In 2020, hospitals all over Japan started giving top priority to patients with COVID-19 in their emergency systems, while emergency responses for other patients became a problem in every region. Our hospital, located in the northern part of Saitama Prefecture, was no exception, and prioritized patients with COVID-19 while also responding to emergency calls from general emergency patients whenever possible. Our hospital is one of the few in the country that actively accepts patients with COVID-19 as well as other patients in severe conditions. As the northern part of Saitama Prefecture is a depopulated area with few hospitals, the need for local medical care is higher than in urban areas. It has been reported that the number of emergency admissions for non-COVID-19 infections decreased among all admissions to Veterans Affairs hospitals1 along with the number of cardiac catheterizations.2 However, this phenomenon does not apply to our hospital, as it is in a depopulated area.
Even in 2020, when COVID-19 infections were widespread, the total number of emergency patient requests increased, which confirmed the development of community-based emergency medical care. At the same time, being a regional COVID-19 institution hospital, the rate of emergency refusal increased compared to 2019. A similar situation led to an increase in out-of-hospital cardiac arrests in Italy.3 Moreover, for unknown reasons, the number of operations in surgical departments, the main users of the ICUs, increased in 2020, and these patients required intensive care management. In the future, it will be necessary to ensure the prompt availability of services for emergency patients without COVID-19.
Overtime tended to be more common for doctors working in neurosurgery, cardiac surgery, and vascular surgery, where the ICUs are predominantly used. A study of the impact of such a situation on the ICU showed some surprising results compared to the situation before the spread of the COVID-19 infections in 2019.4 The number of incidents reported in our intensive care units (ICUs, RCUs) increased significantly in 2020 compared to 2019. One of the reasons for this was the inadequate management system for general critically ill patients. Intensive care for patients with COVID-19 requires special care, and medical personnel must take all possible precautions; hence, use of the ICUs for critically ill patients other than patients with COVID-19 had to be restricted due to a lack of manpower. However, the level of events was low in the majority of the cases, indicating that a minimum level of control could be maintained even in the context of a high acceptance rate of patients with COVID-19 infections.
Contrary to this result, the number of surgeries on general critical care patients increased even during the COVID-19 pandemic, reflecting the high need for critical care management and overtime hours worked by doctors. It is possible that the increase in the number of overtime hours worked by doctors was influenced by the overload of the outbreak, which was not part of the normal system of care.
Our results show that the environment in our region is quite difficult and that doctors, nurses, and other medical staff work at the limit of their abilities. However, efforts to treat other emergencies, including COVID-19 infections, cannot be stopped, and comprehensive national measures are needed to prevent the collapse of community healthcare.
The Japanese Ministry of Health, Labour and Welfare aims to reform of the way doctors work and has established a special level of overtime to manage the problem of the uneven distribution of doctors in rural areas after April 2024. However, this problem will not be solved unless the COVID-19 pandemic improves.5 In addition to working hours, it is also important to ensure special infection prevention measures for healthcare workers associated with COVID-19, especially those involved in intensive care.6 Phua et al. insisted that hospital administrators, governments, and policy makers must work with ICU practitioners to prepare for the substantial increase in critical care bed capacity and must protect healthcare workers from nosocomial transmission, physical exhaustion, and mental health issues.7
A challenge for the future is to improve the medical system and reduce the total number of incidents, even in situations where COVID-19 infections are widespread.
The northern part of Saitama Prefecture is also a depopulated medical area, but this study is limited in its generalizability of the entire area because the data was collected at a single-institution analysis. In addition, since we are comparing the effects of COVID-19 over a 2-year period, a longer observation period is needed.