Otolaryngology Involvement in Emergency Care for Dizziness During the 2024 Korean Resident Physician Workforce Disruption and Subsequent Return: A Single-Center Retrospective Study.

Background/

Objectives

We used dizziness as a tracer condition to describe documented emergency-care changes during resident physician workforce disruption and return, and whether greater diagnostic intensity was accompanied by greater diagnostic yield.

Methods

This single-center retrospective observational study compared two 13-month periods: no-resident (February 2024-February 2025) and resident-return (March 2025-March 2026). Registry data for all 1652 eligible emergency department (ED) dizziness visits provided primary treating department, an administrative department-of-record field, disposition, and length of stay. Detailed chart review was limited to patients with a formally documented otorhinolaryngology (ENT) consultation. Monthly staffing and on-call coverage came from duty rosters, and brain MRI reports were classified by clinical relevance. No causal inference was intended.

Results

Dizziness represented a similar proportion of ED visits across periods (5.9% vs. 5.4%; rate ratio [RR], 0.91; p = 0.061). Formally documented ENT consultation increased from 26/667 (3.9%) to 186/985 (18.9%; RR, 4.84; p < 0.001), although ENT on-call coverage was recorded throughout and combined attending/fellow staffing declined from nine to six. Neurology department-of-record decreased from 24.7% to 13.0% and otolaryngology increased from 3.3% to 17.7% (both p < 0.001), while overall admission remained stable (24.1% vs. 23.9%; p = 0.896). Crude hospital length of stay decreased from 4.68 to 3.51 days (p = 0.002), but not after otolaryngology admissions were excluded (4.68 vs. 5.54 days; p = 0.208), indicating a case-mix effect. Among ENT-consulted patients, MRI utilization increased from 57.7% to 95.7% (p < 0.001); 1/192 classifiable studies showed an acute central lesion (0.5%) and 7 (3.6%) incidental lesions. Dizziness-specific revisits did not differ at 72 h or 30 days.

Conclusions

Documented consultation, imaging, and administrative departmental attribution changed markedly, whereas dizziness burden, overall admission, and short-term revisits remained stable. Differential documentation plausibly explains a substantial part of the consultation difference, which measures documented rather than actual specialist involvement, and greater imaging intensity was not accompanied by greater acute diagnostic yield. These descriptive findings do not establish that care became better, safer, or more accurate.