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Delayed at the Door: Impact of Pandemic Response Policies on Emergency and Critical Care in Korea: An Interrupted
Ho Kyung Sung1,2, Kyung-Shin Lee3, Jeehye Lee4
1National Emergency Medical Center, National Medical Center, Seoul, Korea.
Insights
South Korea's strict COVID-19 policies reduced emergency department to intensive care unit admissions and increased mortality. Reintegrating care improved patient flow, highlighting the need for flexible critical care access during pandemics.
Area of Science:
- Critical care medicine
- Public health policy
- Epidemiology
Background:
- The COVID-19 pandemic significantly impacted global healthcare systems, particularly emergency and critical care access.
- While South Korea effectively contained the virus, the specific effects of its pandemic response on critical care accessibility were not well understood.
Purpose of the Study:
- To analyze the impact of COVID-19 pandemic response policies on emergency department (ED) to intensive care unit (ICU) admissions and patient outcomes in South Korea.
- To evaluate changes in critical care accessibility, emergency department length of stay (EDLOS), and in-hospital mortality during different phases of the pandemic.
Main Methods:
- A nationwide interrupted time-series analysis was performed on ED-to-ICU admissions in South Korea from January 2015 to December 2023.
- The study period was segmented into pre-pandemic, pandemic phase 1 (strict segregation), and pandemic phase 2 (reintegration of care).
- Negative binomial regression and seasonal autoregressive integrated moving average models were used to analyze admission trends, EDLOS, and mortality.
Main Results:
- During pandemic phase 1, ED-to-ICU admissions decreased significantly, while in-hospital mortality and EDLOS ≥ 6 hours increased.
- Pandemic phase 2 saw a rebound in ED-to-ICU admissions, accompanied by a decline in mortality and EDLOS ≥ 6 hours.
- These shifts correlated with the implementation and subsequent modification of COVID-19 care policies.
Conclusions:
- Strict COVID-19 infection control measures, particularly segregated care, likely restricted ICU access for non-COVID patients, leading to adverse outcomes.
- Policy adjustments during phase 2 demonstrated the potential to improve ICU access and patient flow.
- Balancing infection control with flexible critical care management is crucial for maintaining patient access and outcomes during public health emergencies.
Background:
The coronavirus disease 2019 (COVID-19) pandemic strained emergency and critical care systems globally, limiting access. Although Korea has been recognized for effective containment, the impact of the pandemic and its response policies on critical care accessibility remains unclear.
Methods:
We conducted a nationwide interrupted time-series analysis of patients admitted from emergency department (ED) to intensive care unit (ICU) in Korea (January 2015-December 2023). The study period was divided into pre-pandemic, pandemic phase 1 (January 2020-March 2022; strict infection control with segregated COVID-19 care), and pandemic phase 2 (April 2022 onwards; reintegration of COVID-19 care). Negative binomial regression was used for ED-to-ICU admissions, and seasonal autoregressive integrated moving average models for the proportion of ED length of stay (EDLOS) ≥ 6 hours and in-hospital mortality.
Results:
At pandemic onset, ED-to-ICU admissions declined immediately by 6.66% (95% confidence interval [CI], -9.25 to -3.98) and continued to fall by 0.54% per month (95% CI, -0.69 to -0.39) throughout phase I. Despite this, in-hospital mortality rose by 0.08% monthly (95% CI, 0.02 to 0.14), while EDLOS ≥ 6 hours increased by 0.35% per month (95% CI, 0.24 to 0.47). In phase 2, ED-to-ICU admissions rebounded with a 1.22% monthly increase (95% CI, 0.96 to 1.48), while mortality (-0.10% monthly, 95% CI, -0.20 to -0.01) and EDLOS ≥ 6 hours (-0.98% monthly, 95% CI, -1.18 to -0.77) declined.
Conclusion:
During the COVID-19 pandemic, marked changes in Korea's ED-to-ICU admission and in-hospital mortality were observed, reflecting the consequence of pandemic response policies. While infection control was essential, strict segregated COVID-19 care system likely limited ICU access for non-COVID patients, contributing to reduced admissions and increased mortality. These findings underscore the need for policies that balance rigorous infection control with flexible ICU management and effective patient flow strategies during public health emergencies.
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