• Title/Summary/Keyword: clinical management

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A Study on the cost allocation method of the operating room in the hospital (수술실의 원가배부기준 설정연구)

  • Kim, Hwi-Jung;Jung, Key-Sun;Choi, Sung-Woo
    • Korea Journal of Hospital Management
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    • v.8 no.1
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    • pp.135-164
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    • 2003
  • The operating room is the major facility that costs the highest investment per unit area in a hospital. It requires commitment of hospital resources such as manpower, equipments and material. The quantity of these resources committed actually differs from one type of operation to another. Because of this, it is not an easy task to allocate the operating cost to individual clinical departments that share the operating room. A practical way to do so may be to collect and add the operating costs incurred by each clinical department and charge the net cost to the account of the corresponding clinical department. It has been customary to allocate the cost of the operating room to the account of each individual department on the basis of the ratio of the number of operations of the department or the total revenue by each operating room. In an attempt to set up more rational cost allocation method than the customary method, this study proposes a new cost allocation method that calls for itemizing the operation cost into its constituent expenses in detail and adding them up for the operating cost incurred by each individual department. For comparison of the new method with the conventional method, the operating room in the main building of hospital A near Seoul is chosen as a study object. It is selected because it is the biggest operating room in hospital A and most of operations in this hospital are conducted in this room. For this study the one-month operation record performed in January 2001 in this operating room is analyzed to allocate the per-month operation cost to six clinical departments that used this operating room; the departments of general surgery, orthopedic surgery, neuro-surgery, dental surgery, urology, and obstetrics & gynecology. In the new method(or method 1), each operation cost is categorized into three major expenses; personnel expense, material expense, and overhead expense and is allocated into the account of the clinical department that used the operating room. The method 1 shows that, among the total one-month operating cost of 814,054 thousand wons in this hospital, 163,714 thousand won is allocated to GS, 335,084 thousand won to as, 202,772 thousand won to NS, 42,265 thousand won to uno, 33,423 thousand won to OB/GY, and 36.796 thousand won to DS. The allocation of the operating cost to six departments by the new method is quite different from that by the conventional method. According to one conventional allocation method based on the ratio of the number of operations of a department to the total number of operations in the operating room(method 2 hereafter), 329,692 thousand won are allocated to GS, 262,125 thousand won to as, 87,104 thousand won to NS, 59,426 thousand won to URO, 51.285 thousand won to OB/GY, and 24,422 thousand won to DS. According to the other conventional allocation method based on the ratio of the revenue of a department(method 3 hereafter), 148,158 thousand won are allocated to GS, 272,708 thousand won to as, 268.638 thousand won to NS, 45,587 thousand won to uno, 51.285 thousand won to OB/GY, and 27.678 thousand won to DS. As can be noted from these results, the cost allocation to six departments by method 1 is strikingly different from those by method 2 and method 3. The operating cost allocated to GS by method 2 is about twice by method 1. Method 3 makes allocations of the operating cost to individual departments very similarly as method 1. However, there are still discrepancies between the two methods. In particular the cost allocations to OB/GY by the two methods have roughly 53.4% discrepancy. The conventional methods 2 and 3 fail to take into account properly the fact that the average time spent for the operation is different and dependent on the clinical department, whether or not to use expensive clinical material dictate the operating cost, and there is difference between the official operating cost and the actual operating cost. This is why the conventional methods turn out to be inappropriate as the operating cost allocation methods. In conclusion, the new method here may be laborious and cause a complexity in bookkeeping because it requires detailed bookkeeping of the operation cost by its constituent expenses and also by individual clinical department, treating each department as an independent accounting unit. But the method is worth adopting because it will allow the concerned hospital to estimate the operating cost as accurately as practicable. The cost data used in this study such as personnel expense, material cost, overhead cost may not be correct ones. Therefore, the operating cost estimated in the main text may not be the same as the actual cost. Also, the study is focused on the case of only hospital A, which is hardly claimed to represent the hospitals across the nation. In spite of these deficiencies, this study is noteworthy from the standpoint that it proposes a practical allocation method of the operating cost to each individual clinical department.

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A Descriptive Research on Drug Use Pattern of Narcotic Analgesics: a Case of University Hospital in Korea (마약성 진통제의 사용양상에 관한 서술적 조사연구: 한 대학병원의 경우)

  • Rah, Mi-Sook;Yoo, Bong-Kyu
    • Korean Journal of Clinical Pharmacy
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    • v.21 no.1
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    • pp.30-35
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    • 2011
  • The objective of this study was to find out drug use pattern of narcotic analgesics in university hospitals in Korea. A university hospital located in Kyungbuk province was chosen for this study. The drug use pattern was analyzed in terms of ingredient, administration route, patient type, and attending department. Amount of drug usage was counted by unit dose defined by the number of ampule or vial for injectable, tablet or capsule for oral, and each for patch preparations. Result showed that 11 narcotic analgesic ingredients were used during 2007-2009, and the drug usage was increased by about 20% annually during the period. Proportion of oral preparations used for pain management was about two third of all narcotic analgesics usage and kept increasing during the period. Proportion of the drug usage for outpatients was also steadily increased. Notably, the usage of oral preparations of oxycodone, morphine, and hydromorphone was rapidly increased for the management of cancer pain while the usage of codeine and codeine-containing composite preparations for cancer pain were minimal (<10%). About 90% of all narcotic analgesics were used by physicians in Internal Department, especially in Oncology Division of the Department. These findings suggest that pain management is becoming more aggressive and in agreement with WHO's guidelines regarding selection of administration route. However, in terms of 3-step ladder for cancer pain management, the drug use pattern was not congruent to WHO's guidelines. Therefore, in conclusion, it appears that physicians need to try to be congruent to the guidelines when using narcotic analgesics for cancer pain.

Implementation of Ontology-based Clinical Decision Support System for Management of Interactions Between Antihypertensive Drugs and Diet (항고혈압제-식이 상호작용 관리를 위한 온톨로지 기반의 임상의사결정지원시스템 구현)

  • Park, Jeong-Eun;Kim, Hwa-Sun;Chang, Min-Jung;Hong, Hae-Sook
    • Journal of Korean Academy of Nursing
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    • v.44 no.3
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    • pp.294-304
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    • 2014
  • Purpose: The influence of dietary composition on blood pressure is an important subject in healthcare. Interactions between antihypertensive drugs and diet (IBADD) is the most important factor in the management of hypertension. It is therefore essential to support healthcare providers' decision making role in active and continuous interaction control in hypertension management. The aim of this study was to implement an ontology-based clinical decision support system (CDSS) for IBADD management (IBADDM). We considered the concepts of antihypertensive drugs and foods, and focused on the interchangeability between the database and the CDSS when providing tailored information. Methods: An ontology-based CDSS for IBADDM was implemented in eight phases: (1) determining the domain and scope of ontology, (2) reviewing existing ontology, (3) extracting and defining the concepts, (4) assigning relationships between concepts, (5) creating a conceptual map with CmapTools, (6) selecting upper ontology, (7) formally representing the ontology with Protege (ver.4.3), (8) implementing an ontology-based CDSS as a JAVA prototype application. Results: We extracted 5,926 concepts, 15 properties, and formally represented them using Protege. An ontology-based CDSS for IBADDM was implemented and the evaluation score was 4.60 out of 5. Conclusion: We endeavored to map functions of a CDSS and implement an ontology-based CDSS for IBADDM.

Problems Associated with the Management of Nutrition Support Team in Hospitals in Korea (우리나라 병원에서의 영양지원팀 운영과 관련된 문제점에 관한 연구: 한 대학병원의 경우)

  • Kang, Hye-Jin;Shanmugam, Srinivasan;Yong, Chul-Soon;Kim, Jung-Ae;Rhee, Jong-Dal;Yoo, Bong-Kyu
    • Korean Journal of Clinical Pharmacy
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    • v.18 no.1
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    • pp.45-49
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    • 2008
  • The goal of this research was to identify problems associated with the management of nutrition support team (NST) in hospitals in Korea. Management status of NST in the hospitals was surveyed over the phone or interviewed by visit during August 2007. NST in foreign countries was collected by reference search and websites in the internet. Survey analysis also was performed during March, 2007 with forty-one medical staff in a university hospital located in Jinju, Kyungsangnamdo. Korean Society for Parenteral and Enteral Nutrition (KSPEN) was organized in 2001 and currently has thirty-three member hospitals with on-site NST as of August, 2007. Most of the member hospitals were big hospitals with more than 500 beds and were organized within five years. The most significant problem identified was the shortage of nutrition specialists exclusively involved in the NST. Survey analysis revealed that more than half of medical staff prescribed parenteral nutrition based on their own nutrition requirement calculation rather than consultation with NST. It appears that status of NST management of hospitals in Korea are considered to be at beginner stage and therefore, needs more aggressive advertising activity to increase consultation usage by medical staff.

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Guideline on Acceptance Test and Commissioning of High-Precision External Radiation Therapy Equipment

  • Kim, Juhye;Shin, Dong Oh;Choi, Sang Hyoun;Min, Soonki;Kwon, Nahye;Jung, Unjung;Kim, Dong Wook
    • Progress in Medical Physics
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    • v.29 no.4
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    • pp.123-136
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    • 2018
  • The complex dose distribution and dose transfer characteristics of intensity-modulated radiotherapy increase the importance of precise beam data measurement and review in the acceptance inspection and preparation stages. In this study, we propose a process map for the introduction and installation of high-precision radiotherapy devices and present items and guidelines for risk management at the acceptance test procedure (ATP) and commissioning stages. Based on the ATP of the Varian and Elekta linear accelerators, the ATP items were checked step by step and compared with the quality assurance (QA) test items of the AAPM TG-142 described for the medical accelerator QA. Based on the commissioning procedure, dose quality control protocol, and mechanical quality control protocol presented at international conferences, step-by-step check items and commissioning guidelines were derived. The risk management items at each stage were (1) 21 ionization chamber performance test items and 9 electrometer, cable, and connector inspection items related to the dosimetry system; (2) 34 mechanical and dose-checking items during ATP, 22 multileaf collimator (MLC) items, and 36 imaging system items; and (3) 28 items in the measurement preparation stage and 32 items in the measurement stage after commissioning. Because the items presented in these guidelines are limited in terms of special treatment, items and practitioners can be modified to reflect the clinical needs of the institution. During the system installation, it is recommended that at least two clinically qualified medical physicists (CQMP) perform a double check in compliance with the two-person rule. We expect that this result will be useful as a radiation safety management tool that can prevent radiation accidents at each stage during the introduction of radiotherapy and the system installation process.