• Journal of Preventive Medicine and Public Health
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• 제26권4호
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• pp.650-660
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• 1993

This study aims to describe the causes of medically unnecessary hospital stay at a teaching tertiary hospital, using modified version of Delay Tool in which the causes of delay are divided into slx major categories : delay related to test scheduling, test results, surgery, medical staff, patient/family, and administration. For the analysis of hospital stay, 6,479 inpatient-days were reviewed in two medical and four surgical departments for one month. Initially inappropriate hospital stays were identified using Appropriateness Evaluation Protocol (AEP), and causes of delay listed in Delay Tool were assigned to each of them. In both medical and surgical services, the most important cause of delay was related to medical staffs, ranging from 3.6% to 51.6% of total inpatient days. Next important category was delay related to test scheduling in medical services ($4.7{\sim}9.2%$), and delay related to surgery in surgical services ($7.3{\sim}15.0%$). Among subcategories of delay related to medical staffs, delay due to conservative care was the most important cause of inappropriate hospital stay ($2.9{\sim}6.4%$). Each clinical departments had different distribution among delay categories, which could not be fully justified by their clinical charateristics. The Delay Tool would be helpful in exploring factors related to the inefficient use of hospital beds. As a measurement tool of inappropriate hospital stay, however, the Delay Tool should be refined in the definitions of categories and its contents.

• Journal of Hospice and Palliative Care
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• 제17권2호
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• pp.66-74
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• 2014

목적: 본 연구의 목적은 소생술 포기(Do Not Resuscitate, DNR)와 사전의료의향서(Advance Directives, AD)에 대한 환자 보호자와 의료인의 인식을 파악하고 비교하고자 함에 있다. 방법: 이 연구에서는 5개 종합 병원에 입원한 환자 보호자 145명과 이를 담당한 의료인 272명을 대상으로 2009년 9월 21일부터 15일간 조사를 실시하였다. 조사내용은 소생술 포기에 대한 인식 14문항, 연명 의료 중지 선택제에 대한 인식 3문항, 직업유무, 성별, 연령을 포함한 20문항으로 구성하였다. 결과: 소생술 포기와 사전의료의향서에 대한 필요성은 환자 보호자와 의료인에서 모두 높았으며, 특히 의료인이 환자 보호자보다 그 필요성을 더 많이 인식하였다(DNR ${\chi}^2=44.56$, P<0.001; AD ${\chi}^2=16.23$, P<0.001). 의료인은 소생술 포기에 대한 설명을 환자나 환자 보호자에게 제공해야 한다는 인식이 높았으나 환자 보호자의 경우 환자 보다 환자 보호자에게 제공해야 한다는 인식이 높았다. 소생술 포기와 사전의료의향서의 필요성에 대한 주 이유는 '회복 불가능한 환자의 고통 경감'으로 나타났다. 또 소생술 포기 결정 시기는 '말기질환 입원 즉시'가 가장 많았으며 의사결정은 '환자와 환자 가족이 상의하여 결정한다'는 의견이 가장 많았다. 소생술 포기에 대한 지침서의 필요성과 이로 인한 요구도 증가 역시 환자 보호자 보다 의료인이 높게 인식하였다(${\chi}^2=7.41$, P=0.0025). 결론: 이 연구 결과 한국 사회에서 소생술 포기와 사전의료의향서의 결정은 환자 보호자에 의존하는 경향이 높을 것으로 사료되며 따라서 환자와 환자 보호자가 이에 대한 객관적인 정보를 제공받아야 한다. DNR과 AD의 적용은 말기환자의 고통 경감이 주요한 이유로 나타나 호스피스와 연계한 후속 연구의 필요성이 나타났다. 의료인도 환자 보호자와의 인식 차이를 인지하고 DNR과 AD 결정을 위한 의사소통 시 이를 충분히 고려해야 한다.

• Parasites, Hosts and Diseases
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• 제55권4호
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• pp.391-398
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• 2017

Hookworm infections are widely prevalent in tropical and subtropical areas, especially in low income regions. In the body, hookworms parasitize the proximal small intestine, leading to chronic intestinal hemorrhage and iron deficiency anemia. Occasionally, hookworms can cause overt gastrointestinal bleeding, but this is often ignored in heavily burdened individuals from endemic infectious areas. A total of 424 patients with overt obscure gastrointestinal bleeding were diagnosed by numerous blood tests or stool examinations as well as esophagogastroduodenoscopy, colonoscopy, capsule endoscopy or double-balloon enteroscopy. All of the patients lived in hookworm endemic areas and were not screened for hookworm infection using sensitive tests before the final diagnosis. The patients recovered after albendazole treatment, blood transfusion, and iron replacement, and none of the patients experienced recurrent bleeding in the follow-up. All the 31 patients were diagnosed with hookworm infections without other concomitant bleeding lesions, a rate of 7.3% (31/424). Seventeen out of 227 patients were diagnosed with hookworm infections in the capsule endoscopy (CE), and 14 out of 197 patients were diagnosed with hookworm infections in the double balloon enteroscopy (DBE). Hookworm infections can cause overt gastrointestinal bleeding and should be screened in patients with overt obscure gastrointestinal bleeding (OGIB) in endemic infectious areas with sensitive methods. Specifically, the examination of stool specimens is clinically warranted for most patients, and the proper examination for stool eggs relies on staff's communication.

• 간호행정학회지
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• 제9권2호
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• pp.217-232
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• 2003

Purpose : This paper was attempted to identify the job stress related factors among the staff nurses and to provide the basic data concerning development of stress management program focused on hospitals. Method : The subjects were 309 staff nurses at two general hospitals in Seoul. Data were collected with self-reported questionnaires and analyzed by SPSS-PC+10.0 for descriptive analysis, ANOVA, stepwise multiple regression, factor analysis. Results : The subjects exhibit significantly highest level of 'the participation in decision making factor'. The mean score of 'control coping strategies' was higher than 'avoid coping strategies'. The mean scores of social support and stress responses were high. The main factor that affected the stress responses was 'the job characteristic factor' and it was explained 23.0% out of the total variance of the stress responses. Also, it would be explained 42.6% out of the total variance of the stress responses with 'the control coping strategies, work overload factors, social support, and participation in decision making factors'. Conclusion: For developing the hospital- focused stress management program for staff nurses, 'the participation in decision making factors' and 'the job characteristics' should be considered. Also, the organizational efforts and supports should be required to support and use of 'control coping strategies' of nurses

• Asian Pacific Journal of Cancer Prevention
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• 제16권5호
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• pp.1699-1705
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• 2015

Background: Medication errors in oncology may cause severe clinical problems due to low therapeutic indices and high toxicity of chemotherapeutic agents. We aimed to investigate unintentional medication errors and underlying factors during chemotherapy preparation and administration based on a systematic survey conducted to reflect oncology nurses experience. Materials and Methods: This study was conducted in 18 adult chemotherapy units with volunteer participation of 206 nurses. A survey developed by primary investigators and medication errors (MAEs) defined preventable errors during prescription of medication, ordering, preparation or administration. The survey consisted of 4 parts: demographic features of nurses; workload of chemotherapy units; errors and their estimated monthly number during chemotherapy preparation and administration; and evaluation of the possible factors responsible from ME. The survey was conducted by face to face interview and data analyses were performed with descriptive statistics. Chi-square or Fisher exact tests were used for a comparative analysis of categorical data. Results: Some 83.4% of the 210 nurses reported one or more than one error during chemotherapy preparation and administration. Prescribing or ordering wrong doses by physicians (65.7%) and noncompliance with administration sequences during chemotherapy administration (50.5%) were the most common errors. The most common estimated average monthly error was not following the administration sequence of the chemotherapeutic agents (4.1 times/month, range 1-20). The most important underlying reasons for medication errors were heavy workload (49.7%) and insufficient number of staff (36.5%). Conclusions: Our findings suggest that the probability of medication error is very high during chemotherapy preparation and administration, the most common involving prescribing and ordering errors. Further studies must address the strategies to minimize medication error in chemotherapy receiving patients, determine sufficient protective measures and establishing multistep control mechanisms.

• 한국의료질향상학회지
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• 제28권2호
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• pp.39-49
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• 2022

Purpose:The infection and isolation program used at a university hospital in A city was assessed and improved to provide medical staff with easy-to-understand information on isolation precautions and infectious diseases. Methods: Based on the results of the root cause analysis, the infection and isolation alarm computer program was improved. Subsequently, a survey was conducted with infection control leaders and unit managers (n=98) within the department to evaluate the degree of improvement. Results: The isolation registration and release procedures were simplified and unified to prevent confusion among the relevant departments. Additionally, the screen composition was improved so that various information related to infection can be easily accessed. After improvement in the program, the rate of isolation registration (53.0% to 100.0%, p<.001) and user satisfaction (67.6% to 92.2%) improved. Conclusion: This study will help improve the program so that other medical institutions can comply with the isolation precautions in accordance with the type of infections.

• 한방재활의학과학회지
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• 제28권1호
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• pp.97-107
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• 2018

Objectives This is one of the manuals of East-West integrative medicine which was created by the committee on integrative medicine of Chung-Yeon Korean Medicine Hospital. The purpose of this manual is to support clinical decision-making and communication between Korean and western medical staff in a Korean medicine hospital during the rehabilitation of patients after knee surgery. Methods The draft was made by two rehabilitation specialists in Korean medicine. After a rehabilitation specialist in western medicine reviewed the draft and exchanged their ideas, a revised version that reflects the goal of consultation was made. Then the committee agreed to adopt the manuals through the process of review and feedback in addition to face-to-face discussions. Results This manual describes clinical decision-making for rehabilitation after arthroscopic partial meniscus resection, meniscus refixation, reconstruction of anterior and posterior cruciate ligaments. Therefore, it contains the schedule of rehabilitation treatment by the surgical technique, general goal of the rehabilitation by phase, guide for patients and postoperative infection management. Conclusions Despite some limitations, this manual has significance as the first example of a decision-making protocol suggestion for East-West integrative rehabilitation treatment after a knee surgery in one medical institution.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제24권2호
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• pp.55-64
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• 2018

Purpose: The ward division is a representative part of the hospital, where a variety of user activities are performed. Users can be broadly categorized as patients and carers, visitors, and medical staff (doctors and nurses). The relationship between these two is a major issue with ward planning as the patient's place of life centers around the hospital room and the task of the clinical workforce centers around the nursing station (NS). Against this backdrop, the study divides the ward units of the General Hospital of China into patient areas, medical team areas, supply areas, and public domain, with the focus on the ward areas affecting most significantly in the hospital patients. Methods: The theoretical advance studies of the standard ward unit are identified by the associated guidelines, articles, and documentation. Results: This study is a summary analysis of relevant regulations, reference literature, and drawing data from the target hospital. Further work is expected to be undertaken, including further surveys and observational surveys, to produce more detailed results. Implications: It is expected that the research in this paper will provide an effective reference for the future research of China General Hospital Ward department, so as to promote and improve the work system of China General Hospital Ward department.

• 임상간호연구
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• 제19권1호
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• pp.20-32
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• 2013

Purpose: To present necessary data for improvement in communications between health professionals in as characterized by nurses' communications. Methods: This study was a descriptive survey research design with a survey of 1,510 registered nurses working in general hospitals (of at least 1,900 beds) in Seoul. A questionnaire on communication in the ICU, nurse-physician and nurse-nurse, was used. Data were collected from January 9 to 20, 2012, and the response rate was 85.0%. Results: Cronbach ${\alpha}$ values ranged from .75 to .89, except for .59 for accuracy (nurse-physician), with .89 overall. The highest mean score was for perception for timeliness [$3.83{\pm}.57$], followed by shift communication (nurse-nurse) [$3.64{\pm}.66$], openness (nurse-nurse) [$3.64{\pm}.65$], accuracy (nurse-nurse) [$3.14{\pm}.61$], openness (nurse-physician) [$2.90{\pm}.75$], understanding (nurse-physician) [$2.82{\pm}.65$], and accuracy (nurse-physician) [$2.70{\pm}.59$]. Subscales of openness, understanding, and shift communication were strongly associated with communication satisfaction. The general characteristics of nurses with different perceptions of communications included age, clinical experience, work pattern, and department. Conclusion: Proactive activities to improve accuracy, openness and mutual understanding between physicians and nurses are required for patient safety. Further studies are also needed to reassess communications and evaluate the relationship between patient outcomes and nurses' job satisfaction after application of strategies to improve communications.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제27권3호
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• pp.39-49
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• 2021

Purpose: The negative pressure isolation ward is a key facility in preparedness and response to infectious diseases. For the sustainable operation of the facility, appropriate facility improvement is required. The experience of medical staff responding to infectious diseases in the COVID-19 pandemic provides effective informations for facility planning. Methods: The post occupancy evaluation (POE) was conducted by interviewing medical staff who is working on Nationally designated negative pressure isolation ward in general hospital. Floor plan analysis was conducted before field surveys for identifying facility characteristic and spatial composition. After that, field surveys were conducted at 3 hospitals, and interviews and fieldwork were conducted together. Results: It is necessary to increase the standard size of ward area from 15m² to 20m². The size of the doffing room has to be planned for accommodation of two or more people. Equipment storage, clean storage and waste storage also should be properly planned. There were almost no problems with the circulation in the ward. There was not enough space for medical staff. Implications: For a sustainable and safe negative pressure isolation ward planning, it is necessary to exploit learning from the medical staffs who have many experiences of coping with infectious diseases.