• 한국의료질향상학회지
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• 제14권2호
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• pp.125-132
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• 2008

Background : The number of outpatient injected anticancer drug is increasing. and the pathway of prescribing, compounding, and injecting anticancer drug is processed very rapidly in out-patient department. Moreover, Dose of anticancer drug is often changed depending on side effect of patients. So we need more effective inspection of anticancer drug prescriptions. The purpose of this study was to analyze the prescription errors for anticancer drugs in Out-Patient Department and to suggest system to prevent them. Method : The study took place at Asan Medical Center from July to September 2007. The pharmacists performed inspection of anticancer drug prescriptions before compounding and injecting. We used protocol-based anticancer drug order program and Electronic Medical Record (EMR). Result : During the study period, we analyzed 4683 prescriptions for out-patient. And we detected 55 medication errors (1.2%). Most common errors included dosage above or below the correct ones (56.3%), followed by incorrect treatment duration. Because most of dosing errors were in the range of usual dosage, it was hard to detect them. So when inspecting the prescription, we considered the medical records of individual patients. As a result, we could raise the efficiency of intervention. Therefore inspection using EMR could possibly reduce the number of anticancer drug errors. Conclusion : we are preventing the medication errors on stability and dosage above or below the maximum therapeutic dose according to the previous inspection system. However most of dosing errors were in the range of usual dosage according to the result of this study. Because of there was interpatient variability of dosage depending adverse effect. For improvement of quality assurance, we suggest inspection system based on patient's medical history.

• 한국의료질향상학회지
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• 제15권1호
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• pp.113-120
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• 2009

문제: 의무기록 질 관리의 어려움 목적: 의무기록의 질 향상 의료기관: 고려대학교 의료원 안암병원 의료정보팀 질 향상 활동: 의무기록의 질 향상을 위해 입퇴원기록지 24시간 이내 작성율 향상, 입원기록지 24시간 이내 작성율 향상, 외과계 N-C 기재율 감소, 경과기록지 작성율 향상, 일일입퇴원기록지 작성율 향상, STAFF 서명 완성일 단축 활동을 하였다. 개선효과: 의무기록 작성에서 같은 내용을 반복 작성해야 하는 번거로움을 해소하였고, 작성자(의료진) 중심의 프로그램 개선과 개발된 프로그램의 지속적인 모니터링으로 의무기록의 질이 향상되었다.

• 의학교육논단
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• 제11권2호
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• pp.15-24
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• 2009

Medical Students' competencies depend on the medical school curriculum. Basic medical education, in particular, is an important starting point for further medical competency development. We aimed to identify the most important areas of reform in the basic medical education curriculum of Yonsei Medical School. To accomplish this, we sought case studies of different medical schools and discussion points for quality improvement methods. A qualitative comparison method saturated through the systematic discussions on the emerging thematic approaches to determine the current directions in medical school curriculum reform. The discussions, which involved 7 experts, spanned 8 months and were based on a literature review, with focus on the 7 selected case studies. From the discussions, we concluded that in order to improve basic medical education curriculum, the following measures need to be carried out. First, an outcome-based curriculum is to be designed. The expected outcome is to be deliberately and succinctly defined and should be expressed as teaching and learning objectives. Second, the core subjects and elective subjects are to be classified on the basis of the aim, content, and passage level of the subjects. Hence, the core curriculum must be treated as a standard part of medical knowledge, and the elective curriculum must be richer and more in-depth. Third, universities should institutionalize regular evaluation of their departments. Appropriate and just evaluations should be made, and feedback given to the school's administrative department. Fourth, the departmental and administrative management of the basic medical education curriculum should be harmonized with each other. Finally, teaching and learning resources are to be increased and diversified and made available to professors and students for basic medical education.

• 한국의료질향상학회지
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• 제2권1호
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• pp.110-117
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• 1995

The Comprehensive quality assurance for radiation oncology provides an overall organizational structures, responsibilities, procedures, processes and resources for assuring the quality of patient management by radiation treatment. Superior performance of modern radiotherapy equipment will be essential part of quality assurance in radiation oncology, which high degree of accuracy and consistency should be maintained under the optimal quality assurance program. Besides quality control of all radiation equipment, this review also emphasizes quality assurance of clinical aspect such as adequacy of the medical decision-making which eventually leads to the treatment prescription, accuracy of treatment procedure from treatment preparation to radiation delivery, and the significance of assessment of treatment outcomes with structure and process.

• 한국병원경영학회지
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• 제19권2호
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• pp.73-88
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• 2014

Objective: This research investigates how to increase the quality of medical service and supply high quality of medical service to patients. By using Kano Model theory we examines what medical service attributes the hospital would be conducted preferentially for patient's satisfaction and provides informations of management strategies for hospitals. Method: To study patients' perception of medical service quality, first we performed pilot test to derive 30 medical service attributes. With 30 medical service attributes, we conducted survey of 300 subjects who have experienced medical services in 6 months. To examine patients' conception of medical services, a modified Kano's questionnaire using 5 scale is applied. Finally we calculated SI(Satisfaction index) and DI(Dissatisfaction index) and PCSI(Potential Customer Satisfaction Improvement) index with Kano's Model analysis results. Key Findings: We found that the quality of medical service categorized in 15 one-dimensional elements, 9 must-be elements and 6 indifferent elements. Moreover the attribute of gives prompt services and have patient's best interest at heart scored the highest SI, whereas the attributes of accurate and precise medical service, exact records, enough explanation and polite attitudes are the highest score of DI. And also good explanation of the bill scored the highest PCSI. In this study findings indicate that while medical service providers try to increase patients' satisfaction by improving hospital's environments, patients' perception of trust and good interpersonal relationships with medical service providers have strong and positive impact on patients' satisfaction.

• Clinical and Experimental Pediatrics
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• 제61권1호
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• pp.1-5
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• 2018

We often overlook the importance of several safety issues such as identification of patients, timeout procedure, hand hygiene, handoff communication, and many others. This ignorance, along with many other issues, leads to medical error being ranked as a third leading cause of death in the U.S. Consequently, quality improvement (QI) has become one of the major subjects in healthcare despite a relatively short history. Improving quality is about making healthcare safe, effective, patient-centered, timely, efficient, and equitable. Understanding the need and methodology of QI as well as participation is now essential for physicians. Although basic QI methodology has not changed, one of the most fascinating changes in recent QI is conducting large-scale QI projects through multicenter networks. Prospective multicenter QI projects utilizing the Korean Neonatal Network are a substantial initiation of pediatric QI in Korea. The Korean Pediatric Society should set ambitious goals for QI activities for every primary care pediatrician and pediatric subspecialist.

• 한국의료질향상학회지
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• 제29권2호
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• pp.85-93
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• 2023

Purpose: The predominant approach for mitigating inadequate sampling rates has primarily involved bolstering the volume of education. This study aimed to curtail inadequate sampling rates through the implementation of continuous quality improvement (CQI) activities, tailoring effective methods to the unique needs of each institution. Methods: We developed a sample handling guidebook and implemented QI activities to address this issue. Results: These measures resulted in a 4.7% decrease in inadequate sampling rates, concurrently improving knowledge of sample handling and overall nurse satisfaction. We addressed the root causes of inadequate sampling before laboratory pre-processing by: 1) focusing on systematic rather than erratic errors through CQI activities, 2) revising the sample handling guide, and 3) delivering face-to-face education based on the specific needs of the nursing department. These changes resulted in an additional 0.6% decrease in the inadequate sampling rate. Conclusion: This study demonstrates that the implementation of CQI activities based on evidence derived from a multifaceted causal analysis significantly reduced the inadequate sampling rate compared to previous studies.

• 한국의료질향상학회지
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• 제4권2호
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• pp.174-183
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• 1997

Background : Medical records thought to be reflecting the quality of medicine. By this ground, examination of medical records can be served to evaluate, and to improve the quality of medical care. To examine the medical records, we need some standards or checklists which can be used to sort out the problems. Methods: We developed checklists for medical records evaluation. We studied 1,677 medical records about its completeness using this checklists in one educational hospital. Survey was completed by 5 well trained staffs of medical record department. Results are analyzed. SPSS/PC+ program was used for statistics. Results : 13.8% of discharge summary was incomplete. Recording of the demographic information was also poor in incomplete medical records compared to complete ones. Progress note was recorded average 4.16 times during 11.9 hospital days. After 4th hospital day, recording rate of progress note dropped sharply. Rate of professor's signature on operation records was poor(27%). He or she who described the discharge summary well also wrote progress note well. Conclusions: Fill-up of demographic date should be stressed during medical record education program. Strategy to create the environment emphasizing the responsibility of professor on quality medical record should be made. We suggest new index (number of records/hospital stay) for the evaluation of completeness of progress note.

• 한국의료질향상학회지
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• 제10권2호
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• pp.204-215
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• 2003

Background : ICD-10 Classification, which is used domestically as well as internationally, has limited use in the clinical practice since it is developed for at disease statistics and epidemiology. Therefore, the purposes of this study were to improve the quality of diagnosis by constructing a new disease classification based on the diagnoses doctors currently make in the clinical setting and connecting this classification with OCS and EMR, and to meet the demands of doctors for high quality medical study data in medical research. Methods : The specialists in each ophthalmic subfield collected clinical diagnoses and abbreviations based on the ophthalmology textbooks and confirmed the classifications. Total number of clinical diagnoses collected was totaled 672, for which ideal diagnoses had been selected and a new model of disease classification model in connection with ICD-10 was constructed. The constructed classification of clinical diagnoses consisted of six steps: the first step was the classification by ophthalmic subspecialty field; the second to fifth steps were the detailed classification by each specialty field; the sixth step was the classification by site. Results : After introducing the new disease classification, research on the use and a pre-post comparison was conducted. The result from the research on the use of the clinical diagnoses in inpatient and outpatient care has shown a gradually increasing tendency. From the pre-post comparison of EMR discharge summary diagnoses, the result demonstrated that the diagnosis was stated correctly and in detail. Since the diagnosis was stated correctly, code classification became correct as well, which makes it possible to construct high quality medical DB. Conclusion : This construction of clinical diagnoses provides the medical team with high quality medical information. It is also expected to increase the accuracy and efficiency of service in the department of medical record and department of insurance investigation. In the future, if hospitals wish to construct a classification of clinical diagnosis and a standard proposal of clinical diagnosis is presented by a medical society, the standardization of diagnosis seems to be possible.

• 한국의료질향상학회지
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• 제9권1호
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• pp.6-17
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• 2002

Background : This study was conducted to investigate the current situation of medical supply purchasing and stock management at general hospitals having more than 150 beds in Korea and to find methods of effective purchasing and optimal stock management. Methods : Survey was done from staff at the purchasing departments of 229 general hospitals throughout Korea. Data collection was done using a structured questionnaire between January 3 to March 15, 2001. The survey form was returned from 88 hospitals (rate of return: 38.4%). Results : Firstly, 13.6% of the hospitals did not carry the optimal stock of medical supplies, the lead time optimal stock was 3 weeks or longer in 64.4% of the hospitals. Secondly, since 69.8% of the hospitals showed passive attitude toward training on purchasing management and stock management techniques. Thirdly, as for the question on the presence or absence of a deliberation committee for purchasing of new medical supplies, 60% of the hospitals with less than 300 beds did not have one, and 9.4% of the hospitals opened the deliberation committee less than twice a year. Conclusion : At the time of purchasing new medical supplies, purchasing should be done according to the decision by the deliberation committee so that no deduction is made at the time of claiming insurance, and by setting a certain period of time, purchasing of those medical supplies that were not purchased during this period needs to be done according to the decision by the deliberation committee.