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Original Articles
- Epidemiology
- Impact of medical crisis on the critical care system in South Korea
- Ye Rim Chang, Jae Hwa Cho, Joongbum Cho, Tae Sun Ha, Bo Gun Kho, Eunhye Kim, Im-kyung Kim, Dong Hyun Lee, Suk-Kyung Hong
- Acute Crit Care. 2025;40(3):393-401. Published online August 21, 2025
- DOI: https://doi.org/10.4266/acc.000575
- 6,585 View
- 133 Download
- 5 Web of Science
- 5 Crossref
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Abstract
PDF
Supplementary Material - Background
The ongoing medical crisis in Korea has severely impacted the operational environment of intensive care units (ICU), posing significant challenges to quality care for critically ill patients. This study aimed to evaluate the effects of the ongoing crisis on ICUs.
Methods
A survey was conducted in July 2024 among intensivists in charge of ICUs at institutions accredited by the Korean Society of Critical Care Medicine for critical care. The survey compared data from January 2024 (pre-crisis) and June 2024 (post-crisis) on the number ICU beds, staffing composition, work hours, and the number and roles of nurse practitioners.
Results
Among the total of 71 participating ICUs, 22 experienced a reduction in the number of operational beds, with a median decrease of six beds per unit, totaling 127 beds across these ICUs. The numbers of residents and interns decreased from an average of 2.3 to 0.1 per ICU, and the average weekly working hours of intensivists increased from 62.3 to 78.8 hours. Nurse practitioners helped fill staffing gaps, with their numbers rising from 150 to 242 across ICUs, and their scope of practice expanded accordingly.
Conclusions
The medical crisis has led to major changes in the critical care system, including staffing shortages, increased workloads, and an expanded role for nurse practitioners. This is a critical moment to foster interest and engage in active discussions aimed at creating a sustainable and resilient ICU system. -
Citations
Citations to this article as recorded by
- Resident Physician Walkout and High-Incidence Cancer Operation Volumes in South Korea
Chanseok Son, Jaehun Jung, Hyejin Joo
JAMA Network Open.2026; 9(3): e260697. CrossRef - Changes in American Society of Anesthesiologists Physical Status Distribution and Prognostic Performance During the 2024 South Korean Healthcare Crisis: A Large-Scale Retrospective Cohort Study
Chan-Sik Kim, Sang-Wook Lee
Journal of Clinical Medicine.2026; 15(11): 4261. CrossRef - Changes in Patient Characteristics and Early Clinical Outcomes Among Emergency Department–Admitted Inpatients During the 2024 Medical Workforce Crisis in South Korea
Yeon Joo Lee, Sung Woo Moon
Journal of Clinical Medicine.2026; 15(12): 4804. CrossRef - Changes in Health Care Utilization and Costs During the 2024 Medical Strike in Korea: Evidence From a Specialty-Level Analysis
Hyangmi Kim, Joon Young Kim
Asia Pacific Journal of Public Health.2026;[Epub] CrossRef - From trauma surgery to acute care surgery: a 4-year observational study at a single trauma center in Korea
Jung-Woo Woo, Jae Yool Jang, Yo Seok Cho, Hongkyung Shin, Chan Yong Park
Journal of Trauma and Injury.2025; 38(4): 382. CrossRef
- Resident Physician Walkout and High-Incidence Cancer Operation Volumes in South Korea
- Ethics
- The quality of dying and death for patients in intensive care units: a single center pilot study
- Yanghwan Choi, Myoungrin Park, Da Hyun Kang, Jooseon Lee, Jae Young Moon, Heejoon Ahn
- Acute Crit Care. 2019;34(3):192-201. Published online April 8, 2019
- DOI: https://doi.org/10.4266/acc.2018.00374
- 13,467 View
- 210 Download
- 21 Web of Science
- 19 Crossref
-
Abstract
PDFSupplementary Material
- Background
To identify the necessary care for dying patients in intensive care units (ICUs), we designed a retrospective study to evaluate the quality of dying and death (QODD) experienced by the surrogates of patients with medical illness who died in the ICU of a tertiary referral hospital.
Methods
To achieve our objective, the authors compared the QODD scores as appraised by the relatives of patients who died of cancer under hospice care with those who died in the ICU. For this study, a Korean version of the QODD questionnaire was developed, and individual interviews were also conducted.
Results
Sixteen people from the intensive care group and 23 people from the hospice care group participated in the survey and completed the questionnaire. The family members of patients who died in the ICU declined participation at a high rate (50%), with the primary reason being to avoid bringing back painful memories (14 people, 87.5%). The relatives of the intensive care group obtained an average total score on the 17-item QODD questionnaire, which was significantly lower than that of the relatives of the hospice group (48.7±15.5 vs. 60.3±14.8, P=0.03).
Conclusions
This work implies that there are unmet needs for the care of dying patients and for the QODD in tertiary hospital ICUs. This result suggests that shared decision making for advance care planning should be encouraged and that education on caring for dying patients should be provided to healthcare professionals to improve the QODD in Korean ICUs. -
Citations
Citations to this article as recorded by- Development and external validity of a nurse-led intervention program to improve palliative care and quality of dying and death in intensive care unit
Kazuaki Naya, Hideaki Sakuramoto, JONATHAN BAYUO
PLOS One.2026; 21(4): e0346585. CrossRef - Analysis of the quality of dying and death in end-stage intensive care unit patients in China: A single-center cross-sectional study
Peng Zhao, XiaoYan Chen, Yi Wang, JiaYuan Feng, Wei Deng, HuaYing Li
Medicine.2026; 105(18): e48560. CrossRef - Development, Translation, and Validation of the Japanese Quality of Dying and Death Questionnaire for Families of ICU Patients
Kazuaki Naya, Hideaki Sakuramoto, Yuki Kuroiwa, Rika Hamano, Chihiro Kawaguchi, Hina Yamamoto, Wakana Sugihara, Kyoka Horita, Ami Nakaue, Hiromi Iwashita
Cureus.2025;[Epub] CrossRef - A Critical Care Physician’s Perspective on the Care Process and Death of a Terminal Cancer Patient
Jae Young Moon
Korean Journal of Medical Ethics.2025; 28(1): 9. CrossRef - Factors Associated with Time to Change of Resuscitation Code (Do-Not-Resuscitate) and Time to Death after a Stroke: Palliative Aspects from a Tertiary Center
Melissa Correia, Léon von Fournier, Markus Schettle, Giovanna Brandi, David Blum, Susanne Wegener, Caroline Hertler
European Neurology.2025; 88(3-4): 113. CrossRef - Developing Kano’s model of customer satisfaction-driven intensive care unit end-of-life care strategies for gastrointestinal cancer patients
Peng Zhao, Li Miao, Guang-Jing Fu, Jia-Yuan Feng, Wei Deng, Hua-Ying Li
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef - End-of-life care among Koreans in critical care and community-dwelling Korean Americans: A cross-cultural scoping review
Soo Hyun Kim, Changhwan Kim, Erh-Chi Hsu, Zackary Berger, Hae-Ra Han, Binu Koirala, Jung Kwak, Katherine A. Ornstein, Rebecca Wright
Palliative and Supportive Care.2025;[Epub] CrossRef - Recent Trends in the Withdrawal of Life-Sustaining Treatment in Patients with Acute Cerebrovascular Disease : 2017–2021
Seung Hwan Kim, Ji Hwan Jang, Young Zoon Kim, Kyu Hong Kim, Taek Min Nam
Journal of Korean Neurosurgical Society.2024; 67(1): 73. CrossRef - Family Members’ Feedback on the “Quality of Death” of Adult Patients Who Died in Intensive Care Units and the Factors Affecting the Death Quality: A Systematic Review and Meta-Analysis
Kazuaki Naya, Hideaki Sakuramoto, Gen Aikawa, Akira Ouchi, Shun Yoshihara, Yuma Ota, Saiko Okamoto, Ayako Fukushima, Haruyoshi Hirashima
Cureus.2024;[Epub] CrossRef - Factors associated with the quality of dying and death and missed nursing care
Shahin Gahramani, Mokhtar Mahmoudi, Nouri, Sina Valiee
International Journal of Palliative Nursing.2024; 30(4): 190. CrossRef - Bereaved family members’ perspectives on quality of death in deceased acute cardiovascular disease patients compared with cancer patients – a comparison of the J-HOPE3 study and the quality of palliative care in heart disease (Q-PACH) study
Takahiro Suzuki, Mitsunori Miyashita, Takashi Kohno, Jeffrey Rewley, Naoko Igarashi, Maho Aoyama, Michiaki Higashitani, Naoto Kawamatsu, Takeshi Kitai, Tatsuhiro Shibata, Makoto Takei, Kotaro Nochioka, Gaku Nakazawa, Hiroki Shiomi, Shigeru Tateno, Toshihi
BMC Palliative Care.2024;[Epub] CrossRef - Intensive care unit interventions to improve quality of dying and death: scoping review
Kazuaki Naya, Hideaki Sakuramoto, Gen Aikawa, Akira Ouchi, Yusuke Oyama, Yuta Tanaka, Kentaro Kaneko, Ayako Fukushima, Yuma Ota
BMJ Supportive & Palliative Care.2024; 14(e2): e1689. CrossRef - Associations between palliative-care consultations and end-of-life quality in cancer patients’ last 6 months
Shan Ting Chen, San Chi Chen, Hsing Jung Lee, Chen Hsiu Chen
Supportive Care in Cancer.2024;[Epub] CrossRef - Quality of dying and death in intensive care units: family satisfaction
Fur-Hsing Wen, Ming Chu Chiang, Chung-Chi Huang, Tsung-Hui Hu, Wen-Chi Chou, Li-Pang Chuang, Siew Tzuh Tang
BMJ Supportive & Palliative Care.2023; 13(e3): e1217. CrossRef - Development of an End-of-Life Nursing Care Protocol for Intensive Care Units
Jungeun Kim, Hye Young Yun, Euni Ji Kim, Hyunsook Kim, Geon Ah Kim, Sung Ha Kim, Jayoung Koo, Ju Youn Park, Aisoon Park, Eugene Han, So Yeon Kim, Jihye Jeong, Sanghee Kim
Journal of Hospice & Palliative Nursing.2022; 24(4): E159. CrossRef - Nurses’ perceptions of barriers and supportive behaviors in end-of-life care in the intensive care unit: a cross-sectional study
Dan-dan Xu, Dan Luo, Jie Chen, Ji-li Zeng, Xiao-lin Cheng, Jin Li, Juan-juan Pei, Fen Hu
BMC Palliative Care.2022;[Epub] CrossRef - The Quality of Dying and Death of Advanced Cancer Patients in Palliative Care and Its Association With Place of Death and Quality of Care
Daniel Gutiérrez-Sánchez, Rafael Gómez-García, María Luisa Martín Roselló, Antonio I. Cuesta-Vargas
Journal of Hospice & Palliative Nursing.2021; 23(3): 264. CrossRef - The Role of Anesthesiologists in Perioperative Limitation of Potentially Life-Sustaining Medical Treatments: A Narrative Review and Perspective
Tera Cushman, David B. Waisel, Miriam M. Treggiari
Anesthesia & Analgesia.2021; 133(3): 663. CrossRef - Decision-Making Processes in Surrogates of Cancer Patients in a Taiwan Intensive Care Unit
Wan-Na Sun, Hsin-Tien Hsu, Nai-Ying Ko, Yu-Tung Huang
International Journal of Environmental Research and Public Health.2020; 17(12): 4443. CrossRef
- Development and external validity of a nurse-led intervention program to improve palliative care and quality of dying and death in intensive care unit
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