Objective: The length of stay in the emergency department (ED) is a major contributor to ED overcrowding, which in turn negatively affects the quality of emergency care. Several efforts have been made to reduce the ED length of stay (ED-LOS), including a mandatory target to limit ED-LOS within certain parameters. However, the association between ED-LOS and treatment results is yet to be clarified. The authors investigated the influence of ED-LOS on patient survival by comparing severity-adjusted survival. Methods: This study was a retrospective analysis of data registered in 2018 in the National Emergency Department Information System (NEDIS). Cases registered by the regional and local emergency centers were included for analysis. The standardized W scores (Ws) based on the Emergency Department Initial Evaluation Score were used to assess treatment outcomes represented by severity-standardized survival, and the correlation between the Ws and the ED-LOS was analyzed. Results: A total of 2,281,526 cases were included for analysis. The overall mortality comprised 52,284 cases (2.3%) and the median ED-LOS was 165 minutes (interquartile range, 96-301). Although a longer ED-LOS was associated with poorer outcomes overall, the association was not apparent when an analysis of cases eligible for ED-LOS evaluation in the national evaluation program was carried out. Moreover, in the analysis of severe cases with a predicted survival probability of less than 0.9, an ED-LOS shorter than 6 hours was associated with significantly poorer severity-adjusted survival. Conclusion The study revealed that the current ED-LOS criteria used in the national evaluation program were not associated with better survival.

Objective: This study investigates the characteristics of patients who were re-transferred from other hospitals to regional or local emergency medical centers. Methods: Data from 2016 to 2017 was obtained from the National Emergency Department Information System (NEDIS). The study population was classified as ‘transferred group’ and ‘direct visit group.’ The transferred group was further subdivided into the ‘re-transfer group’ (patients transferred out to another hospital) and ‘single transfer group’ (patients not transferred out). Multiple logistic regression analysis was performed to identify factors associated with re-transfer. Results: The re-transfer rate (3.7%) of the ‘transferred group’ was higher than the transfer rate (1.3%) of the ‘direct visit group’. Multiple regression analysis revealed that older age, male (adjusted odds ratio [aOR], 1.082; 95% confidence interval [CI], 1.606-1.105), medical aid (aOR, 1.231; 95% CI, 1.191-1.105), injury origin (aOR, 1.063; 95% CI, 1.006-1.122), and Korean Triage and Acuity Scale level 1 or 2 (aOR, 1.214; 95% CI, 1.182-1.247), are associated with re-transfer. The Korean Standard Classification of Diseases group having the highest re-transfer rate was determined to be the neoplasm disease group. Conclusion Data from the current study reveals that factors associated with an increased likelihood of re-transfer were high severity, old age, medical aid, and neoplasm diagnosis. Considering these characteristics of re-transferred patients, it is necessary to improve the transfer system to reduce re-transfers. However, further research is required, including the reasons for the transfer.

Objective: The purpose of this study was to analyze the effects of emergency department length of stay (ED LOS) on the prognosis of patients classified in 28 severe illness diagnosis code groups. Methods: We used data from the National Emergency Department Information System (NEDIS) from 2016 to 2017. Patients with severe illness diagnosis codes as per the discharge diagnosis reports of the emergency department were included and classified into 28 diagnosis code groups. We used multiple logistic regression analysis on the various diagnosis groups to determine whether 6 hours of ED LOS was a factor influencing mortality. Results: Of the 18,217,034 patients in the NEDIS data, 553,918 patients were hospitalized with a severe illness code at regional or local emergency medical centers. The average ED LOS was 389 minutes in the non-survivor group and 420 minutes in the survivor group. After adjusting for confounders, ED LOS >6 hours was associated with lower mortality (odds ratio, 0.737; 95% confidence interval, 0.715-0.759). The association of ED LOS >6 hours with lower mortality was found in the diagnosis groups for acute myocardial infarction, intracranial hemorrhage, major trauma, aortic dissection, gastrointestinal bleeding/foreign bodies, intoxication, acute kidney injury, and post-resuscitation status. Conclusion In the analysis for the 28 severe disease illness code groups, ED LOS of more than 6 hours was not a factor that adversely affects the in-hospital mortality.

Objective: With trends in population aging an increasing number of older patients are visiting the emergency department (ED). This study aimed to identify the characteristics of ED utilization and risk factors for in-hospital mortality in older patients who visited EDs. Methods: This nationwide observational study used National Emergency Department Information System data collected during a 2-year period from January 2016 to December 2017. The characteristics of older patients aged 70 years or older were compared with those of younger patients aged 20 to 69 years. Risk factors associated with in-hospital mortality were analyzed by multivariable logistic regression. Results: A total of 6,596,423 younger patients and 1,737,799 older patients were included. In the medical and nonmedical older patient groups, significantly higher proportions of patients were transferred from another hospital, utilized emergency medical services, had Korean Triage and Acuity Scale scores of 1 and 2, required hospitalization, and required intensive care unit admission in the older patient group than in the younger patient group. ED and post-hospitalization mortality rates increased with age; in particular, older medical patients aged 90 or older had an in-hospital mortality rate of 9%. Older age, male sex, transfer from another hospital, emergency medical service utilization, a high Korean Triage and Acuity Scale score, systolic blood pressure <100 mmHg, respiratory rate >20/min, heart rate >100/min, body temperature <36°C, and altered mental status were associated with in-hospital mortality. Conclusion Development of appropriate decision-making algorithms and treatment protocols for high risk older patients visiting the ED might facilitate appropriate allocation of medical resources to optimize outcomes.

Objective: With trends in population aging an increasing number of older patients are visiting the emergency department (ED). This study aimed to identify the characteristics of ED utilization and risk factors for in-hospital mortality in older patients who visited EDs. Methods: This nationwide observational study used National Emergency Department Information System data collected during a 2-year period from January 2016 to December 2017. The characteristics of older patients aged 70 years or older were compared with those of younger patients aged 20 to 69 years. Risk factors associated with in-hospital mortality were analyzed by multivariable logistic regression. Results: A total of 6,596,423 younger patients and 1,737,799 older patients were included. In the medical and nonmedical older patient groups, significantly higher proportions of patients were transferred from another hospital, utilized emergency medical services, had Korean Triage and Acuity Scale scores of 1 and 2, required hospitalization, and required intensive care unit admission in the older patient group than in the younger patient group. ED and post-hospitalization mortality rates increased with age; in particular, older medical patients aged 90 or older had an in-hospital mortality rate of 9%. Older age, male sex, transfer from another hospital, emergency medical service utilization, a high Korean Triage and Acuity Scale score, systolic blood pressure <100 mmHg, respiratory rate >20/min, heart rate >100/min, body temperature <36°C, and altered mental status were associated with in-hospital mortality. Conclusion Development of appropriate decision-making algorithms and treatment protocols for high risk older patients visiting the ED might facilitate appropriate allocation of medical resources to optimize outcomes.

Background: Insulin resistance (IR) and inflammation are closely related to each other and share common pathophysiological and metabolic mechanisms. We aimed to investigate the combined effect of IR and inflammation on comorbidities of type 2 diabetes mellitus (T2DM). Methods: A total 3,758 patients with T2DM were recruited through Huh’s Diabetes Center from January 2003 to June 2009. Insulin sensitivity was measured by a rate constant for plasma glucose disappearance (Kitt , %/min) using short insulin tolerance test. High sensitivity C-reactive protein (hs-CRP) was used as a surrogate for inflammation. Results: Patients with the lowest tertile of Kitt (IR group) showed worse cardio-metabolic parameters while those with the highest tertile of hs-CRP levels had worse cardio-metabolic parameters. The prevalence of metabolic syndrome, fatty liver, albuminuria, and carotid atherosclerosis decreased with Kitt tertile, but increased with hs-CRP tertile. In multiple regression analysis, both Kitt and hs-CRP were independent risk factors for comorbidities of T2DM. In addition, they showed synergistic effects on these comorbidities. Conclusion Both IR and inflammation were significantly associated with comorbidities of T2DM in a dose dependent manner. In addition, the coexistence of IR and inflammation may synergistically contribute to increased comorbidities of T2DM.

Objective: Emergency department (ED) overcrowding is a global trend that has negative impacts on the clinical outcomes, especially on critically ill patients. Reducing the portion of these critical patients by limiting the ED length of stay (LOS) to less than 6 hours has become one of the most crucial targets of government policy. This could be valuable for resolving overcrowding, but the clinical impacts and applicability had not been evaluated. Methods: Consecutive emergency patients registered on the National Emergency Department Information System from January 2016 to December 2017 were analyzed. This study included critically ill patients who had a severe illness code, as defined by the government. The in-hospital mortality rate was compared by under or over six hours of ED LOS, in patients with a severe illness code, and intensive care unit (ICU) patients. Results: Among 18,217,034 patients, 436,219 patients had a severe illness code. The ED LOS in the less than six hours group showed a higher in-hospital mortality rate than that of more than six-hours group (7.1% vs. 6.5%, respectively). When the rule for the severe illness code to ICU admission was changed, the in-hospital mortality rate showed a remarkable difference between the under and over six-hour group (12.8% vs. 15.0%, respectively). The proportion of critically ill patients admitted within six hours increased when the standard for outlier removal was set higher than the current. Conclusion A more suitable quality indicator or criterion for severe illness code is required for improving the clinical outcomes.

Objective: Emergency department (ED) overcrowding is a global trend that has negative impacts on the clinical outcomes, especially on critically ill patients. Reducing the portion of these critical patients by limiting the ED length of stay (LOS) to less than 6 hours has become one of the most crucial targets of government policy. This could be valuable for resolving overcrowding, but the clinical impacts and applicability had not been evaluated. Methods: Consecutive emergency patients registered on the National Emergency Department Information System from January 2016 to December 2017 were analyzed. This study included critically ill patients who had a severe illness code, as defined by the government. The in-hospital mortality rate was compared by under or over six hours of ED LOS, in patients with a severe illness code, and intensive care unit (ICU) patients. Results: Among 18,217,034 patients, 436,219 patients had a severe illness code. The ED LOS in the less than six hours group showed a higher in-hospital mortality rate than that of more than six-hours group (7.1% vs. 6.5%, respectively). When the rule for the severe illness code to ICU admission was changed, the in-hospital mortality rate showed a remarkable difference between the under and over six-hour group (12.8% vs. 15.0%, respectively). The proportion of critically ill patients admitted within six hours increased when the standard for outlier removal was set higher than the current. Conclusion A more suitable quality indicator or criterion for severe illness code is required for improving the clinical outcomes.

In Korea, the national evaluation program for emergency medical centers (EMCs) was introduced in 2003. EMCs in Korea have three levels of emergency centers including regional emergency centers, local emergency centers, and local emergency rooms. The evaluation system assesses the performance of EMCs at all three levels. The role of both regional emergency centers and local emergency centers administer the final treatment for severe emergency patients, although the definition of severe emergency patients is unclear. These factors may aggravate crowding at the emergency department. The national evaluation system aims to reduce the length of stay in the emergency department. However, reduction of the length of stay at emergency department may cause a conflict with the administration of final treatment for critically ill emergency patients owing to a lack of in-hospital beds. Crowding of the emergency department is not a problem of EMCs but that of the health system. In 2019, the Korean Society of Emergency Medicine performed a study to improve the national evaluation program for EMC and the performance of EMC. Here, we have summarized the results.