Impact of COVID-19 on accident and emergency attendances and emergency and planned hospital admissions in Scotland: an interrupted time-series analysis

J R Soc Med. 2020 Nov;113(11):444-453. doi: 10.1177/0141076820962447. Epub 2020 Oct 4.


Objectives: Following the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and the subsequent global spread of the 2019 novel coronavirus disease (COVID-19), health systems and the populations who use them have faced unprecedented challenges. We aimed to measure the impact of COVID-19 on the uptake of hospital-based care at a national level.

Design: The study period (weeks ending 5 January to 28 June 2020) encompassed the pandemic announcement by the World Health Organization and the initiation of the UK lockdown. We undertook an interrupted time-series analysis to evaluate the impact of these events on hospital services at a national level and across demographics, clinical specialties and National Health Service Health Boards.

Setting: Scotland, UK.

Participants: Patients receiving hospital care from National Health Service Scotland.

Main outcome measures: Accident and emergency (A&E) attendances, and emergency and planned hospital admissions measured using the relative change of weekly counts in 2020 to the averaged counts for equivalent weeks in 2018 and 2019.

Results: Before the pandemic announcement, the uptake of hospital care was largely consistent with historical levels. This was followed by sharp drops in all outcomes until UK lockdown, where activity began to steadily increase. This time-period saw an average reduction of -40.7% (95% confidence interval [CI]: -47.7 to -33.7) in A&E attendances, -25.8% (95% CI: -31.1 to -20.4) in emergency hospital admissions and -60.9% (95% CI: -66.1 to -55.7) in planned hospital admissions, in comparison to the 2018-2019 averages. All subgroup trends were broadly consistent within outcomes, but with notable variations across age groups, specialties and geography.

Conclusions: COVID-19 has had a profoundly disruptive impact on hospital-based care across National Health Service Scotland. This has likely led to an adverse effect on non-COVID-19-related illnesses, increasing the possibility of potentially avoidable morbidity and mortality. Further research is required to elucidate these impacts.

Keywords: A&E attendances; COVID-19; SARS-CoV-2; hospital admissions; secondary care; uptake.

MeSH terms

  • COVID-19 / epidemiology*
  • COVID-19 / therapy
  • Emergency Service, Hospital / trends*
  • Female
  • Humans
  • Interrupted Time Series Analysis*
  • Male
  • Organizational Innovation
  • Patient Admission / statistics & numerical data
  • Patient Admission / trends*
  • SARS-CoV-2*
  • Scotland
  • State Medicine