Lessons Learned: Delayed Care — The Harmful Impact of COVID-19 on Health Care

Quality Quarterly Article

As we wrap up a pandemic year and work through2021 with COVID-19 still at large, the arrival of the vaccine leaves most of us cautiously optimistic at best. While there is light on the horizon, many are still, and will continue to be impacted by delays in care during this epic time. HQI kicked off its first Safe Table of the year with this topic. 

In January, we were privileged to host Peter Hull, MD, chief medical executive, at Sutter Roseville Medical Center, where he has served various leadership roles since 1996. He joined the medical staff as an emergency medicine physician and was chief of the emergency department from 2004-2014. Dr. Hull has also been a member of the Sutter Valley Hospital Board of Directors since 2012, where his functions include the chair of the Quality and Safety Committee, as well as the Research and Education Committee of the Board.   

To set the stage, Dr. Hull described several situations where discontinuity and cracks within our healthcare system have made our population more vulnerable and at risk during the pandemic. He shared several studies, including data from the Centers for Disease Control and Prevention, which reports that nearly 40% to as high as 57% of people living in the U.S. have chosen to postpone or not seek medical care due to fear of getting COVID-19.  During the early phase of the pandemic following lockdown, emergency department visits plummeted 42% — heart attacks, strokes, and uncontrolled glycemic events were documented as having dropped significantly. 

There are several factors that lead to bad outcomes. They include:  

  • Pre-existing barriers in accessing care 
  • High unemployment and loss of insurance 
  • Millions choosing not to seek care  
  • 30 million people uninsured and another 40 million with bare minimum insurance  
  • Many health services canceled, including regularly scheduled and elective procedures 
  • It will take several years to measure the intensity and severity of the harmful impacts of COVID-19.   

Other issues addressed during the forum included a subject matter that alone, requires a dedicated discussion. Front-line workers have been taxed and overwhelmed by the stress of caring for severely sick patients. An October 2020 survey from the American College of Emergency Physicians (ACEP) found that 87% of health care workers stated they were more stressed now than in the beginning of the pandemic. Furthermore, 72% admitted they are experiencing burnout. Many choose not to seek mental health experts, as they don’t want to be stigmatized or endure reprisal from their colleagues for requesting intervention. 

Dr. Hull emphasized the need for patients to get timely care when required. He suggested that telehealth might help mitigate some of the delays in care by helping patients address the care they need without the fear of exposure to COVID-19. However, he stated those who are experiencing a medical emergency should seek care immediately and without delay.  Delaying care can potentially cause serious health threats and at minimum, create more complications especially for chronic conditions. Many hospitals have developed workflows to accommodate a safe environment for those seeking care. It’s important to continue to get the care that is needed not only for emergent or urgent situations, but also for well child visits, other chronic conditions and particularly for mental health support. 

CHPSO members can email info@chpso.org for access to the members-only information related to this Safe Table topic. The member list can be found on the CHPSO website.  For more information on becoming a CHPSO member, please check out the prospective members section of our website.