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

Rachel H. Mulholland, Rachael Wood, Helen R. Stagg, Colin Fischbacher, Jaime Villacampa, Colin R. Simpson, Eleftheria Vaseleiou, Colin McCowan, Sarah J. Stock, Annemarie B. Docherty, Lewis D. Ritchie, Utkarsh Agrawal, Chris Robertson, Josie Murray , Fiona MacKenzie, Aziz Sheikh

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Objectives: Following the outbreak of SARS-CoV-2, 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 05 January to 28 June 2020) encompassed the pandemic announcement by the World Health Organization (WHO) 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 NHS Health Boards.
Setting: Scotland, UK.
Participants: Patients receiving hospital care from NHS Scotland.Main outcome measures: 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% 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 NHS 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.
Original languageEnglish
Pages (from-to)444-453
JournalJournal of the Royal Society of Medicine
Issue number11
Early online date4 Oct 2020
Publication statusPublished - Nov 2020


  • COVID-19
  • SARS-CoV-2
  • A&E attendances
  • Hospital admissions
  • Uptake
  • Secondary care


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