J Korean Med Sci.  2021 Apr;36(16):e121. 10.3346/jkms.2021.36.e121.

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

Affiliations
  • 1National Emergency Medical Center, National Medical Center, Seoul, Korea
  • 2Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
  • 3Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
  • 4Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea

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 inhospital mortality by preventing excessive deaths.

Keyword

COVID-19; Emergency Care Policies; Quasi-experimental Study
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