Background : To evaluate the frequency and cause of return to the emergency department within 48 hours and to identify the nature of the problem. Methods : We reviewed the medical records of 76 patients who returned to the emregency department within 48 hours from September 1998 to February 1999. Results : Overall revisit rate within 48hours was 2.6%. Of 76 patients, 5(6.6%) had planned return, 64(84.2%) had unplanned return and 7(9.2%) had incomplete documentation. The causes of unplanned return were inadequate medical management (11.8%), discharge against medical advice (27.6%), return after scheduled ambulatory care (22.4%), and unavoidable revisit due to symptom aggrevation or development of new symptom (22.4%). Conclusion : The study provided a basic information for us to improve the quality of emergency care by reducing unnecessary return to the emergency department. It is necessary to monitor continuously the quality of emergency care and to develop the standard of emergency return rate.

Background : The clothing is considered as second skin. The patient clothing needs basic clothing demands which are comfortable, functional and aesthetical and special demeands which are associated with medical examination, treatment and management of daily-life inconveniences. The patient is weak and labile to psychic trauma and has limitation of movement. So the help of others is needed. But recent patient clothing does not satisfy above demands. So the design, making and management of patient clothing to satisfy those demands are very important. The purpose of this study' is to develop multipurpose clothing which is comfortable, functional, aesthetical and satisfying patients and medical personnels. Method : The questionnaires of existing patient clothing were tested by patients, medical doctors, and nurses. After analyzing two types of questionnaires, eight types of experimental patient clothing were made. After preference test, shortcomings were removed and merits were adapted. One type of multipurpose patient clothing mixing eight above experimental clothing was made. The state of wearing and moving were videotaped. The videotape-recoding was watched by patient, caregivers(medical doctors, nurses) and clothing specialists. Result : The general reaction for experimental clothing were positive by the group of patients, medical personnels and clothing specialist, there were significant differences among three groups. Conclusion : It was thought that to develop one type of multipurpose clothing is possible. If the studys for patient clothing which are free-size and economic matters that are type of clothes and method of washing are made in depth, the desirable patient clothing will appear.

Background : With the CQI concepts, which emphasize doing the right things right the first time, we tried to enhance the timely completion of medical records by changing the review process from retrospective method to concurrent one. Methods : Against the current retrospective QA activity, Medical record administrator did the concurrent QA of the inpatient medical records with the deficiency sheets. One general surgery ward was chosen as a trial one. The deficiency rate of the medical records of the discharged patients was compared before and after the enforcement of the system. Job analysis of the medical record departments was done about four tertiary care hospitals located in Seoul to estimate the cost and the time consumed by current system. Results : There was a little improvement in the completion rate of the medical records after the trial. The new system was effective. And job analysis showed that much money and time were wasted by current retrospective feedback system. Conclusion : Though the result was not so satisfactory, it should be considered that this test was a voluntary one and the interns and residents were not forced to complete the medical records during this trial period. If there be any strong motivation to complete the medical record in time, this system is sure to be succeed. As the DRG system requires the concurrent review of the medical records to confirm severity of the patient's illness and to assure the timely discharge, it is desirable to enforce this method with the DRG system together. DRG coding and reducing deficiency rate of the medical records can be accomplished simultaneously.

Background : In many university hospitals, intravenous(IV) therapies and samplings had been one of the most important works of doctors who are in training. However, recently as patient oriented care is becoming more weighted for qualified health service IV therapies should be the works of specialized personnels. This study was conducted to investigate the medical staff's perception on IV team, to survey patient or parent's expectation on IV team, and to assess the frequency of IV therapy related complications and the characteristics of phlebitis among the hospitalized children. Methods : We collected data prospectively before the start of IV team from February 22 to February 29. 1999 and from September 27 to October 3, 1999, 6 months after beginning of IV team at Seoul National University Children's Hospital. IV team started their activities from March 1, 1999. General pediatric wards were not included for the IV and sampling team and oncology ward and surgical units were all included for the IV and sampling team's work. IV specialist was the well trained nurse who had been working in the field of pediatrics especially for the oncology patients. The subjects of this study were medical staffs who were working in children's hospital as doctors in training and patients who were treated with IV therapies in children's hospital during the same period. Results : Doctors responded that IV team need to be organized for IV care and expected IV team could reduce their work load. Parents of patients also responded IV team was very improtant to perform high quality IV care. They had willingness to pay extra charge for IV team care. In the wards where IV team did not work, they used various kinds and sizes of catheters, but in the wards where IV team worked, they needed just one or two types of catheters. As the exact role of IV team is not still established, job description is needed between the IV team and medical doctors. In the aspects of medical costs. it could save the materials for the IV also. Conclusion : This study showed that IV team could increase patient's satisfaction with decrease of medical doctors work load and concomitantly could save the costs of IV materials. And for the expansion of the IV team, job description is needed and for the total care of the children IV specialist and sampling team should expand their roles.

Background : To study any interference of demonstrated in different patient satisfaction scores for the same questionnaires handled by hospital staff and by independent surveyors, respectively. Methods : This study included 728 subjects who were admitted to a university hospital from June 22 to July 1, 1999. The contents of the questionnaire were composed of six dimensions: hospital structure and process, staffs technical competence and humaneness, information & education and communication. Measurements were performed on a 5-score Likert scale. T-test and logistic regression analysis were also performed. Results : In an outpatient survey, satisfaction scores from a questionnaire delivered by hospital staff were significantly higher than independent surveyors for the dimension of communication, but no differences were shown among other dimensions. In an inpatient survey, satisfaction scores by hospital staff were higher for the process and communication dimensions(p<0.05). In particular, in both the inpatient and outpatient surveys, the difference of satisfaction scores for personnel items were significant between groups. After adjustment for age and sex those differences were significant between groups. Conclusion : To minimize the bias on questionnaire survey, the effects of personnel, who deliver and gather the questionnaire should be carefully considered in the evaluation of health service satisfaction.

Background : This study was conducted to reduce the neonatal infection rate in nursery. Methods : 50 items, structural problems in NICU were selected by open questionnaire and categorized into 11 similar items. 38 items were picked out among them and then categorized into 6 similar items. We carried out quality improvement focusing around 6 items. Results : The high achievement of goal in CQI Activities was shown in hand washing for reducing infection of NICU after July. The local infection in IV site was not found and hand washing and gowning of protectors were achieved by 100%. Conclusion : Neonatal infection rate was reduced through the quality improvement activities, but structural problem of Hospital still remained.

Background : Although a number of studies are related to QA improvement, there are few studies applied various method of QA tools. This study reviewed the availability of general quality assurance(QA) tools according to ten steps in performing quality improvement activities at emergency room of a tertiary teaching hospital which has more than 1,000 beds. Methods : All patients in emergency room from 15th Oct. 1997 to 5th Sep. 1998 were surveyed. The survey data based on the patient's records of emergency room were evaluated according to length of stay, and we tried to identify problems with management of emergency room. To solve the problems, our team applied general QA tools(brainstorming, flow chart, nominal group technique, benchmarking, cause-and-effect diagram, run chart, control chart) to quality improvement activities and discussed the availability of the tools. Results : After the activities such as changes of staffing, the establishment of local area network and chest pain clinic, application of triage and so on, the percentage of patient who had stayed more than six hours was reduced from 56.0% to 46.8%. The mean number of patients per day in emergency room was increased from 49 to 62. But the reporting time for laboratory test was not changed after these activities. Conclusion : Each QA tool has unique benefit and limitation, but we can implement and evaluate the quality improvement activities more scientifically and systematically by applying these tools to practice according to QA ten steps.

Background : Because hospitals had to faced with financial hardship, we have to have more effective hospital management. In this study, we tried to improve job performance and to reduce cost maintaining safety in fields of patients care. Methods : Central Supply Room(CSR) staffs taught strategy of material cost reduction to middle level managers and staffs 14 times. All staffs and voluntary service workers, working in 33 nursing units, participated in this activity. We developed questionnaire to check the degree of participate in cost reduction activity and job performance in CSR, and quality improvement in the wards. Two hundred questionnaires were distributed and 197 returned. Results : Because CSR staffs developed new items and every item was managed at each department, stocks of each department were reduced. Overall, by comparing before and after cost reduction activity, almost 1.2 billion won reduced for one year. Staffs' loyalty and spirits of cost reduction were improved by changing clothes and duty environment. Furthermore, these activity improved patients' satisfaction. Conclusion : We suggest that CSR activity in a university hospital contributes to improve job performance and to reduce cost without any problem in patient care.