• International Journal of Quality Innovation
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• 제2권2호
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• pp.127-135
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• 2001

Personnel engaged in the medical field have implemented continual improvement by team activities in an effort to construct a system that reduces the risks involved in medical care. Knowledge in total quality management (TQM), especially statistical quality control (SQC) developed for industry, seems to be applicable to medical care. This paper describes the application of SQC to continual improvement in medical care.

• KSII Transactions on Internet and Information Systems (TIIS)
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• 제7권5호
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• pp.1058-1076
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• 2013

The WBAN(Wireless Body Area Network) supplies mobile convenience to our medical services. But if we have few effective control variables across this service deployment, the hidden distortions or defects of the system might threaten the lives and rights of the stakeholders. Therefore we need to increase the service credibility, to get WBAN effective. This study proposes a governance mechanism using feasible variables that are currently in use in practices in WBAN environments against medical incidents. Control variables were tested in Seoul National University hospital and related medical industries of South Korea. We assume that WBAN systems would be open based on integrating patients, medical employees and law enforcements to get smart theater operations against medical incidents by implementing proposed MJA(Multilateral Joint Analysis) model. MJA model also contributes to the convergence of computer systems and medical services by demonstrating flexible SOA(Service Oriented Architecture) dashboard of healthcare services with credibility factors in medicine. The important components in MJA model across WBAN, were found to be "Safety, Accuracy and Reliability" in priority order. Factor analysis, correlations and ANOVA were used to evaluate this model and an IT dashboard with a realization of mobile application, was used to support participants' decision-making.

• 간호행정학회지
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• 제20권4호
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• pp.353-361
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• 2014

Purpose: The aim of this study was to compare job satisfaction, quality of life (QOL), incident report rate and overtime hours for 12-hour shifts and for 8-hour shifts in a pediatric intensive care unit (PICU). Methods: A descriptive survey was conducted with a convenience sample of 36 staff nurses from a PICU in a regional hospital in Korea. Data were collected using self-administrated questionnaires regarding job satisfaction and QOL at 6 months before and after the beginning of 12-hour shifts. Incident report rate and overtime hours for both 12-hour and 8-hour shifts were compared. Comparisons were made using $x^2$-test, paired t-test and Mann-Whitney U test. Results: After 12-hour shifts were initiated, job satisfaction significantly increased (t=3.93, p<.001) and QOL was higher for nurses on 12-hour shifts compared to 8-hour (t=7.83, p<.001). There was no statistically significant change in incident report rate ($x^2=0.15$, p=.720). The overtimes decreased from $36.3{\pm}34.7$ to $17.3{\pm}34.9$ minutes (Z=-8.91, p<.001). Conclusion: These results provide evidence that 12-hour shifts can be an effective ways of scheduling for staff nurses to increase job satisfaction and quality of life without increasing patient safety incidents or prolonged overtime work hours.

• 임상간호연구
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• 제29권1호
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• pp.56-66
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• 2023

Purpose: This study aimed to investigate whether the comprehensive nursing care service positively affected accidental falls and pressure injuries. Methods: This study was a retrospective study that analyzed the accidental falls and pressure injuries cases in an acute care hospital located in Seoul and compared the rates of accidental falls and pressure injuries before and after the comprehensive nursing care service was operated. Results: Comparing the accidental fall incidence rates per 100 person-months between a comprehensive nursing care ward and a general ward, it showed fewer accidental falls by 0.44 in comprehensive nursing care wards, but the result was not statistically significant. In the case of pressure ulcers, the incident rate per 100 person-month was 6.17 in general wards and 4.77 in comprehensive nursing care wards, which showed that the number of pressure ulcer patients was lower in comprehensive nursing care wards, however it was also not statistically significant. Conclusion: It is not confirmed that the operation of the comprehensive nursing care service contributes to the reduction of accidental hospital falls or pressure injuries. Follow-up studies are recommended to determine the effectiveness of comprehensive nursing services in quality indicators.

• 한국의료질향상학회지
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• 제27권2호
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• pp.57-72
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• 2021

Purpose: At present, there are a variety of serious patient safety incidents related to problems in health information technology (HIT), specifically involving electronic medical records (EMRs). This emphasizes the need for an enhanced electronic medical record system (EMRS). As such, this study analyzed both the nature of and potential to prevent incidents associated with HIT/EMRS based on data from the Korea Patient Safety Reporting and Learning System (KOPS). Methods: This study analyzed patient safety incidents submitted to KOPS between August 2016 and December 2019. HIT keywords were used to extract HIT/EMRS incidents. Each case was reviewed to confirm whether the contributing factors were related to HIT/EMRS (HIT/EMRS-related incidents) and if the incident could have been prevented (HIT/EMRS-preventable incidents). The selected reports were summarized for general clarity (e.g., incident type, and degree of harm). Results: Of the 25,515 obtained reports, 2,664 incidents (10.4%) were HIT-related, while 2,525 (9.9%) were EMRS-related. HIT/EMRS-related incidents were the third largest type of incident followed by 'fall' and 'medication incidents.' More than 80% of HIT/EMRS-related incidents were medication-related, accounting for approximately one-third of the total number of medication incidents. Approximately 10% of HIT/EMRS-related incidents resulted in patient harm, with more than 94% of these deemed as preventable; further, sentinel events were wholly preventable. Conclusion: This study provides basic data for improving EMR use/safety standards based on real-world patient safety incidents. Such improvements entail the establishment of long-term plans, research, and incident analysis, thus ensuring a safe healthcare environment for patients and healthcare providers.

• Safety and Health at Work
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• 제12권3호
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• pp.390-395
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• 2021

Background: Health-care providers typically undergo shift work and are subjected to increased stress. Night shift work may induce disturbed sleep cycles and circadian rhythm. The objective of this study was to explore if night shift workers (NSWs) show an increased risk of abnormal thyroid-stimulating hormone (TSH). Methods: We conducted a retrospective cohort study of 574 employees without thyroid disease and abnormal TSH at baseline who underwent annual check-ups between 2007 and 2016 in a medical center. NSWs were defined as those with working time schedules other than daytime hours. We calculated the incidence rate and estimated the adjusted hazard ratio (HR) for incident abnormal TSH and subclinical hypothyroidism compared with non-NSWs using a Cox regression model. Results: A total of 56 incident abnormal TSH cases and 39 subclinical hypothyroidism cases in NSWs were identified during 3000 person-years of follow-up. In models adjusted for age, sex, obesity, and working departments, we found no increased relative risk for incident abnormal TSH (HR: 0.72, 95% confidence interval: 0.33-1.60) or subclinical hypothyroidism (HR: 0.52, 95% confidence interval: 0.19-1.45) when comparing NSWs to non-NSWs; nor were incidence rates significantly different among exclusively medical employees after excluding administrative staff. Conclusion: In this hospital-based nine-year follow-up retrospective cohort study, NSWs were not associated with increased relative risk of incident abnormal TSH and subclinical hypothyroidism, in contrast to previous cross-sectional studies.

• Tuberculosis and Respiratory Diseases
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• 제58권3호
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• pp.213-229
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• 2005

The first and the longest criminal indictment case of Korean medico-legal battle, so called BORAMAE Hospital Incident, was finally on its end by Korean Supreme Court's decision on June 24, 2004, after 7 years long legal dispute via Seoul District Court and Seoul Superior Appeal Court's decision. Boramae Hospital case was the first Korean legal case of Withdrawing Life-sustaining treatment of mechanical respirator on 58 years old Extradural Hematoma victim who was on Respirator under Coma after multi-organ failure postoperatively(APACHE II score: 34-39). Two physicians who have involved patient's care and had helped to make discharge the Near-death patient to home after repeated demand of patient's wife, due to economic reason, were sentenced as homicidal crime. This review article will discuss the following items with the review of US cases, Quinlan(1976), Nancy Cruzan(1990), Barber (1983), Helen Wanglie(1990), Baby K (1994) and Baby L cases, along with Official Statement of ATS and other Academic dignitaries of US and World.: [1] Details of Boramae Hospital incident, medical facts description and legal language of homicidal crime sentence. [2] The medical dispute about the legal misinterpretation of patient's clinical status, regarding the severity of the victim with multi-organs failure on Respirator under coma with least chance of recovery, less than 10% probability. [3] Case study of US, of similar situation. [4] Introduction of ATS official Statement on Withdrawing/ Withholding Life sustaining treatment. [5] Patient Autonomy as basic principle. [6] The procedural formality in Medical practise for keeping the legitimacy. [7] The definition of Medical Futility and its dispute. [8] Dying in Dignity and PAS(Physician Assisted Suicide)/and/or Euthanasia [9] The Korean version of "Dying in Dignity", based on the Supreme Court's decision of Boramae Hospital incident (2004.6.24.) [10] Summary and Author's Note for future prospects.

• Journal of Preventive Medicine and Public Health
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• 제35권4호
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• pp.340-350
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• 2002

Objectives : To evaluate the annual visit days, the annual prescription days and the medical costs of hypertensive patients. Methods : The medical insurance records of 40,267 incident patients with the diagnostic code of hypertension from September 1998 through August 1999 in Daegu city were reviewed. Results : The proportion of the most proper medical care pattern group (Group VIII) who visited for 6-15 days with 240 prescription days or more a year was only 6.2%. The proper care group (Group IX) who visited for more than 16 days with 240 prescription days or more a year was 9.3%. The overall proper care group (Group VIII+IX) was therefore 15.5%. The proportion of the insufficient care group (Group I, IV) in both the number of visiting days and prescription days was 57.4%. The mean prescription day of the most proper group (Group VIII) was 29 days; the mean annual medical expenses,453,587won; the mean annual amount paid by patients, 218,013won; and mean medical expenses per prescription day, 1,483won. The proportion of the overall proper care group (Group VIII+IX) was significantly higher in adults aged 50-59, those who were enrolled in industrial workers health insurance as well as government employees and private school teachers health insurance, and those who made a higher contribution per month (p<0.01). According to the type of medical facilities, the proportion of the most proper medical care pattern group was highest in the general hospitals (9.3%) but the overall proper care group was higher in the public health centers (22.1%) and private clinics (17.1%). Conclusions : The management system of hypertension should be reinforced urgently. Therefore, it is necessary to develop guidelines including the number of visiting days per year and prescription days per visit day, and make the system provide medical facilities to more properly care for hypertensive patients.

• 농촌의학ㆍ지역보건
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• 제28권1호
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• pp.15-27
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• 2003

Objectives: This study was conducted to compare the medical care patterns of hypertensive patients between rural and urban areas. Methods: We selected one rural county(Region A where there were 19 public health centers; one health center, 8 health sub-centers and 10 community health posts) and two urban districts(Region B and C where there was no health sub-center and community health post) in Daegu city. Region B had similar socioeconomic characteristics with rural county A while region C had different characteristics. The medical insurance records of 14,422 incident patients (2,501 in region A, 4,873 in region B and 7,048 in region C) with diagnostic code of hypertension from September 1998 to August 1999 were reviewed. Incident patient was defined as a patient who had no record of medical fee claim for hypertension to the national health insurance corporation in past 6 months and visited a medical facility for hypertension for the first time. The data for annual visit days, annual prescription days and annual total medical expenses were abstracted. The medical care pattern was categorized by the number of annual visit days and prescription days. The most proper care group was defined as the patient who visited 6-15 days with 240 prescription days or more in a year. Results: The type of medical facilities for the most visit was clinics, 373.% and it was followed by general hospitals, 28.2%; public health centers, 24.7%; and hospitals, 9.8% in region A(p<0.05). In region B, it was clinics, 63.1% and followed by general hospitals, 27.6%; health center, 5.2%; and hospitals, 4.1%(p<0.05). In region C, it was clinics, 53.8% and followed by general hospitals, 35.0%; health center, 6.3%; and hospitals, 4.9%(p<0.05). Annual mean total medical expenses per patient was highest in region C(won195,993) and followed by region A(won191,683) and region B(won178,713). The proportion of the most proper care group was 7.7% in region A, 5.2% in region B and 6.7% in region C(p<0.05). According to the type of medical facilities for the first visit, the proportion of the most proper care group was highest(14.7%) in the patients of public health centers, and it was followed by general hospitals, 8.8%; clinics, 3.6%; and hospitals, 2.0% in region A(p<0.05). In region B, it was highest in general hospitals, 9.7% and followed by hospitals, 4.0%; health center, 3.6%; and clinics, 3.4%(p<0.05). In region C, it was highest in general hospitals, 10.1% and followed by clinics, 5.2%; hospitals, 4.1%; and health center, 3.1%(p<0.05). Conclusions: The proportion of proper care for hypertension was higher in rural area and it was attributed to the care of health center, sub-centers and community health posts which appeared to follow patients better than hospitals and clinics.

• 보건행정학회지
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• 제29권2호
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• pp.105-111
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• 2019

On December 31, 2018, an incident occurred where a doctor was attacked and killed by a patient carrying a lethal weapon in the outpatients' clinic of the psychiatric department of a tertiary general hospital. The suspect was diagnosed with bipolar affective disorder (manic depressive disorder) and has been hospitalized and cared for in the psychiatric ward of this hospital. This incident illustrates the necessity of more active cures and therapeutic intervention for mental patients with intellectual developmental disorders who require treatment considering the fact that a radical outcome has been caused by such a patient. However, on the other hand, there is also a need for an approach and analysis from the perspective of crime prevention for all medical departments. The reason for this is that even a tertiary general hospital equipped with the largest human resources, medical devices, facilities, and so forth, is susceptible to violence. As for illegal actions perpetrated against health and medical service personnel in medical institutions, such as verbal abuse, assault, injury, etc. there have neither been understanding shown for the current extent of damage in detail, nor discussions of active institutional improvement related to the seriousness of the act. It can be said that violence in the field of medical treatment is a realm requiring serious discussion and appropriate remedial actions. This is because when such incidents take place, if a patient who is supposed to get treatment from the damaged health care provider is in an urgent situation or on the waiting list of serious cases, he or she could suffer serious damage caused by deprivation of treatment opportunity, or secondary damage might be caused to the patient and/or a guardian who can hardly have an opportunity to take action. Accordingly, in this review, we would like to help create the necessary conditions for both health and medical service personnel and patients/guardians, respectively, to provide and receive medical treatment in a more secure environment. Therefore, objective assessment of the institution and issues relating to this aforementioned incident and general cases of violence occurring in medical institutions, and by suggesting legal and institutional improvements and solutions.