Emergency-Care Utilisation During Two Healthcare Crises in South Korea: A Single-Centre Comparison of Calendar-Aligned 32-Week Windows
- 1Department of Emergency Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
Abstract
Background/Objectives: Emergency department (ED) attendance may change differently from subsequent hospital utilisation during healthcare disruptions. We compared two historical crisis episodes within one Korean regional emergency medical centre. Methods: Four calendar-aligned 224-day windows before and after the onset of COVID-19 and the 2024 workforce disruption were analysed using episode-by-phase interactions. Modified Poisson models used patient-and-day two-way clustered variance. Less-conditioned and initial-acuity-conditioned models were compared. Daily counts used calendar-lag autocorrelation-consistent variance. Source-data audits, full-period segmented analyses and alternative-baseline sensitivities were added. Results: The windows included 83,998 visits by 66,096 patients after source-data recoding. The ratio of relative changes was 0.73 (95% confidence interval [CI], 0.68–0.78) for daily visits, 1.28 (1.19–1.37) for transfer-in presentation and 1.44 (1.33–1.55) for acuity-conditioned ICU admission. EMS arrival increased more during COVID-19, but the corrected physiological composite showed no clear between-episode contrast. ED-origin ICU admissions/day were 9.24 before and 9.67 during the workforce episode; the primary ratio of incidence rate ratios was 1.13 (1.05–1.22), but the prior-calendar-year sensitivity included the null (1.06, 0.97–1.15). Workforce-period mortality associations differed before and after acuity conditioning, with adjusted risk ratios of 1.28 (1.10–1.49) and 1.06 (0.92–1.22), respectively. Conclusions: Attendance contracted more than ED-origin ICU admission volume during the observed workforce episode. These findings describe utilisation, not measured capacity pressure, and depend partly on baseline and adjustment choices. The contribution is a multidimensional approach to utilisation surveillance, not universal crisis-specific effects or evidence of unchanged survival.
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BibTeX
@article{park2026emergencycare,
title = {{Emergency-Care Utilisation During Two Healthcare Crises in South Korea: A Single-Centre Comparison of Calendar-Aligned 32-Week Windows}},
author = {Chan Park and Kang Hyun Lee and Oh Hyun Kim and Sun Ju Kim},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207783},
url = {https://www.mdpi.com/2077-0383/15/20/7783},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Emergency-Care Utilisation During Two Healthcare Crises in South Korea: A Single-Centre Comparison of Calendar-Aligned 32-Week Windows
AU - Chan Park
AU - Kang Hyun Lee
AU - Oh Hyun Kim
AU - Sun Ju Kim
PY - 2026
DA - 2026/10/09
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207783
UR - https://www.mdpi.com/2077-0383/15/20/7783
AB - Background/Objectives: Emergency department (ED) attendance may change differently from subsequent hospital utilisation during healthcare disruptions. We compared two historical crisis episodes within one Korean regional emergency medical centre. Methods: Four calendar-aligned 224-day windows before and after the onset of COVID-19 and the 2024 workforce disruption were analysed using episode-by-phase interactions. Modified Poisson models used patient-and-day two-way clustered variance. Less-conditioned and initial-acuity-conditioned models were compared. Daily counts used calendar-lag autocorrelation-consistent variance. Source-data audits, full-period segmented analyses and alternative-baseline sensitivities were added. Results: The windows included 83,998 visits by 66,096 patients after source-data recoding. The ratio of relative changes was 0.73 (95% confidence interval [CI], 0.68–0.78) for daily visits, 1.28 (1.19–1.37) for transfer-in presentation and 1.44 (1.33–1.55) for acuity-conditioned ICU admission. EMS arrival increased more during COVID-19, but the corrected physiological composite showed no clear between-episode contrast. ED-origin ICU admissions/day were 9.24 before and 9.67 during the workforce episode; the primary ratio of incidence rate ratios was 1.13 (1.05–1.22), but the prior-calendar-year sensitivity included the null (1.06, 0.97–1.15). Workforce-period mortality associations differed before and after acuity conditioning, with adjusted risk ratios of 1.28 (1.10–1.49) and 1.06 (0.92–1.22), respectively. Conclusions: Attendance contracted more than ED-origin ICU admission volume during the observed workforce episode. These findings describe utilisation, not measured capacity pressure, and depend partly on baseline and adjustment choices. The contribution is a multidimensional approach to utilisation surveillance, not universal crisis-specific effects or evidence of unchanged survival.
SN - 2077-0383
ER -