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StudyMedical sciences (Basel, Switzerland) · 2026

Impact of the COVID-19 Pandemic on Primary Care Referral Patterns and Resource Utilization in a Hospital Emergency Department: A Comparative Pre- and Later-Pandemic Study.

Angel Iván Díaz-Salado, Francisco Javier García-Sánchez, Alicia Fuente-Gaforio … Natalia Mudarra-García

Family MedicineStudy

Primary care referrals to the emergency department more than doubled after the pandemic

Impact of the COVID-19 Pandemic on Primary Care Referral Patterns and Resource Utilization in a Hospital Emergency Department: A Comparative Pre- and Later-Pandemic Study.

Angel Iván Díaz-Salado … Natalia Mudarra-García

Medical sciences (Basel, Switzerland) · 2026

Background

The COVID-19 pandemic profoundly disrupted healthcare utilization patterns at both primary care (primary care) and hospital emergency department (emergency department) levels.

Purpose

This study aimed to assess the impact of the pandemic on referral patterns from primary care to a hospital emergency department and on the resource consumption associated with those referrals.

Methods

A descriptive, retrospective, longitudinal comparative study with multivariable sensitivity analyses was conducted at a first-level hospital of Madrid (Spain).

n = 946

Results

monthly referrals from primary care doctors to the emergency room more than doubled

OR by subgroup · 95% CI

More results

Emergency department length of stay between 3 and 6 h increased from 13.0% to 42.8% (p<0.001), while the need for urgent blood tests fell from 68.9% to 56.0% (p<0.001), hospital admission from 68.4% to 10.9% (p<0.001), and referral to another center from 12.3% to 0.9% (p<0.001).

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Conclusion · 1 of 3

During the later-pandemic period, PC-to-emergency department referrals increased substantially while being associated with fewer complementary investigations and fewer hospital admissions.

Conclusion · 2 of 3

This study documents between-period differences in referral patterns and emergency department resource utilization rather than causal effects; the differences persisted after adjustment for seasonality but cannot be definitively attributed to the pandemic.

Conclusion · 3 of 3

Future multi-center longitudinal studies are needed to confirm these trends and clarify their underlying mechanisms.

Post

Impact of the COVID-19 Pandemic on Primary Care Referral Patterns and Resource Utilization in a Hospital Emergency Department: A Comparative Pre- and Later-Pandemic Study.

Primary care referrals to the emergency department more than doubled after the pandemic

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