Effects of a Sequential Transfer System for Patients with Drug Overdose in an Emergency Department of a University Hospital in Busan

Background: Among Organization for Economic Co-operation and Development (OECD) countries, Korea has the highest suicide rate, with drug overdose being a major method.In metropolitan areas, transfer delays persist because of staff shortages and emergency department (ED) overcrowding.To address this, a sequential system was introduced in Busan on September 1, 2020, designating university hospital EDs to alternately receive patients suffering from drug intoxication.Methods: This retrospective study analyzed adult patients (18 years) who presented with drug intoxication to a university hospital ED between September 2017 and August 2023.Patients were divided into pre-implementation (September 2017-August 2020) and post-implementation (September 2020-August 2023) groups.Demographics, clinical outcomes, and transfer indicators were compared.Results: A total of 1,276 patients were included.Following the implementation, the mean age decreased (p=0.007), and the number of mild cases increased (p<0.001).The length of stay in the ED was significantly longer (p=0.035);however, the discharge type and mortality showed no differences.The average time for hospital selection shortened from 36 minutes to 6 minutes, delayed transfers decreased from 57 to 0, and intercity transfers declined from 19 to 1. Conclusion: The sequential system did not alter mortality but effectively reduced transfer delays and improved emergency resource utilization.The increase in mild case presentations to tertiary hospitals indicates a need for improved triage and referral systems.