• Korea Journal of Hospital Management
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• v.10 no.2
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• pp.64-80
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• 2005

The objectives of this study were to identify factors associated with unexpected revisit to an emergency medical center (EMC) located in Seoul and to examine reasons for revisit. During March, June, September and December, 2002, a total of 168 patients had unexpected revisits to the EMC within 48 hours of a previous discharge. As a 1:1 matched control, we included 136 patients who: discharged from the EMC during the same time period: did not return to the EMC; had the same diagnosis and age(${\pm}5$) with the case. In this study, factors associated with unexpected revisits were defined as characteristics of a previous discharge, which were classified into three: sociodemographic, EMC visit-related, and discharge management factors. Reasons for revisit were categorized into disease, physician, patients, and system-related factors. Data were collected by medical chart review with assistance from clinicians of the EMC. Logistic regression results showed that patients who headed home after discharge without follow-up schedule had a 27.6 times higher risk of revisiting EMC than those who were hospitalized following EMC visit. Patients discharged on his own will had a 5.9 times higher risk of revisiting than those discharged following physician's advice. Patients requiring continual observation at the time of discharge were more likely to revisit by 8.7 times than those discharged with improved condition. About 69.13% of the revisits were due to disease-related factors, followed by 13.90% due to patient-related factors, 8.64% due to system-related factors, and 8.34% due to physician-related factors. It appears that the most significant factors influencing revisits are discharge management factors such as patient's condition at discharge, whether the discharge was accorded with physician's advice, and whether returning home without follow-up schedule. Therefore, appropriate discharge management is necessary to prevent EMC revisit.

• Journal of the Korea Society for Simulation
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• v.18 no.3
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• pp.35-45
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• 2009

Emergency medical center(EMC) is the place for patients who need medical treatment immediately due to a disease, childbirth, or all sorts of accidents. Currently, most of EMCs use temporary beds because regular EMC beds cannot afford to serve all incoming patients. However, since it decreases the quality of service(QoS) of EMC patients and their guardians and efficiency of the EMC, some improvements are highly required to diminish the usage of temporary beds. The system duration time is one of the typical QoSs. This thesis proposes the information which is critical to make a better decision for cut down the number of temporary beds without sacrificing QoS of patients. The key point is to control the duration time of medical treatments for the consultation and hospitalization process, since it is the major reason of overcrowding in EMC and the usage of temporary beds. In this paper, we proposed an Arena simulation model reflecting real world substantially. Arena is one of the most widely accepted simulation softwares in the world. Using the developed model, we can obtain the optimal EMC operation parameters through simulation experiments. Optquest, included in the Arena, is used to make the developed simulation model collaborate with an optimization model. The results showed one can determine the set of optimal operation parameters decreasing the required number of temporary beds without deteriorating EMC patient's QoS.

• Journal of Home Health Care Nursing
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• v.17 no.1
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• pp.21-27
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• 2010

Purpose: The study evaluated a program to shorten EMC stay time. Methods: The subjects were EMC patients, and comprised a control group of 8,477 and an experimental group of 8,378. Data were collected from June 2006 to August 2007, and analyzed concerning stay time for doctor visit, decision making, and discharge. The data were analyzed by $X^2$-test and ANCOVA using SPSS14.0. Result: The stay time of doctor visit, decision making and discharge of the experimental group was significantly less compared to the control group. Using second and third grade triage criteria, the stay time of experimental group was statistically reduced from the control. Conclusion: The implemented shortening program was effective in reducing EMC stay time and increasing EMC effectiveness.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.6 no.3
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• pp.522-531
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• 1999

This research identifies the ingress to egress primary factors that causes a patient to receive delayed emergency medical care. This material was collected between February 1st to 28th, 1998. Research envolved 4,118 people who visited the college emergency medical center in Kyeongido Province, South Korea. Medical records were examined, using the retrospective method. to determine the length of stay and the main cause for waiting. Results are as follows : 1. The age group with the highest admission rate was 10 and under, approximately 1,394 (33.9%). Followed by an even distribution for ages between 11-50 at 10-15% for their respective ranges. The lowest admission rate was 50 years and above. 2. From the 4,118 records examined, 3,489 received outpatient treatment (84.7%); 601 were admitted for inpatient care (14.6%); 25 arrived dead on arrival (0.6%); and 4 people died at the hospital. 3. Between 7PM to 12AM, 42.9% were admitted to the EMC. The hours from 9PM to 11PM recorded the highest admission rate and 5AM to 8AM was the lowest From 8PM to 12AM, the most beds were occupied. 4. For most patients. the average length of stay was approximately 2.2 hours. By medical department, external medicine was the longest for 2.8 hours. Pediatrics was the shortest for 1.6 hours. The average waiting period for inpatient admission was 2.6 hours. Inpatient admission for pediatrics and external medicine was 3.4 hours and 2.2 hours respectively. 5. Theses are primary factors for delay at EMC: 1) pronged medical consultations to decide between inpatient versus outpatient treatment, and delaying to be inpatient, 2) when you call physicians they are delayed to come 3) Understaffing during peak or critical hours, 4) Excessive consulting with different medical departments, 5) some patients require longer monitoring periods, 6) medical records are delayed in transit between departments, 7) repeated laboratory tests make delay the result, 8) overcrowded emergency x-ray place causes delay taking x-ray and portable x-ray, 9) the distance between EMC and registration and cashier offices is too far. 10) hard to control patient's family members. The best way to reduce EMC waiting and staying time is by cooperation between departments, both medical and administrative. Each department must work beyond their job description or duty and help each other to provide the best medical service and satisfy the patient needs. The most important answer to shortened the EMC point from ingress to egress is to see things from a patient point of view and begin from there to find the solution.

• Journal of Home Health Care Nursing
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• v.18 no.2
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• pp.81-87
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• 2011

Purpose: The aim of this study was to estimate optimization model of stay time in EMC. Methods: Data were collected at an EMC in a hospital using medical records from June to August in 2007. The sample size was 8,378. The data were structured by stay time for doctor visit, decision making, and discharge from EMC. Descriptive statistics were used to find out general characteristics of patients. Average mean and quantile regression models were adopted to estimate optimized stay time in EMC. Results: The stay times in EMC were highly skewed and non-normal distributions. Therefore, average mean as an indicator of optimal stay time was not appropriate. The total stay time using conditional quantile regression model was estimated about 110 min, that was about 166 min shorter than estimated time using average mean. Conclusion: According to these results, we recommend to use a conditional quantile regression model to estimate optimal stay time in EMC. We suggest that this results will be used to develop a guideline to manage stay time more effectively in EMC.

• Korean Journal of Clinical Pharmacy
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• v.30 no.3
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• pp.206-208
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• 2020

An 80-year-old Korean woman who previously experienced penicillin allergy presented to a dental hospital for treatment of a fractured tooth. A dentist extracted the tooth and prescribed her A-cillin (amoxicillin hydrate) 250 mg orally 3 times a day for 3 days and Carol-F^® (ibuprofen arginine) orally 3 times a day for 3 days. She received the prescriptions, returned home, and took one dose of each drug. One hour later, she experienced hypertension, itching, shortness of breath, and was unable to move her tongue to pronounce words. Approximately 6 hours after drug administration, the symptoms persisted, and the patient was admitted to an emergency medical center (EMC). The patient was discharged from the EMC after a one-night stay in the hospital for symptomatic treatment.