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* (Corresponding Author), Rachael Wood, Helen R Stagg, Colin Fischbacher, Jaime Villacampa, Colin R Simpson, Eleftheria Vasileiou, Colin McCowan, Sarah J Stock, Annemarie B Docherty, Lewis D Ritchie, Utkarsh Agrawal, Chris Robertson, Josephine Lk Murray, Fiona MacKenzie, Aziz Sheikh

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

63 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)444-453
Number of pages10
JournalJournal of the Royal Society of Medicine
Issue number11
Early online date4 Oct 2020
Publication statusPublished - Nov 2020

Bibliographical note

This analysis is part of the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) study. EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE – The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. Additional support has been provided through the Scottish Government DG Health and Social Care. HRS is supported by the Medical Research Council (MR/R008345/1).

We are grateful for the Public Health Scotland team who have created and monitor the dashboard for the underlying data. These include Victoria Elliott, Ewout Jaspers and Diane Gibbs. Many thanks to Helen Stagg and Chris Robertson for their advice on the methods.

All R code scripts on the analysis and figures will be made available on the EAVE II GitHub page (


  • COVID-19
  • hospital admissions
  • SARS-CoV-2
  • secondary care
  • A&E attendances
  • uptake


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