COVID-19 Testing in Emergency Departments: Disparities in Access and Utilization

Strategic Insights -

During the COVID-19 pandemic, emergency departments became a crucial site for accessing COVID-19 testing, particularly for those who lacked access to at-home testing. A new study published in the Western Journal of Emergency Medicine found that patients assigned a chief concern of "COVID-19 Test" had a high COVID-19 positivity rate, often underwent additional emergency department interventions, and were at low risk of return ED visits or admission. However, the study also revealed that minoritized and low-income patients were disproportionately represented in the "COVID-19 Test" chief concern group, highlighting potential disparities in access to at-home COVID-19 testing and implementation of this chief concern.

Key Takeaways:

  • The study found that during the COVID-19 pandemic, emergency departments became a preferred site for accessing COVID-19 testing for some patients.
  • Patients assigned a chief concern of "COVID-19 Test" had a high COVID-19 positivity rate, with 45% testing positive for SARS-CoV-2.
  • Nearly half (46.9%) of patients assigned a "COVID-19 Test" chief concern underwent additional emergency department interventions.
  • Admission or repeat emergency department visit at 72 hours occurred in only 5.3% of patients.
  • Minoritized and low-income patients were disproportionately represented in the "COVID-19 Test" chief concern group, with patients on Medicaid and those who self-identified as Black or Hispanic/Latino being overrepresented.
  • The study concluded that patients assigned a chief concern of "COVID-19 Test" had a low risk of return emergency department visits or admission, but highlighted potential disparities in access to at-home COVID-19 testing.

Statistics:

  • 0.5% of all emergency department encounters from October 11, 2021-July 31, 2022 were assigned a "COVID-19 Test" chief concern by a triage nurse (320 patients out of 64,320 total encounters).
  • 45% of patients assigned a "COVID-19 Test" chief concern tested positive for SARS-CoV-2.
  • 46.9% of patients assigned a "COVID-19 Test" chief concern underwent additional emergency department interventions.
  • 5.3% of patients assigned a "COVID-19 Test" chief concern were admitted or returned to the emergency department within 72 hours.
  • Adjusted odds ratio for receiving additional interventions associated with an Emergency Severity Index of 1, 2, or 3 was 46.85 (95% CI 13.28-165.26; p=0.001).

Sources:

  • Western Journal of Emergency Medicine
  • Evaluating the Implementation of a "COVID-19 Test" Chief Concern in the Emergency Department (2025, 26(3):507-512)
  • University of Wisconsin School of Medicine and Public Health
  • University of California, eScholarship Publishing
  • doi: 10.5811/westjem.34850