Sim Jeongyong, Choi Yuri, Jeong Jinwoo
Department of Emergency Medicine, Dong-A University Hospital, Busan, Republic of Korea.
Department of Emergency Medicine, Dong-A University College of Medicine, Busan, Republic of Korea.
Emerg Med Int. 2021 Jul 8;2021:1786728. doi: 10.1155/2021/1786728. eCollection 2021.
A nationwide strike that took place from August 21 to September 7, 2020, which was led by young doctors represented by residents and interns, resulted in shortages of manpower at almost all university and training hospitals. This study aimed to identify differences in the process and outcomes of emergency department (ED) patient care by comparing the performance over about 2 weeks of the strike with that during the usual ED operations.
This retrospective observational study evaluated ED flow and performance during the junior doctors' strike and compared it with the usual period in a single tertiary-care academic hospital. The outcome variables were defined as ED length of stay, crude mortality, and hospital mortality and adjusted for demographic and clinical parameters. The effect of the doctors' strike on hospital mortality adjusted for demographic and clinical variables was investigated using logistic regression.
A total of 1,121 and 1,496 patients visited the ED during the strike and control periods (both 17 days), respectively. The care usually provided by four or six physicians, including one specialist, was replaced with that by one or two specialists at any one time. During the trainee doctors' strike, EM specialists managed patients with fewer consultations. However, the proportion of patients who underwent laboratory and radiologic tests did not change significantly. The median ED length of stay significantly decreased from 359 minutes (interquartile range, IQR: 147-391) in the control period to 326 minutes (IQR: 123-318) during the strike period ( < 0.001). The doctors' strike was not found to have a significant effect on mortality after adjustments with other variables.
During the junior doctors' strike in 2020 in Korea, EM specialists efficiently managed the care of emergency patients with higher levels of acuity without compromising the survival rate, through fewer consultations and faster disposition.
2020年8月21日至9月7日发生的全国性罢工由住院医师和实习医师等年轻医生领导，导致几乎所有大学医院和培训医院人力短缺。本研究旨在通过比较罢工约两周期间与急诊科常规运营期间的表现，确定急诊科患者护理过程和结果的差异。
这项回顾性观察研究评估了初级医生罢工期间急诊科的流程和表现，并将其与一家三级医疗学术医院的常规时期进行比较。结局变量定义为急诊科住院时间、粗死亡率和医院死亡率，并针对人口统计学和临床参数进行了调整。使用逻辑回归研究医生罢工对经人口统计学和临床变量调整后的医院死亡率的影响。
罢工期间和对照期间（均为17天）分别有1121例和1496例患者就诊于急诊科。通常由包括一名专科医生在内的四名或六名医生提供的护理，在任何时候都由一两名专科医生替代。在实习医生罢工期间，急诊专科医生管理的患者会诊次数减少。然而，接受实验室和放射学检查的患者比例没有显著变化。急诊科住院时间中位数从对照期的359分钟（四分位间距，IQR：147 - 391）显著降至罢工期的326分钟（IQR：123 - 318）（<0.001）。在对其他变量进行调整后，未发现医生罢工对死亡率有显著影响。
在2020年韩国初级医生罢工期间，急诊专科医生通过减少会诊和更快的处置，有效地管理了急性程度较高的急诊患者的护理，且未影响生存率。
