The postponement of non-essential care and the treatment of COVID-19 patients had a considerable impact on hospital activity in 2020. We find that the number of stays decreased by 16% in general hospitals and by 7% in psychiatric hospitals[1]. The greatest decrease, by 23%, can be observed in the number of surgical day hospitalisations. The strong reduction in the number of outpatient contacts with the emergency department could be an indirect consequence of the measures taken in 2020. Indeed, especially during the first wave, social contacts were greatly limited, teleworking became the norm, and work in some sectors came to a complete halt. As a result, fewer accidents occurred, which led to a lower number of contacts with the emergency department.
EVOLUTION IN THE NUMBER OF STAYS PER TYPE OF STAY
Both in March and in November 2020, we see a clear effect of the measures taken regarding the postponement of non-essential care. There is a considerable drop in the number of stays for all types of hospitalisations. At the restart of day hospitalisation and classic hospitalisation in May 2020, we observe that the number of stays remains below the level of the number of stays in January and February 2020.
In November 2020 – when the second wave of COVID-19 hits – we once again observe a considerable reduction in activity as a result of the measures taken. Although at that time this was not part of the measures adopted, we also see a reduction in non-surgical day hospitalisations.
EVOLUTION IN THE WEEKLY NUMBER OF ADMISSIONS PER TYPE OF STAY
During the period from 14/3/2020 to 4/5/2020[2]we saw that the total number of hospital stays more or less halved in 2020 compared to the median of the number of stays in the years 2016 to 2019. The greatest reduction could be observed in surgical day hospitalisations, where only 11% of expected stays took place. Classic hospitalisations, non-surgical day hospitalisations and ambulatory contacts through the emergency department saw a drop to 55%, 50% and 61%, respectively, compared to the activity in the previous four years.
In the period from 26/10/2020 to 27/11/2020, 75% of expected stays took place, compared to the activity in the period from 2016 to 2019. Once again, we observe the greatest reduction in surgical day hospitalisations, where 46% of expected stays took place, followed by ambulatory contacts with the emergency department (64%), classic hospitalisation (71%), and non-surgical day hospitalisation (95%).
PERCENTAGE OF THE NUMBER OF STAYS IN THE REFERENCE PERIOD COMPARED WITH THE MEDIAN OF THE 4 PRECEDING YEARS BY HOSPITALISATION TYPE [3]
In the two periods where non-essential care was postponed, one third of hospitalisations of non-COVID-19-patients was a contact for chemo or immune therapy (28%), 11% a stay relating to a form of chronic pain, and 6% of stays were for giving birth.
Impact of the pandemic on the nursing workload
In the graph below, an overview is given of the general nursing workload for patients with and without a COVID-19 diagnosis. The general nursing workload gives an idea of the care needs of the patient. These are determined based on how many nursing care services were performed, how much time was necessary to provide the care services, or the degree of nursing competency required for the care services.
PERCENTAGE OF NURSING WORKLOAD
FOR PATIENTS WITH AND WITHOUT COVID-19 INFECTION
For 46% of COVID-19 patients, the nursing workload is high to very high, which means that the nursing workload amounts to more than 150% of the nursing workload for the average patient[4]. In addition, for 10% of patients, the nursing workload is even more than 3 times as high as for the average patient. By way of comparison, we find that only 25% of patients without COVID-19 infection are classified into the categories high to very high.
[1]Source: MHD and MPD, Data and Policy Information Service, FPS HSFCE. At the time of publication, our services only have data for 2020 for all stays (both COVID-19-related and non-COVID-19-related) in general and psychiatric hospitals.
[2]The reference periods chosen are the periods in which the HTSC Committee asked to postpone non-essential care. Hence, these periods do not comprise the entire COVID-19 wave. Due to the nature of the registration, these figures cannot be shown for the evolution of the number of stays in psychiatric hospitals.
[3]For stays in psychiatric hospitals, due to the manner of registration, no comparison can be made based on the number of stays in the chosen reference periods. For this reason, these stays are not included in this graph.
[4]Patients are classified into 5 categories: ‘Very low’: the care workload amounts to max. 25% of the care workload for the average patient; ‘Low’: the care workload amounts to 25 to 50% of the care workload for the average patient; ‘Medium’: the care workload amounts to 50 to 150% of the care workload for the average patient; ‘High’: the care workload amounts to 150 to 300% of the care workload for the average patient; ‘Very high’: the care workload amounts to more than 300% of the care workload for the average patient.