Changes in Patient Characteristics and Early Clinical Outcomes Among Emergency Department-Admitted Inpatients During...

Background/Objectives: In February 2024, a nationwide medical crisis in South Korea caused a massive withdrawal of resident physicians. We described changes in patient characteristics and early clinical outcomes among emergency department (ED)-admitted inpatients during this disruption. Methods: We retrospectively analyzed 8149 internal medicine admissions via the ED at a tertiary hospital, 6 months pre- and post-crisis. Multivariable logistic regression evaluated early clinical outcomes, adjusting for baseline confounders. Results: Post-crisis, the internal medicine physician workforce decreased by 36%. Total admissions dropped, while patient acuity increased. After adjustment, the post-crisis group exhibited higher odds of Orders for Life-Sustaining Treatment documentation (adjusted odds ratio [aOR] 1.53, 95% confidence interval [CI] 1.34-1.74), inter-hospital transfers (aOR 1.71, 95% CI 1.49-1.96), and 48 h mortality (aOR 1.81, 95% CI 1.25-2.61). However, adjusted overall in-hospital mortality did not significantly differ (aOR 1.10, 95% CI 0.95-1.27). Conclusions: The crisis led to decreased admissions and higher patient acuity. Despite these shifts, adjusted in-hospital mortality did not significantly differ. This suggests that during severe workforce shortages, acute care was concentrated on a highly selected, high-acuity patient cohort, accompanied by an increased reliance on inter-hospital transfers.