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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Declining Emergency Department Visits and Costs During the Severe Acute Respiratory Syndrome (SARS) Outbreak</title><author><name sortKey="Huang, Hsien Hao" sort="Huang, Hsien Hao" uniqKey="Huang H" first="Hsien-Hao" last="Huang">Hsien-Hao Huang</name><affiliation><nlm:aff id="aff1">Department of Emergency Medicine, Taipei Veterans General Hospital, College of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</nlm:aff></affiliation></author><author><name sortKey="Yen, David Hung Tsang" sort="Yen, David Hung Tsang" uniqKey="Yen D" first="David Hung-Tsang" last="Yen">David Hung-Tsang Yen</name><affiliation><nlm:aff id="aff1">Department of Emergency Medicine, Taipei Veterans General Hospital, College of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</nlm:aff></affiliation></author><author><name sortKey="Kao, Wei Fong" sort="Kao, Wei Fong" uniqKey="Kao W" first="Wei-Fong" last="Kao">Wei-Fong Kao</name><affiliation><nlm:aff id="aff1">Department of Emergency Medicine, Taipei Veterans General Hospital, College of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</nlm:aff></affiliation></author><author><name sortKey="Wang, Lee Min" sort="Wang, Lee Min" uniqKey="Wang L" first="Lee-Min" last="Wang">Lee-Min Wang</name><affiliation><nlm:aff id="aff1">Department of Emergency Medicine, Taipei Veterans General Hospital, College of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</nlm:aff></affiliation></author><author><name sortKey="Huang, Chun I" sort="Huang, Chun I" uniqKey="Huang C" first="Chun-I" last="Huang">Chun-I Huang</name><affiliation><nlm:aff id="aff1">Department of Emergency Medicine, Taipei Veterans General Hospital, College of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</nlm:aff></affiliation></author><author><name sortKey="Lee, Chen Hsen" sort="Lee, Chen Hsen" uniqKey="Lee C" first="Chen-Hsen" last="Lee">Chen-Hsen Lee</name><affiliation><nlm:aff id="aff1">Department of Emergency Medicine, Taipei Veterans General Hospital, College of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">16440068</idno><idno type="pmc">7135596</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7135596</idno><idno type="RBID">PMC:7135596</idno><idno type="doi">10.1016/S0929-6646(09)60106-6</idno><date when="2006">2006</date><idno type="wicri:Area/Pmc/Corpus">001136</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001136</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Declining Emergency Department Visits and Costs During the Severe Acute Respiratory Syndrome (SARS) Outbreak</title><author><name sortKey="Huang, Hsien Hao" sort="Huang, Hsien Hao" uniqKey="Huang H" first="Hsien-Hao" last="Huang">Hsien-Hao Huang</name><affiliation><nlm:aff id="aff1">Department of Emergency Medicine, Taipei Veterans General Hospital, College of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</nlm:aff></affiliation></author><author><name sortKey="Yen, David Hung Tsang" sort="Yen, David Hung Tsang" uniqKey="Yen D" first="David Hung-Tsang" last="Yen">David Hung-Tsang Yen</name><affiliation><nlm:aff id="aff1">Department of Emergency Medicine, Taipei Veterans General Hospital, College of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</nlm:aff></affiliation></author><author><name sortKey="Kao, Wei Fong" sort="Kao, Wei Fong" uniqKey="Kao W" first="Wei-Fong" last="Kao">Wei-Fong Kao</name><affiliation><nlm:aff id="aff1">Department of Emergency Medicine, Taipei Veterans General Hospital, College of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</nlm:aff></affiliation></author><author><name sortKey="Wang, Lee Min" sort="Wang, Lee Min" uniqKey="Wang L" first="Lee-Min" last="Wang">Lee-Min Wang</name><affiliation><nlm:aff id="aff1">Department of Emergency Medicine, Taipei Veterans General Hospital, College of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</nlm:aff></affiliation></author><author><name sortKey="Huang, Chun I" sort="Huang, Chun I" uniqKey="Huang C" first="Chun-I" last="Huang">Chun-I Huang</name><affiliation><nlm:aff id="aff1">Department of Emergency Medicine, Taipei Veterans General Hospital, College of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</nlm:aff></affiliation></author><author><name sortKey="Lee, Chen Hsen" sort="Lee, Chen Hsen" uniqKey="Lee C" first="Chen-Hsen" last="Lee">Chen-Hsen Lee</name><affiliation><nlm:aff id="aff1">Department of Emergency Medicine, Taipei Veterans General Hospital, College of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of the Formosan Medical Association</title><idno type="ISSN">0929-6646</idno><idno type="eISSN">0929-6646</idno><imprint><date when="2006">2006</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The immediate and long-term impact of severe acute respiratory syndrome (SARS) outbreak on emergency department (ED) visits and hospital expenditures for these visits has not been thoroughly investigated. The objectives of this retrospective observational study investigated the impact of SARS outbreak on ED visits and the cost of these visits in a designated SARS medical center.</p></sec><sec><title>Methods</title><p>Data related to the total number of ED visits and their costs were collected for the SARS epidemic period in 2003 and the same period in the preceding year in 2002. Data collected included total number of ED visits, services provided, triage categories, and total expenditures for all patients. Data for before and during the outbreak were retrieved and compared.</p></sec><sec><title>Results</title><p>At the peak of the SARS epidemic, the reduction in daily ED visits reached 51.6% of pre-epidemic numbers (<italic>p</italic> < 0.01). In pediatric, trauma and non-trauma patients, the maximum mean decreases in number of visits were 80.0% (<italic>p <</italic> 0.01), 57.6% (<italic>p <</italic> 0.01) and 40.8% <italic>(p <</italic> 0.01), respectively. In triage 1, 2 and 3 patients, the maximum mean decreases were 18.1% (<italic>p</italic> < 0.01), 55.9% (<italic>p</italic> < 0.01) and 53.7% (<italic>p</italic> < 0.01), respectively. The maximum decrease in total costs was 37.7% (<italic>p</italic> < 0.01). The maximum mean costs per patient increased 35.9% (<italic>p</italic> < 0.01). The proportions of increases in mean costs for each patient were attributed to laboratory investigations (31.4%), radiography (21.9%) and medications (29.5%).</p></sec><sec><title>Conclusion</title><p>The SARS outbreak resulted in a marked reduction in the number of ED visits which persisted for 3 months after the end of the epidemic. Total cost of treating individual patients showed a simultaneous marked increase, while overall operational costs in the ED showed a marked decrease. The increased total cost for each patient was attributed to the increased number of diagnostic procedures to screen for possible SARS in the ED.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Ksiazek, Tg" uniqKey="Ksiazek T">TG Ksiazek</name></author><author><name sortKey="Erdman, D" uniqKey="Erdman D">D Erdman</name></author><author><name sortKey="Goldsmith, Cs" uniqKey="Goldsmith C">CS Goldsmith</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Drosten, C" uniqKey="Drosten C">C Drosten</name></author><author><name sortKey="Gunther, S" uniqKey="Gunther S">S Gunther</name></author><author><name sortKey="Preiser, W" uniqKey="Preiser W">W Preiser</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Varia, M" uniqKey="Varia M">M Varia</name></author><author><name sortKey="Wilson, S" uniqKey="Wilson S">S Wilson</name></author><author><name sortKey="Sarwal, S" uniqKey="Sarwal S">S Sarwal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Seto, Wh" uniqKey="Seto W">WH Seto</name></author><author><name sortKey="Tsang, D" uniqKey="Tsang D">D Tsang</name></author><author><name sortKey="Yung, Rw" uniqKey="Yung R">RW Yung</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Poutanen, Sm" uniqKey="Poutanen S">SM Poutanen</name></author><author><name sortKey="Low, De" uniqKey="Low D">DE Low</name></author><author><name sortKey="Henry, B" uniqKey="Henry B">B Henry</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ho, As" uniqKey="Ho A">AS Ho</name></author><author><name sortKey="Sung, Jj" uniqKey="Sung J">JJ Sung</name></author><author><name sortKey="Chan Yeung, M" uniqKey="Chan Yeung M">M Chan-Yeung</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Centers For Disease Control And Prevention" uniqKey="Centers For Disease Control And Prevention">Centers for Disease Control and Prevention</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Man, Cy" uniqKey="Man C">CY Man</name></author><author><name sortKey="Yeung, Rs" uniqKey="Yeung R">RS Yeung</name></author><author><name sortKey="Chung, Jy" uniqKey="Chung J">JY Chung</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chang, Hj" uniqKey="Chang H">HJ Chang</name></author><author><name sortKey="Huang, N" uniqKey="Huang N">N Huang</name></author><author><name sortKey="Lee, Ch" uniqKey="Lee C">CH Lee</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Twu, Sj" uniqKey="Twu S">SJ Twu</name></author><author><name sortKey="Chen, Tj" uniqKey="Chen T">TJ Chen</name></author><author><name sortKey="Chen, Cj" uniqKey="Chen C">CJ Chen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hu, Sc" uniqKey="Hu S">SC Hu</name></author><author><name sortKey="Yen, D" uniqKey="Yen D">D Yen</name></author><author><name sortKey="Yu, Yc" uniqKey="Yu Y">YC Yu</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Hsueh, Pr" uniqKey="Hsueh P">PR Hsueh</name></author><author><name sortKey="Yang, Pc" uniqKey="Yang P">PC Yang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lateef, F" uniqKey="Lateef F">F Lateef</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chen, Wk" uniqKey="Chen W">WK Chen</name></author><author><name sortKey="Cheng, Yc" uniqKey="Cheng Y">YC Cheng</name></author><author><name sortKey="Chung, Yt" uniqKey="Chung Y">YT Chung</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hay, E" uniqKey="Hay E">E Hay</name></author><author><name sortKey="Bekerman, L" uniqKey="Bekerman L">L Bekerman</name></author><author><name sortKey="Rosenberg, G" uniqKey="Rosenberg G">G Rosenberg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nelson, M" uniqKey="Nelson M">M Nelson</name></author><author><name sortKey="Waldrop, Rd" uniqKey="Waldrop R">RD Waldrop</name></author><author><name sortKey="Jones, J" uniqKey="Jones J">J Jones</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Formos Med Assoc</journal-id><journal-id journal-id-type="iso-abbrev">J. Formos. Med. Assoc</journal-id><journal-title-group><journal-title>Journal of the Formosan Medical Association</journal-title></journal-title-group><issn pub-type="ppub">0929-6646</issn><issn pub-type="epub">0929-6646</issn><publisher><publisher-name>Formosan Medical Association & Elsevier. Published by Elsevier (Singapore) Pte Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">16440068</article-id><article-id pub-id-type="pmc">7135596</article-id><article-id pub-id-type="publisher-id">S0929-6646(09)60106-6</article-id><article-id pub-id-type="doi">10.1016/S0929-6646(09)60106-6</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Declining Emergency Department Visits and Costs During the Severe Acute Respiratory Syndrome (SARS) Outbreak</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Huang</surname><given-names>Hsien-Hao</given-names></name><xref rid="aff1" ref-type="aff">a</xref><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><name><surname>Yen</surname><given-names>David Hung-Tsang</given-names></name><email>hjyen@vghtpe.gov.tw</email><xref rid="aff1" ref-type="aff">a</xref><xref rid="aff2" ref-type="aff">b</xref><xref rid="cor1" ref-type="corresp">*</xref></contrib><contrib contrib-type="author"><name><surname>Kao</surname><given-names>Wei-Fong</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Wang</surname><given-names>Lee-Min</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Huang</surname><given-names>Chun-I</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Chen-Hsen</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib></contrib-group><aff id="aff1"><label>a</label>Department of Emergency Medicine, Taipei Veterans General Hospital, College of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</aff><aff id="aff2"><label>b</label>Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.</aff><author-notes><corresp id="cor1"><label>*</label><bold>Correspondence to:</bold> Dr. David Hung-Tsang Yen, Department of Emergency Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, Taiwan, R.O.C. <email>hjyen@vghtpe.gov.tw</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>11</day><month>7</month><year>2009</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="ppub"><year>2006</year></pub-date><pub-date pub-type="epub"><day>11</day><month>7</month><year>2009</year></pub-date><volume>105</volume><issue>1</issue><fpage>31</fpage><lpage>37</lpage><history><date date-type="received"><day>23</day><month>2</month><year>2005</year></date><date date-type="rev-recd"><day>28</day><month>3</month><year>2005</year></date><date date-type="accepted"><day>7</day><month>6</month><year>2005</year></date></history><permissions><copyright-statement>Copyright © 2006 Formosan Medical Association & Elsevier. Published by Elsevier (Singapore) Pte Ltd.</copyright-statement><copyright-year>2006</copyright-year><copyright-holder>Formosan Medical Association & Elsevier</copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract><sec><title>Background</title><p>The immediate and long-term impact of severe acute respiratory syndrome (SARS) outbreak on emergency department (ED) visits and hospital expenditures for these visits has not been thoroughly investigated. The objectives of this retrospective observational study investigated the impact of SARS outbreak on ED visits and the cost of these visits in a designated SARS medical center.</p></sec><sec><title>Methods</title><p>Data related to the total number of ED visits and their costs were collected for the SARS epidemic period in 2003 and the same period in the preceding year in 2002. Data collected included total number of ED visits, services provided, triage categories, and total expenditures for all patients. Data for before and during the outbreak were retrieved and compared.</p></sec><sec><title>Results</title><p>At the peak of the SARS epidemic, the reduction in daily ED visits reached 51.6% of pre-epidemic numbers (<italic>p</italic> < 0.01). In pediatric, trauma and non-trauma patients, the maximum mean decreases in number of visits were 80.0% (<italic>p <</italic> 0.01), 57.6% (<italic>p <</italic> 0.01) and 40.8% <italic>(p <</italic> 0.01), respectively. In triage 1, 2 and 3 patients, the maximum mean decreases were 18.1% (<italic>p</italic> < 0.01), 55.9% (<italic>p</italic> < 0.01) and 53.7% (<italic>p</italic> < 0.01), respectively. The maximum decrease in total costs was 37.7% (<italic>p</italic> < 0.01). The maximum mean costs per patient increased 35.9% (<italic>p</italic> < 0.01). The proportions of increases in mean costs for each patient were attributed to laboratory investigations (31.4%), radiography (21.9%) and medications (29.5%).</p></sec><sec><title>Conclusion</title><p>The SARS outbreak resulted in a marked reduction in the number of ED visits which persisted for 3 months after the end of the epidemic. Total cost of treating individual patients showed a simultaneous marked increase, while overall operational costs in the ED showed a marked decrease. The increased total cost for each patient was attributed to the increased number of diagnostic procedures to screen for possible SARS in the ED.</p></sec></abstract><kwd-group><title>Key Words</title><kwd>cost</kwd><kwd>emergency department (ED)</kwd><kwd>epidemiology</kwd><kwd>severe acute respiratory syndrome (SARS)</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="bib1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ksiazek</surname><given-names>TG</given-names></name><name><surname>Erdman</surname><given-names>D</given-names></name><name><surname>Goldsmith</surname><given-names>CS</given-names></name></person-group><article-title>A novel corona-virus associated with severe acute respiratory syndrome</article-title><source>N Engl J Med</source><volume>348</volume><year>2003</year><fpage>1953</fpage><lpage>1966</lpage><pub-id 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