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Kim W, Kim K, Nam EJ, Kye SY, Choi JY. Trends of hospice utilization in Korea before and after the COVID- 19 pandemic in patients with cancer: an interrupted time series analysis using nationwide data. Support Care Cancer 2025; 33:364. [PMID: 40199786 DOI: 10.1007/s00520-025-09432-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 04/03/2025] [Indexed: 04/10/2025]
Abstract
PURPOSE The coronavirus disease (COVID- 19) outbreak has impacted hospice care. This study investigated the impact of the pandemic on the rate and average length of hospice utilization in patients with end-stage cancer. METHODS Data from the 2017 to 2022 National Hospice and Palliative Care registry and the cause-of-death statistics were used. The study population included patients with end-stage cancer who received hospice care. Outcome measures were the monthly utilization rate and length of hospice care. An interrupted time series analysis was performed to compare outcome measures before and after the pandemic, set at January 2020. The pre-intervention period was set from August 2017 to December 2019, and the post-intervention period was set from February 2020 to December 2022. RESULTS The study population included 88,753 individuals. Total hospice utilization rate showed an increasing pre-intervention trend, at a rate of 0.2500 per month (p < 0.0001). The post-intervention trend decreased at a rate of - 0.2634 per month (p < 0.0001). However, the post-intervention slope did not show a significant trend. Total length of utilization showed a decreasing pre-intervention trend, at a rate of - 2.2160 days (p = 0.0001). The post-intervention trend decreased at a rate of - 0.0003 (p < 0.0001), and the post-intervention slope also decreased at a rate of - 0.0001 (p < 0.0001). CONCLUSION The pandemic has led to a general decrease in total hospice utilization and average length of utilization. Policies on end-of-life care should be strengthened to ensure adequate provision of hospice care.
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Affiliation(s)
- Woorim Kim
- National Hospice Center, National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 10408, Republic of Korea
| | - Kyuwoong Kim
- National Hospice Center, National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 10408, Republic of Korea
| | - Eun Jeong Nam
- National Hospice Center, National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 10408, Republic of Korea
| | - Su Yeon Kye
- National Hospice Center, National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 10408, Republic of Korea
| | - Jin Young Choi
- National Hospice Center, National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 10408, Republic of Korea.
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Seo H, Ahn I, Gwon H, Kang HJ, Kim Y, Cho HN, Choi H, Kim M, Han J, Kee G, Park S, Seo DW, Jun TJ, Kim YH. Prediction of hospitalization and waiting time within 24 hours of emergency department patients with unstructured text data. Health Care Manag Sci 2024; 27:114-129. [PMID: 37921927 PMCID: PMC10896961 DOI: 10.1007/s10729-023-09660-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 10/11/2023] [Indexed: 11/05/2023]
Abstract
Overcrowding of emergency departments is a global concern, leading to numerous negative consequences. This study aimed to develop a useful and inexpensive tool derived from electronic medical records that supports clinical decision-making and can be easily utilized by emergency department physicians. We presented machine learning models that predicted the likelihood of hospitalizations within 24 hours and estimated waiting times. Moreover, we revealed the enhanced performance of these machine learning models compared to existing models by incorporating unstructured text data. Among several evaluated models, the extreme gradient boosting model that incorporated text data yielded the best performance. This model achieved an area under the receiver operating characteristic curve score of 0.922 and an area under the precision-recall curve score of 0.687. The mean absolute error revealed a difference of approximately 3 hours. Using this model, we classified the probability of patients not being admitted within 24 hours as Low, Medium, or High and identified important variables influencing this classification through explainable artificial intelligence. The model results are readily displayed on an electronic dashboard to support the decision-making of emergency department physicians and alleviate overcrowding, thereby resulting in socioeconomic benefits for medical facilities.
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Affiliation(s)
- Hyeram Seo
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Imjin Ahn
- Division of Cardiology, Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Hansle Gwon
- Division of Cardiology, Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Hee Jun Kang
- Division of Cardiology, Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Yunha Kim
- Division of Cardiology, Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Ha Na Cho
- Division of Cardiology, Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Heejung Choi
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Minkyoung Kim
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Jiye Han
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Gaeun Kee
- Division of Cardiology, Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Seohyun Park
- Division of Cardiology, Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Dong-Woo Seo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Songpagu, Seoul, Korea
| | - Tae Joon Jun
- Big Data Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88, Olympicro 43gil, 05505, Songpagu, Seoul, Korea.
| | - Young-Hak Kim
- Division of Cardiology, Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea.
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Na SK, Kim JH, Lee WY, Oh MR. Impact of the COVID-19 Pandemic on Admission and Mortality Among Patients With Severe Emergency Diseases at Emergency Departments in Korea in 2020: Registry Data From the National Emergency Department Information System. J Korean Med Sci 2023; 38:e243. [PMID: 37527913 PMCID: PMC10396429 DOI: 10.3346/jkms.2023.38.e243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 06/12/2023] [Indexed: 08/03/2023] Open
Abstract
We aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on admissions of patients with acute myocardial infarction, stroke, and severe trauma, and their excess mortality in emergency departments (EDs) in South Korea using registry data from the National Emergency Department Information System (NEDIS) for patients attending EDs of regional and local emergency medical centers. During the outbreak period of 2020, there were 350,698 ED visits, which was lower than the total in 2019 (392,627 visits). Multiple logistic regression revealed that, compared with 2019, there was significantly higher ED mortality rate during the COVID-19 outbreak in 2020 (adjusted odds ratio, 1.10; 95% confidence interval, 1.07-1.13). This finding implies that during the early outbreak period, people might have avoided seeking medical care even for acute and life-threatening conditions, or transfer times at the scene to the hospital arrival were delayed, or treatment for the patients in EDs were delayed.
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Affiliation(s)
- Sun Kyoung Na
- Department of Healthcare, Graduate School of Nursing & Health Professions, Chung-Ang University, Seoul, Korea
- National Emergency Medical Center of National Medical Center, Seoul, Korea
| | - Jeung-Hee Kim
- Division of Chronic Disease Investigation, Capital Regional Center for Disease Control and Prevention, Korea Disease Control and Prevention Agency, Seoul, Korea
- Department of Food and Resource Economics, College of Life Science and Biotechnology, Korea University Graduate School, Seoul, Korea
| | - Weon-Young Lee
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, Korea.
| | - Mi Ra Oh
- National Emergency Medical Center of National Medical Center, Seoul, Korea
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Kim Y, Shin JM, Yoo SH, Keam B. Challenges in Care for Non-COVID-19 Patients with Severe Chronic Illnesses during COVID-19 Pandemic: A Qualitative Study of Healthcare Providers Working around Acute Care Hospitals in South Korea. Healthcare (Basel) 2023; 11:611. [PMID: 36833145 PMCID: PMC9957023 DOI: 10.3390/healthcare11040611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The COVID-19 epidemic has afflicted patients with severe chronic illnesses who need continuous care between home and hospitals. This qualitative study examines the experiences and challenges of healthcare providers around acute care hospitals who have cared for patients with severe chronic illness in non-COVID-19 situations during the pandemic. METHODS Eight healthcare providers, who work in various healthcare settings around acute care hospitals and frequently care for non-COVID-19 patients with severe chronic illnesses, were recruited using purposive sampling from September to October 2021 in South Korea. The interviews were subjected to thematic analysis. RESULTS Four overarching themes were identified: (1) deterioration in the quality of care at various settings; (2) new emerging systemic problems; (3) healthcare providers holding on but reaching their limit; and (4) a decline in the quality of life of patients at the end of their lives, and their caregivers. CONCLUSION Healthcare providers of non-COVID-19 patients with severe chronic illnesses reported that the quality of care was declining due to the structural problems of the healthcare system and policies centered solely on the prevention and control of COVID-19. Systematic solutions are needed for appropriate and seamless care for non-infected patients with severe chronic illness in the pandemic.
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Affiliation(s)
- Yejin Kim
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Jeong Mi Shin
- Public Healthcare Center, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
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Katayama Y, Tanaka K, Kitamura T, Dohmi H, Masui J, Hirose T, Nakao S, Tachino J, Oda J, Matsuoka T. Incidence and outcome of patients with difficulty in hospital acceptance during COVID-19 pandemic in Osaka Prefecture, Japan: A population-based descriptive study. Acute Med Surg 2023; 10:e880. [PMID: 37564634 PMCID: PMC10410119 DOI: 10.1002/ams2.880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/24/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023] Open
Abstract
Aim The impact of the coronavirus disease (COVID-19) pandemic on the emergency medical service system in Japan has not been fully revealed. The purpose of this study was to determine the impact of the COVID-19 pandemic in 2021 on the difficulty in hospital acceptance of patients and patient outcome in Osaka Prefecture. Methods This study was a descriptive epidemiological study with a 3-year study period from January 2019 to December 2021. We included patients who were transported by ambulance and had registered in the Osaka Emergency Information Research Intelligent Operation Network (ORION) system. The primary end-point of this study was the difficulty in hospital acceptance by month, and the secondary outcome was the mortality of patients who experience difficulty in hospital acceptance in each year. Results We included 1,302,646 cases in this study. The proportion of cases with difficulty in hospital acceptance was 2.74% (12,829/468,709) in 2019, 3.74% (15,527/414,987) in 2020, and 5.09% (21,311/418,950) in 2021. The crude odds ratio for 2020 was 1.38 (95% confidence interval, 1.35-1.41) and for 2021 was 1.90 (95% confidence interval, 1.86-1.95). In 2019, 218 patients with difficulty in hospital acceptance had died by 21 days after hospitalization, whereas the number increased to 405 in 2020 and 750 in 2021. Conclusion The number of patients experiencing difficulty in hospital acceptance during the COVID-19 pandemic in Osaka Prefecture increased, and patient outcomes were worse than before the pandemic.
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Affiliation(s)
- Yusuke Katayama
- The Working Group to Analyse the Emergency Medical Care System in Osaka PrefectureOsakaJapan
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Kenta Tanaka
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tetsuhisa Kitamura
- The Working Group to Analyse the Emergency Medical Care System in Osaka PrefectureOsakaJapan
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Hisaya Dohmi
- The Working Group to Analyse the Emergency Medical Care System in Osaka PrefectureOsakaJapan
- Osaka Prefectural GovernmentOsakaJapan
| | - Jun Masui
- The Working Group to Analyse the Emergency Medical Care System in Osaka PrefectureOsakaJapan
- Osaka Prefectural GovernmentOsakaJapan
- Department of Emergency MedicineTane General HospitalOsakaJapan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Jun Oda
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tetsuya Matsuoka
- The Working Group to Analyse the Emergency Medical Care System in Osaka PrefectureOsakaJapan
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Shin J, Kim Y, Yoo SH, Sim JA, Keam B. Impact of COVID-19 on the End-of-Life Care of Cancer Patients Who Died in a Korean Tertiary Hospital: A Retrospective Study. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2022; 25:150-158. [PMID: 37674665 PMCID: PMC10179996 DOI: 10.14475/jhpc.2022.25.4.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 09/08/2023]
Abstract
Purpose Social distancing and strict visitor restrictions at hospitals have been national policies since the onset of the coronavirus disease 2019 (COVID-19) pandemic. This has challenged the concept of a good death in comfort with the opportunity to say goodbye. Little is known about how these measures have influenced end-of-life (EOL) care among cancer patients who die in acute care hospitals. This study examined changes in the EOL care of cancer patients during the COVID-19 pandemic. Methods We retrospectively analyzed 1,456 adult cancer patients who died in 2019 (n=752) and 2020 (n=704) at a tertiary hospital. Data on EOL care-symptom control and comfort care in an imminently dying state, preparation for death, place of death, and aggressive care in the last month-were reviewed. Results The 1,456 patients had a median age of 67 years, and 62.5% were men. Patients who died in 2020 were more likely to experience agitation or delirium before death (17.2% vs. 10.9%), to use inotropes/vasopressors near death (59.2% vs. 52.3%), and to receive cardiopulmonary resuscitation in their last months (16.3% vs. 12.5%) than those who died in 2019. Additionally, the number of deaths in the emergency room doubled in 2020 compared to 2019 (from 7.1% to 14.1%). Conclusion This study suggests that EOL care for cancer patients who died in a tertiary hospital deteriorated during the COVID-19 pandemic. The implementation of medical care at the EOL and the preferred place of death should be discussed carefully in advance for high-quality EOL care.
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Affiliation(s)
- Jeongmi Shin
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Yejin Kim
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Jin-Ah Sim
- School of AI Convergence, Hallym University, Chuncheon, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Lee YJ, Park SY. Comparison of emergency department workloads before and during the COVID-19 pandemic as assessed using relative value units. Clin Exp Emerg Med 2022; 9:354-360. [PMID: 36195468 PMCID: PMC9834830 DOI: 10.15441/ceem.22.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/07/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study aimed to assess and compare emergency department (ED) workloads by using relative value units (RVUs) before and during the COVID-19 pandemic. METHODS This retrospective observational study investigated the RVUs of a single ED from 2019 to 2021. We calculated the mean number of patients per day (PPD) for each year and selected the days when the number of patients was equal to the yearly mean PPD for each of the three years. We calculated the total RVUs per day and RVUs per patient and compared them. RESULTS We analyzed the RVUs of 12 days in 2019 (mean PPD, 88), 10 days in 2020 (mean PPD, 75), and 14 days in 2021 (mean PPD, 83). The mean of the total RVUs per day were as follows: 533,057.5±66,239.1 in 2019, 505,994.6±48,935.4 in 2020, and 634,219.6±64,024.2 in 2021 (P<0.001). The RVUs per patient in the three year-groups were significantly different (6,057.5±752.7 in 2019, 6,746.6±652.5 in 2020, and 7,641.2±771.4 in 2021; P<0.001). Post hoc analyses indicated that the total RVUs per day and the RVUs per patient in 2021 were significantly higher than in 2019 or 2020, although the mean PPD in 2019 was the highest. CONCLUSION Since the onset of the COVID-19 pandemic, the mean RVUs per patient have increased, suggesting that the workload per patient may also have increased in the regional emergency medical center.
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Affiliation(s)
- Yu Jin Lee
- Department of Emergency Medicine, Inha University School of Medicine, Incheon, Korea
| | - Song Yi Park
- Department of Emergency Medicine, Dong-A University College of Medicine, Busan, Korea,Correspondence to: Song Yi Park Department of Emergency Medicine, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Korea E-mail:
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Changes in Emergency Department Case Severity and Length of Stay before and after COVID-19 Outbreak in Korea. Healthcare (Basel) 2022; 10:healthcare10081540. [PMID: 36011197 PMCID: PMC9408214 DOI: 10.3390/healthcare10081540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Severe patients visited regional emergency centers more frequently during the COVID-19 period, and disposition status warranting admission to the intensive care unit or resulting in death was more common during the COVID-19 period. This study was conducted to compare the characteristics and severity of patients, and emergency department length of stay before and after the COVID-19 outbreak. Subjects were 75,409 patients who visited the regional emergency medical center from 1 February 2019 to 19 January 2020 and from 1 February 2020 to 19 January 2021. Data was analyzed using the SPSS/WIN 22.0 program. The significance level was p < 0.05. The chi-square test and t-test were used for variables, and Cramer V was used for correlation. We found that the total number of patients visiting the emergency room decreased by 37.6% after COVID-19, but emergency department length of stay among severely ill patients increased by 203.7%. Additionally, the utilization rate of 119 ambulances and relatively more severe patients increased by 9.0% and by 2.1%. More studies about emergency department designs and operational programs should be conducted for better action not only during regular periods but also during periods of pandemic.
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Ryu S, Kim D, Jung LY, Kim B, Lee CS. Decreased door-to-balloon time in patients with ST-segment elevation myocardial infarction during the early COVID-19 pandemic in South Korea: An observational study. Medicine (Baltimore) 2022; 101:e29596. [PMID: 35905280 PMCID: PMC9333082 DOI: 10.1097/md.0000000000029596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) resulted in a marked decrease in the number of patient visits for acute myocardial infarction and delayed patient response and intervention in several countries. This study evaluated the effect of the COVID-19 pandemic on the number of patients, patient response time (pain-to-door), and intervention time (door-to-balloon) for patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Patients with STEMI or NSTEMI visiting a hospital in South Korea who underwent primary coronary intervention during the COVID-19 pandemic (January 29, 2020, to December 31, 2020) were compared with those in the equivalent period from 2018 to 2019. Patient response and intervention times were compared for the COVID-19 pandemic window (2020) and the equivalent period from 2018 to 2019. We observed no decrease in the number of patients with STEMI (P = .88) and NSTEMI (P = 1.00) during the COVID-19 pandemic compared to that in the previous years. Patient response times (STEMI: P = .39; NSTEMI: P = .59) during the overall COVID-19 pandemic period did not differ significantly. However, we identified a significant decrease in door-to-balloon time among patients with STEMI (14%; P < .01) during the early COVID-19 pandemic. We found that the number of patients with STEMI and NSTEMI was consistent during the COVID-19 pandemic and that no time delays in patient response and intervention occurred. However, the door-to-balloon time among patients with STEMI significantly reduced during the early COVID-19 pandemic, which could be attributed to decreased emergency care utilization during the early pandemic.
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Affiliation(s)
- Sukhyun Ryu
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, South Korea
| | - Dasom Kim
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, South Korea
| | - Lae Young Jung
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Baekjin Kim
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, South Korea
| | - Chang-Seop Lee
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
- *Correspondence: Chang-Seop Lee, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, South Korea (e-mail: )
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10
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Yoo SH, Sim JA, Shin J, Keam B, Park JB, Shin A. The Impact of COVID-19 on Cancer Care in a Tertiary Hospital in Korea: Possible Collateral Damage to Emergency Care. Epidemiol Health 2022; 44:e2022044. [PMID: 35538696 DOI: 10.4178/epih.e2022044] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/01/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives We investigated the impact of the COVID-19 pandemic on cancer care in a tertiary hospital of South Korea without the specific lockdown measures. Methods A retrospective cohort of cancer patients from one of the largest tertiary hospitals in South Korea was used to compare the healthcare utilization in different settings (outpatient clinic, emergency department (ED), and admission) between the period of January 1 and December 31, 2020 and the same time period in 2019. The percent changes in healthcare utilization between two periods were calculated. Results A total of 448,833 cases from the outpatient cohort, 26,781 cases from the ED cohort, and 14,513 cases from the admission cohort were reviewed for 2019 and 2020. The total number of ED visit cases significantly decreased in 2020 than in 2019 by 18.04%, whereas the proportion of cancer patients maintained. The reduction in ED visits was more prominent in cases with COVID-19 suspicious symptoms, with high acuity, and those who lived in non-capital city area. There were no significant changes in the number of total visits and new cases in the outpatient clinic between two periods. No significant differences in the total number of hospitalizations were observed between two periods. Conclusion During the pandemic, the number of ED visits significantly decreased, while the use of outpatient clinic and hospitalizations were not affected. Cancer patients' ED visits decreased after the COVID-19 outbreak, suggesting the potential for collateral damage outside the hospital if the ED could not be reached in a timely manner.
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Affiliation(s)
- Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Jin-Ah Sim
- School of AI Convergence, Hallym University, Chuncheon, Korea
| | - Jeongmi Shin
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
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Lee JH, Kim JH, Park I, Lee HS, Park JM, Chung SP, Kim HC, Son WJ, Roh YH, Kim MJ. Effect of a Boarding Restriction Protocol on Emergency Department Crowding. Yonsei Med J 2022; 63:470-479. [PMID: 35512750 PMCID: PMC9086691 DOI: 10.3349/ymj.2022.63.5.470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/29/2021] [Accepted: 01/13/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Access block due to the lack of hospital beds causes crowding of emergency departments (ED). We initiated the "boarding restriction protocol" that limits the time of stay in the ED for patients awaiting hospitalization to 24 hours from arrival. The purpose of this study was to determine the effect of the boarding restriction protocol on ED crowding. MATERIALS AND METHODS The primary outcome was ED occupancy rate, which was calculated as the ratio of the number of occupying patients to the total number of ED beds. Time factors, such as length of stay (LOS), treatment time, and boarding time, were investigated. RESULTS The mean of the ED occupancy rate decreased from 1.532±0.432 prior to implementation of the protocol to 1.273±0.353 after (p<0.001). According to time series analysis, the absolute effect caused by the protocol was -0.189 (-0.277 to -0.110) (p=0.001). The proportion of patients with LOS exceeding 24 hours decreased from 7.6% to 4.0% (p<0.001). Among admitted patients, ED LOS decreased from 770.7 (421.4-1587.1) minutes to 630.2 (398.0-1156.8) minutes (p<0.001); treatment time increased from 319.6 (198.5-482.8) minutes to 344.7 (213.4-519.5) minutes (p<0.001); and boarding time decreased from 298.9 (109.5-1149.0) minutes to 204.1 (98.7-545.7) minutes (p<0.001). In pre-protocol period, boarding patients accumulated in the ED during the weekdays and resolved on Friday, but this pattern was alleviated in post-period. CONCLUSION The boarding restriction protocol was effective in alleviating ED crowding by reducing the accumulation of boarding patients in the ED during the weekdays.
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Affiliation(s)
- Ji Hwan Lee
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoon Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Korea
| | - Incheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Sim Lee
- Department of Emergency Nursing, Yonsei University Health System, Seoul, Korea
| | - Joon Min Park
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jeong Son
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Impact of COVID-19 on Emergency Medical Services for Patients with Acute Stroke Presentation in Busan, South Korea. J Clin Med 2021; 11:jcm11010094. [PMID: 35011835 PMCID: PMC8745620 DOI: 10.3390/jcm11010094] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 12/23/2022] Open
Abstract
The purpose of this retrospective observational study was to identify the impact of COVID-19 on emergency medical services (EMS) processing times and transfers to the emergency department (ED) among patients with acute stroke symptoms before and during the COVID-19 pandemic in Busan, South Korea. The total number of patients using EMS for acute stroke symptoms decreased by 8.2% from 1570 in the pre-COVID-19 period to 1441 during the COVID-19 period. The median (interquartile range) EMS processing time was 29.0 (23–37) min in the pre-COVID-19 period and 33.0 (25–41) minutes in the COVID-19 period (p < 0.001). There was a significant decrease in the number of patients transferred to an ED with a comprehensive stroke center (CSC) (6.37%, p < 0.001) and an increase in the number of patients transferred to two EDs nearby (2.77%, p = 0.018; 3.22%, p < 0.001). During the COVID-19 pandemic, EMS processing time increased. The number of patients transferred to ED with CSC was significantly reduced and dispersed. COVID-19 appears to have affected the stroke chain of survival by hindering entry into EDs with stroke centers, the gateway for acute stroke patients.
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