The quality of pediatric emergency medical care has declined due to the Covid-19 pandemic, as shown by the young patients’ extended stays at emergency rooms and their increased transfers to other ERs, a study showed.
Dr. Sung Ho-kyung, a specialist in the Department of Preventive Medicine at the Big Data Strategy Team of the National Medical Center (NMC), analyzed the National Emergency Department Information System (NEDIS) in a recent issue briefing on emergency medicine published by the NMC.
The analysis showed that pediatric patients’ use of emergency medical institutions has decreased due to the impact of Covid-19. In 2020, pediatric patients visiting emergency departments decreased by 50 percent to 908,105, from 1,721,961 in 2019. The number fell further to 892,001 in 2021 before rebounding slightly to 1,137,965.
The quality of pediatric emergency care has also declined. Sung cited the increase in pediatric patients’ transfer rate and their length of stay in ERs.
She added that compared to 2018, adult patients’ transfer rate has decreased slightly, but that of pediatric patients remained unchanged.
The adult patient transfer rate decreased from 2.0 percent in 2018 to 1.97 percent in 2019, 1.75 percent in 2020, and 1.72 percent in 2021, before increasing slightly to 1.78 percent in 2022. The comparable rate for pediatric patients maintained a similar level, with 0.49 percent in 2018 and 0.44 percent in 2022.
In particular, that for the 0-year-old population decreased from 0.91 percent in 2018 to 0.67 percent in 2021 but rose to 0.87 percent in 2022. It indicated that emergency care institutions cut down on the final treatment of infants and children, according to Dr. Sung.
Besides, fewer patients visited emergency medical institutions in 2020, decreasing the length of stay across all age groups. In 2021, however, the stay length increased significantly from the pre-Covid-19 period.
Sung analyzed based on four hours of stay and considered more than four hours as an extended stay. As a result, the share of adults and pediatric patients who stayed longer than four hours has increased since 2021. The share rose from 9.53 percent in 2018 to 12.24% in 2021 and 12.76 percent in 2022.
The increase was especially significant for younger patients. Among 0-year-olds, the four+-hour stay rate increased from 19.76 percent in 2018 to 20.11 percent in 2020, 24.10 percent in 2021, and 26.31 percent in 2022. Patients aged 1-6 also saw a sharp increase, from 9.54 percent in 2018 to 12.16 percent in 2021 and 13.57 percent in 2022.
The time spent in ERs for pediatric patients before being admitted to the hospital also increased. The analysis of the share of hospitalized young patients aged 0 to 17 who stayed four hours or more at ERs increased across the board.
According to Sung, the increase in length of stay might be attributable to delays due to aggressive Covid-19 testing, disruptions in emergency care, lack of beds, and staffing shortages.
“Since the outbreak of Covid-19, the length of stay at ERs, an indicator of the smoothness of the emergency care, has increased, mostly in infants and inpatients,” Dr. Sung said. “Considering the increase in transfer rates and the length of stay at ERs, the quality of emergency care for infants and children is declining.”
It is clear these trends have occurred since Covid-19, so we can expect to see improvements in 2023 when the pandemic is declared over, she said, adding that continued data-driven monitoring is needed.