Effects of Emergency Care-related Health Policies during the COVID-19 Pandemic in Korea: a Quasi-Experimental Study

Abstract

Background The purpose of this study was to review the nationwide emergency care-related health policies during the coronavirus disease 2019 (COVID-19) pandemic disaster in Korea and to analyze the effects of the policies on the safety of patients who visit emergency departments (EDs) during this period. Methods This study is a quasi-experiment study. The study population was patients who visited all 402 EDs in Korea between December 31, 2019 and May 13, 2020, using the National Emergency Department Information System (NEDIS) database. The study period was classified into 5 phases according to the level of national crisis warning of infectious disease and the implementation of emergency care-related health policies, and all study phases were 27 days. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay (LOS) in the ED during the COVID-19 outbreak. Results The number of ED visits during the study period was 2,636,341, and the in-hospital mortality rate was 1.4%. The number of ED visits decreased from 803,160 in phase 1 to 496,619 in phase 5 during the study period. For in-hospital mortality, the adjusted odds ratio (OR) (95% confidence interval) was 0.77 (0.74–0.79) in phase 5 compared to phase 3. Additionally, by subgroup, the ORs were 0.69 (0.57–0.83) for the patients with acute myocardial infarction and 0.76 (0.67–0.87) for severe trauma in phase 5 compared to phase 3. The ED LOS increased while the number of ED visits decreased as the COVID-19 pandemic progressed, and the ED LOS declined after policy implementation (beta coefficient: −5.3 [−6.5 to −4.2] minutes in phase 5 compared to phase 3). Conclusion Implementing appropriate emergency care policies in the COVID-19 pandemic would have contributed to improving the safety of all emergency patients and reducing in-hospital mortality by preventing excessive deaths.

Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea

“…The decrease in the total number of ED visits in the current study is consistent with the previous ones [ 21 – 24 ]. It may be due to general hesitancy or ED transport refusal among patients [ 43 , 44 ] and limited resources under new policies [ 24 ].…”

“…Furthermore, the coronavirus disease of 2019 (COVID-19) pandemic has also imposed strict quarantine policies such as large-scale screening for viral symptoms and visitor restrictions [ 18 ], thus making the ED more unsuitable for death [ 19 , 20 ]. Although the total number of ED visitations decreased during the pandemic in the United States [ 21 , 22 ] and Korea [ 23 , 24 ], the ED mortality rate significantly increased after COVID-19 in Korea [ 25 ]. Hence, there is growing interest in providing and even initiating palliative care for terminal patients in ED [ 26 – 30 ].…”

Impact of the COVID-19 Pandemic on Emergency Care Utilization and Outcomes in Pediatric Patients with Intussusception

“…Pak et al also reported that the application of appropriate emergency care policies during the COVID-19 pandemic in Korea improved the safety of all emergency patients and reduced hospital mortality [ 22 ]. On the other hand, the temporary ED closures because of unpredicted COVID-19 exposure resulted in an increase in in-hospital mortality rates of emergency patients [ 7 ].…”

Association between time to emergency neurosurgery and clinical outcomes for spontaneous hemorrhagic stroke: A nationwide observational study

“…Inaccurate data is filtered by a data processing system. The NEDIS data is updated in real time by the National Emergency Medical Center and approved annually by National Statistics for data quality management [ 13 , 14 ].…”