• 한국병원경영학회지
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• 제spc호
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• pp.1-13
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• 2016

In a situation where competition becomes intense, health care organizations constantly strive to provide more services with given personnel and time. While not only the 'quantity' of the services but also the 'quality' becomes increasingly important, various problems that can occur during the 'process' of service provision can be effectively managed by applying the methods of management science. In this study, we introduce the cases where the methods of management science can be applied for the management of health care organizations in Korea and abroad. There are many cases where various scenarios for improving the patients' accessibility to the services and for maximizing the efficient use of limited resources are established, and simulation or basic statistical analysis methods are used to solve the problems more systematically or to develop improvement plans. In this study, several exemplary cases, such as no-show of patients, crowding in the emergency room, prediction of the number of available beds in the intensive care units, nurse scheduling, delay of arrival of patients, and ordering of the proper amount of therapeutic materials, are introduced and discussed. From the perspective of administrators or clinicians, however, it may not be easy to master the methodology that requires considerable mathematical background or apply the theories to practice directly. Therefore, it is suggested that more practical and relatively simple analytical methods should be applied. Also, having a more positive attitude toward improving the current performance (e.g., a belief that 'we can always be better than now'), and paying attention to improving the job satisfaction by addressing problems, with experimental spirit and data-driven decision management.

• Clinical and Experimental Emergency Medicine
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• 제5권4호
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• pp.272-277
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• 2018

Objective While the effect of typhoons on emergency medicine has been evaluated, data are scarce on their effects on the emergency medical service (EMS). This study evaluated the effect of typhoons on EMS patients and performance. Methods The study period was January 2010 to December 2012. Meteorological data regarding typhoons were provided by the Korean Meteorological Administration. EMS data were retrieved from the EMS database of the national emergency management agency. The database includes ambulance run sheets, which contain clinical and operational data. In this case-crossover study, the cases and controls were EMS calls on the day of typhoon warnings and calls one week prior to the typhoon warnings, respectively. Results During the study period, 11 typhoons affected Korea. A total of 14,521 cases were selected for analysis. Overall, there were no obvious differences between the case and control groups. However, there were statistically significant differences in age, place, and time requests. There were fewer patients between 0 and 15 years of age (P=0.01) and more unconscious patients (P=0.01) in the case group. The EMS operational performance, as measured by the times elapsed between call to start, call to field, and call to hospital did not differ significantly. There was also no significant difference in the time from hospital arrival between the cases (28.67, standard deviation 16.37) and controls (28.97, standard deviation 28.91) (P=0.39). Conclusion Typhoons did not significantly affect the EMS system in this study. Further study is necessary to understand the reasons for this finding.

• Journal of Trauma and Injury
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• 제21권2호
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• pp.78-84
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• 2008

Purpose: Recently, the incidence of blast injury has been on the increase worldwide. The purpose of this study was to evaluate and analyze blast injuries in South Korea. Methods: This was a retrospective multi-center study of blast injuries in three tertiary military centers. The medical records of patients with blast injuries from January 2003 to December 2007 were reviewed. The injury severity was evaluated according to the Injury Severity Score (ISS), the Revised Trauma Score (RTS), and the Trauma Score and the Injury Severity Score (TRISS). Results: This study revealed epidemiological data of blast injury in the three tertiary military hospital. A total of 94 cases of blast injury had occurred. Various body regions were involved. The most frequently injured site was the upper extremity (52.1%). The mechanisms for the blast injuries were primary (41.5%), secondary (74.5%), tertiary (7.4%), and quaternary (29.8%). The mean injury-to-hospital arrival time was $3.2{\pm}1.7hour$. The rate of admission was 88.3%, and the rate of ICU admission was 32.5%. Thirty-six (36) cases required an emergency operation. Most were performed by an Orthopedist (55.6%), an Ophthalmologist (19.4%), or a general surgeon (13.9%). The mortality rate from blast injury was 4.3%. Conclusion: This was the first paper to present data on the type of injury, the site of injury, the cause of death, and the mortality from blast injury in South Korea. Chest injury, brain injury, tertiary injury mechanisms, $ISS{\geq_-}16$, and a Maximal Abbreviated Injury Scale Score $(ABI){\geq_-}4$ were significantly associated with death.

• 한국의료질향상학회지
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• 제21권2호
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• pp.12-24
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• 2015

Purpose: The need for the rapid evaluation and treatment of emergency department patients with major trauma is essential. A computerized physician order entry (CPOE) system can improve communication and provide immediate access to information with the goal of reducing ED time delays. The aim of this study was to report on the operation of a trauma CPOE program and demonstrate its usefulness by comparing time intervals from ED arrival to various evaluation steps before and after implementation of the program. Methods: This was a before-and-after observational study from a single emergency department at an academic center. The CPOE program was implemented for 6 months and compared with the data collected from the pre-CPOE implementation period. The efficacy of the program was assessed by comparing the time difference before and after CPOE implementation based on the following factors: total boarding time in ED, door-to-disposition decision time, door-to-blood-test report time, door-to-X-ray time, door-to-CT time, and door-to-transfusion time. Results: Over a period of 6 months, the CPOE was activated for a total of 17 patients. Total boarding time was reduced significantly after implementation [median, 641.5 minutes (IQR, 367.3-859.3) versus289.0 minutes (IQR, 140.0-508.0) for pre-CPOE vs. post-CPOE, respectively, p< 0.05). Time intervals for all evaluation steps were reduced after implementation of the program. The improvements in the door-to-blood-test and door-to-CT times were both statistically significant. Conclusion: This study demonstrated that a standard CPOE system can be successfully implemented and can reduce ED time delays in managing trauma patients.

• Journal of Chest Surgery
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• 제45권4호
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• pp.230-235
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• 2012

Background: Although patients with a ruptured abdominal aortic aneurysm (RAAA) often reach the hospital alive, the perioperative mortality is still very high. We retrospectively reviewed thirty patients who underwent repair of RAAA to identify the factors affecting postoperative mortality in a single hospital. Materials and Methods: Between September 2007 and May 2011, thirty patients with RAAA underwent emergent surgery (n=27) or endovascular aneurysm repair (n=3). Their medical records were retrospectively reviewed regarding three categories: 1) preoperative patient status: age, gender, vital signs, serum creatinine, blood urea nitrogen, hematocrit, and hemoglobin level: 2) aneurysmal status: size, type, and rupture status; and 3) operative factors: interval time to operating room, operative duration, and amount of perioperative transfusion. Results: The 30-day postoperative mortality rate was 13.3% (4/30); later mortality was 3.3% (1/30). On multivariate analysis, the initial diastolic blood pressure (BP), interval time to operating room and amount of preoperative packed cell transfusion were statistically significantly linked with postoperative mortality (p<0.05). Conclusion: In this study, preoperative diastolic BP, preoperative packed cell transfusion amount and interval time between arrival and entry to operating room were significantly associated with postoperative mortality. It is important to prevent hemorrhage as quickly as possible.

• 대한안전경영과학회지
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• 제17권1호
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• pp.45-52
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• 2015

The purpose of this investigation is to enhance the survival rate of patients by transporting them to the hospital within the golden hour through the operational improvement of emergency dispatch instruction. To this end, problems and improvements of current operating system were derived by carrying out a survey against paramedics of Incheon city in 2012 and analyzing the current emergency dispatch instruction. This study analyzed the emergency activity daily reports for one year from January 1 through December 31, 2012 and researched the consciousness of 119 emergency medical technician. According to the analysis of the survey, there were no meaningful differences in the on-site arrival times per triage. Therefore, the item of 'Emergency Classification' specified in the emergency dispatch instruction needs to be integrated in the scheme of "triage". Also, the feedbacks of the emergency action log and the emergency dispatch instruction are necessary for 'duty for operation' to review the adequacy to the severity after the end of emergency operation. Finally, the improvement of the system for the continuous communication between the paramedics and the command staff is necessary. This improvements as stated above are expected to contribute to raise survival rate of patients.

• 대한한의학회지
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• 제20권4호
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• pp.50-61
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• 2000

This study on the visits of the oriental medical night clinic of patients, was made to be used as reference data by examining and analyzing statistically the many actual conditions of patients who had been visited in Semyung University Attached Oriental Medical Hospital during the period from April, 1998 to March, 1999. The purpose of this survey was to understand the characteristics of patients, to evaluate the roles of Night Clinic of oriental medical hospital, and contribute to the systemic and efficient management of night clinic service. The results obtained were as follows: I. Distribution of sex: male 53% (421 cases), female 47% (379 cases) 2. The age distribution of patients showed the highest in under ten, followed by the thirties and fifties, forties and twenties in order. 3. The monthly distribution of patients showed the highest in October 1998, followed by May 1998 and February 1999 in order. 4. The daily distribution of patients showed the highest in Sunday, followed by Saturday, Monday, Friday and Tuesday in order. 5. The regional distribution revealed the highest in Jecheon with 76% of all patients, followed by Danyang in order. 6. The distribution of arrival time showed the highest in 7:00 pm～0:00 am (27%), followed by 5:30 pm～7:00 pm (23%) in order. 7. The admission rate in patients was 17%. Among them direct visiting rate was 85%. Circulatory systemic disease was the highest. 8. The highest incidences by disease were of motor system with 48% (394cases), followed by diseases in circulatory system with 19% (l48cases). The majority of the patients 67% was connected with two diseases. 9. The chief complaint of pediatric diseases was febrile seizure with 64% (32cases), digestive disease was abdominal pain with 44% (90cases), circulatory diseases was motor disturbance with 43% (83cases), motor system disease was leg pain with 37% (l19cases), respiratory disease was fever with 46% ( 41 cases). 10. In the treatment method, a major portion of treatment methods was acupuncture treatment with 32% (373cases), followed by acupuncture & herbal medicine treatment with 23% (275cases). The most commonly used herbal medicines were Hangsapyunguisan(l6%) and Ojeoksan(l4%).

• 대한임상독성학회지
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• 제3권1호
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• pp.22-26
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• 2005

The majority of acute toxic poisoning occur via oral route. The most important emergency treatment of acute poisoning are gastric lavage. Gastric lavage should be considered a patient has ingested a potentially life-threatening amount of a poison and the procedure can be undertaken within 60 mins of ingestion. But, gastric lavage does not consist properly in the cases of emergency situation or an inexperienced doctors treat. The purpose of this study was to determine whether gastric lavage is performed properly. Eighty patients were enrolled in the study in 12-month period from January to December 2002. A retrospective chart review was performed on patients identified as drug overdose who admitted to ER. To assess whether there was a subgroup of patients who may have been candidates for the initiation of gastric lavage in the ER, the patients divided in two groups by time interval from toxin ingestion to ER arrival. The group 1 that admit within 60 minutes after drug ingestion was 38 cases ($47.5\%$), and the group 2 patient who admitted after 60 minutes was 42 cases ($52.5\%$). The average age was $44\pm19$ years in group 1, and $48\pm24$ years in group 2. There were no differences in sexual distribution of two groups. The mean time interval was $49\pm20$ minutes in the group $1,258\pm190$ minutes in the group 2. Only thirty ($37.5\%$) of the patients had an overdose for which the treatment of gastric lavage was potentially feasible according to guideline. The correctly performed gastric lavage was 18 ($47.4\%$) in group 1, 12 ($28.6\%$) in group 2. We must enforce education about the gastric lavage, and do so that may treat according to guideline.

• 한방재활의학과학회지
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• 제23권3호
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• pp.177-186
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• 2013

Objectives This study is to evaluate the current situation of Russian tourists for medical tourism of Spine Specialty Korean Medicine Hospital. Methods 133 Russian tourists visiting Spine Specialty Korean Medicine Hospital from January 1, 2012 to December 31, 2012, were analysed in the statistics. Their data was sourced from the computerized medical records. And 87 of them answer a questionnaire about reasons for selection of Spine Specialty Korean Medicine Hospital and satisfactory for medical service. Results A total of 133 Russian visited Spine Specialty Korean Medicine Hospital for medical service, consisting of 73 females (54.8%), the fourties to fifties 58.9% by age. They avoided visiting in the winter. The average number of visiting was 7.1 times. The average treatment period was 9.9days. Majority of the elapsed time from the onset to the arrival was more than 1 year (56.6%). Low back pain (56.4%) is the most in musculoskeletal disorders and obesity (21.7%) and gynecological diseases (30.4%) were the most in a non-musculoskeletal disorders. Medication and acupuncture was the major treatment. 89.2% of the prescribed medication was the efficacy of musculoskeletal. Russian medical tourists most visited by support of travel agent (58.6%). The main reason of their visiting was non-surgical treatment for spinal disorder (31%). 96.6% of them were satisfied because rapid pain relief and kindness. Conclusions For this study, we confirmed a possibility for the Korean medical treatment of Russian tourists for medical tourism. Still, more research and goverment support for the expansion of Korean medical tourism is needed.

• 성인간호학회지
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• 제12권3호
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• pp.323-333
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• 2000

The purpose of this study was to determine the impact of situational, clinical and psychsoical factors on treatment-seeking behavior among those with acute myocardial infarction(AMI). This study used a retrospective, descriptive design. The sample consisted of 72 patients aged over 30 and who were diagnosed with an acute myocardial infarction at two large university-affiliated medical centers from July 1, 1998 to March 30, 2000. But of 72, patients 5 who were an outlier in treatment-seeking time were deleted. Data were collected by using questionnaires, which included demographic data, situational, clinical and psychosocial data. Also patient interviews and chart review were used to obtain information related to treatment-seeking time. The results of this study were summarized as follows ; 1. Mean time from the onset of AMI symptoms to arrival at the hospital was $12.09{\pm}11.44$ hours; 2. Treatment-seeking time was not significantly different by age, gender, or education; 3. Most(44 or 65.78%) patients were at home when they began having AMI symptoms. The remaining patients were either in a public area, workplace or in a car. Patients at home delayed longer than those who had their first symptoms elsewhere, but not significantly different. Also, most patients were with another person when they began to experience AMI symptoms: a spouse(25 or 37.3%), other family member(31 or 46.3%); the remaining 11 were alone. There were no significant differences in treatment-seeking time based on whether alone or with others. Most patients(46 or 68.7%) used an ambulance rather than taking private transportation, and patients who used an ambulance were delayed longer than those who used private transportation, but there were no significant differences; 4. Time to treatment-seeking was not significantly different by blood pressure, heart rate on admission and the peak CK-MB, CPK and Cholesterol level, Killips class; 5. There were no significant statistical differences in treament-seeking times by anxiety level, mood status or control ability.