparison between Two European Settings

Objective: To analyze the changes in the Emergency Department (ED) activity of two hospitals during the 2020 lockdown and corresponding timeframes in 2019 and 2021 to assess whether a more structured primary healthcare service could have influenced the COVID-19 pressure on the ED. Subject and Methods: This is a multicenter, retrospective study on adult subjects registered to the selected ED during the timeframes considered. Patients <16 years old and women with obstetric or gynecological complaints were excluded. Study period: March 09 to May 03 for the Italian ED (55 days) and March 14 to May 10 for the Spanish ED (57 days) in 2019, 2020 and 2021. Primary outcome: difference in the number of ED admissions. Secondary outcomes: differences in hospital admission rates, priority code at triage, and disease group. Results: Overall, a greater number of patients flowed through the Spanish ED (14,034 vs 8,569 in 2019, 7,208 vs 3,101 in 2020, and 13,214 vs 5,555 in 2021), with smaller proportional declines and lower admission rates (13% vs 16.9% in 2019, 19.6% vs 34.3% in 2020, and 14.3% vs 26.3% in 2021) observed. Most referrals were for non-emergency conditions, followed by trauma and intoxications. Conclusions: In comparison to the Italian setting, the Spanish ED showed increased activity alongside lower hospitalization rates. Further investigation is required to evaluate the potential role of more structured primary healthcare assistance in enhancing the discharge rate to homecare or primary healthcare facilities during the specified timeframes.