title: The impact of the SARS outbreak on an urban emergency department in Taiwan.
abstract: OBJECTIVE
  Emergency departments (ED) were on the front lines for possible cases of transmission during the severe acute respiratory syndrome (SARS) epidemic. The purpose of this study was to investigate the impact of the SARS catastrophe on an urban ED.
  
  
  METHODS
  The patients' characteristics in an urban ED were collected from March to May 2003 during the SARS outbreak in Taiwan. The crisis period was divided into 2 periods: 30 days before (period 1) and after (period 2) April 21, the date of the first hospital-associated transmission. Problem severity in the ED and stress levels of ED staff during the SARS catastrophe were rated from mild (1 point) to severe (5 points).
  
  
  RESULTS
  The number of ED patients declined 33.4% in period 2. There was a 2.1% (95%CI, 0.4-3.8) increase in the percentage of male patients, a 2.5% (95% CI, 1.5-3.7) increase in percentage of fever (>38 degrees C), and a 4.0% (95% CI, 2.6-5.4%) increase in chief complaint of fever in period 2. The number of nontrauma patients younger than 18 years had declined by 44.5% in period 2. The total charge for reimbursement from an insurance institution declined 21.7%. During the SARS outbreak, the most severe stress experienced by either physicians or nurses occurred during emergency resuscitation (median stress rating point, 4; interquartile range, 1).
  
  
  CONCLUSIONS
  The SARS catastrophe affected the ED visit volume, finances, various patient characteristics, and stress levels in the ED physicians and nurses. EDs must be fully prepared to face the challenges of the next outbreak of SARS or other infectious disease.
authors.affiliation: Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan. ercwk@www.cmuh.org.tw
authors.forename: Wei-Kung
authors.initials: WK
authors.lastname: Chen
authors.forename: Yi-Chang
authors.initials: YC
authors.lastname: Cheng
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Chung
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Lin
mesh_terms: D000328:Adult; D002648:Child; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004196:Disease Outbreaks; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D017048:Health Care Costs; D006281:Health Occupations / Q000193:education; D006801:Humans; D010342:Patient Acceptance of Health Care; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology; D019037:Urban Health Services