• 대한간호학회지
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• 제49권6호
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• pp.783-794
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• 2019

Purpose: This study identified factors related to the quality of care in nursing homes, and elicited consensus opinions from experts on nursing homes. Methods: A Delphi questionnaire was developed based on a review of the literature using the keywords "nursing homes," "workforce," and "quality of care." A total of two Delphi surveys were conducted with 14 experts. The important and urgent factors related to the quality of care for nursing home residents emerged. Results: A consensus was achieved on the important and urgent factors relating to the quality of care. The related factors were grouped into four sections: Organizational Characteristics, Staffing Characteristics, the Long-Term Care Market and Legal and Policy Issues, and Nursing Processes. In total, 23 items were important factors and 26 items were urgent factors relating to the quality of care. In addition, the unanimous advocacy by the experts for increased hours per resident day for registered nurses (RNs, 41 minutes 59 seconds) was much higher than the current hours per resident day of RNs in Korea. Conclusion: To provide optimal care for residents in nursing homes in Korea, the mandatory and essential placement of RNs with professional knowledge and skills is paramount.

• 대한응급의학회지
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• 제29권5호
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• pp.391-398
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• 2018

Objective: This study was conducted to analyze and compare the classifications of a prehospital triage system and an in-hospital triage system. Methods: The records of patients transferred from the '119' emergency service for 5 months (from January 1 to May 31, 2016) were collected and records of first aid activities were assessed. We examined cases classified as four (urgent, semi-urgent, potentially urgent, and non-urgent) of five stages, excluding death. In the hospital, data were collected from medical records and classifications made using the five Korean Triage and Acuity Scale (KTAS) stages (1, resuscitation; 2, emergency; 3, urgent; 4, less urgent; and 5, non-urgent) were analyzed. Results: The number of patients enrolled in the study was 3,457. Of them, 2,301 were discharged after treatment and 1,156 were hospitalized. According to the prehospital triage classification, 726 of the 3,457 cases were urgent, 593 were semi-urgent, 1,944 were potentially urgent, and 194 were non-urgent. The results of the in-hospital triage were as follows: 114 KTAS 1 (3.3%), 491 KTAS 2 (14.2%), 1,345 KTAS 3 (38.9%), 1,227 KTAS 4 (35.5%), and 280 KTAS 5 (8.1%). The odds ratio trend for hospitalization showed a larger decrease according to in-hospital staging (95% CI, 0.32-0.39) than according to prehospital staging (95% CI, 0.50-0.60). The odds ratio trend for intensive care unit (ICU) admission also showed a larger decrease according to in-hospital staging (95% CI, 0.16-0.22) than according to prehospital staging (95% CI, 0.37-0.48). Conclusion: We found little correspondence in classifications made according to the KTAS and prehospital triage systems. However, the tendencies toward decreases in the hospitalization and ICU admission rates were similar.

• 대한간호
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• 제17권1호통권93호
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• pp.82-91
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• 1978

A Study on Nursing Care of the Chest Injury Patient Park, Choon Ja (School of Nursing, the National Medical center) Chest injury is the most urgent and serious one ,because of vital organs such as heart, great vessels and lungs are in the thoracic cavity.

• 한국병원경영학회지
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• 제21권3호
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• pp.65-70
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• 2016

The Long-Term Care Hospital (LTCH) accreditation system was initiated in 2013 in the form of mandatory accreditation system in order to improve patient safety and the quality of medical service at LTCHs. By June 2016, the accredited LTCHs were 76.2%. This research was conducted to review the implementation process in the first cycle and to promote development of the second cycle of LTCH accreditation system. There are some changes which reinforced the accreditation standards, accreditation survey, and public access to accreditation results in order to strengthen patient safety in the first cycle LTCH accreditation system. LTCHs which participated in the accreditation system achieved certain outcomes in respect to patient safety and employee satisfaction. However, there are several urgent problems in placement criteria of night duty health care providers, reinforcement plans in the accreditation system, and incentives for accredited hospitals. In order to solve these problems, the most important thing is to clearly recognize the fact that the healthcare accreditation system is not the means for control and regulate hospitals but a system to induce hospitals to continue to strive for improvements in patient safety and medical service quality. In addition, it is required that LTCHs, accrediting agency and the Ministry of Health and Welfare compromise and cooperate to seek solutions every time issues related to the accreditation system arise.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제28권4호
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• pp.61-69
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• 2022

Purpose: In response to the rapid spread of COVID-19 in 2020, the government supported facilities and equipment through the 'Urgent Isolation Ward Expansion Project'. Design and remodeling of efficient negative pressure isolation facilities had to be done in a short period of time, and the performance gap between facilities was very large because the types of hospitals and wards of existing medical facilities were diverse. In order to secure the stability of isolation wards between medical facilities and reduce the facility gap, guidelines for planning isolation wards considering the diversity of each hospital should be appropriately presented. In consideration of these points, this study aims to provide basic data for future remodeling guidelines for each plan type of the negative pressure isolation ward first. Methods: We analyzed the plans before and after the change of 13 case hospitals that performed the urgent care bed expansion project for COVID-19 confirmed patients. Before the remodeling, the current status of the facility was analyzed according to the type of corridor, the location of the nursing station, and the location of the elevator. After remodeling, the flow of medical staff and patients, the flow of entry and exit of clean and contaminated items, and the space of negative pressure and non-negative pressure areas. Results: The ward type was divided into three types according to the corridor type and room arrangement: double loaded corridor type with two side wards, race track type with one side ward, and race track type with two side wards. Based on these three types, the standard floor plan type of the isolation ward was proposed in terms of the location of the elevator bank and Nurse station. Implications: When the existing general ward is converted into a negative pressure isolation ward, this study can be a basic data to present customized guidelines for each ward type.

• 보건행정학회지
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• 제7권2호
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• pp.46-64
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• 1997

Background & Objectives : Korea is face with the social need for health care technology assessment so that it is urgently needed to found principles and methodology in technology assessment in health care. As a groundwork for health care technology assessment, we tried to prioritize medical technology for assessment. Among medical technologies, procedure is somewhat difficult to assess, compared to drug or equipment. In this study, we aimed at the prioritisation of medical procedure to be assessed, in terms of efficay, safety, and adequacy. Method : For the standardized classification of medical procedure, ICD-9-CM(International Classification of Diseases 9th edition - Clinical Modification) was used. Among the list the procedures coming under otorhinolaringjology and thoracic surgery were selected by three family physicians. The list of procedure was mailed to the board certified surgeons of both disciplines, with the question asking about the necessity for assessment in terms of efficay, safety, and adequacy. Replied questionnaires were analyzed in each procedure. Results : Of 560 otorhinolaryngologist and 480 thoracic surgeon, 114 surgeons replied. Of otorhinolaryngological procedure, incision, excision, and destruction of inner ear : fenestration of inner ear : stapedectomy and its revision were the most urgent technology to assess in the aspect of safety. For adequacy, operations on Eustachian tube: fenestration of inner ear: incision, excision, and destruction of inner ear were highly ranked in necessity, and for efficary, operations on Eustachian tube; external maxillary antrotomy; fenestration of inner ear. Thoracic surgeons replied thoracic procedures, lung transplantation; heart transplantation; implantation of heart assist system [pump] are most important for evaluation in terms of safety; and heart transplantation; Lung transplantation; Implantation of heart assist system [pump] in terms of adequacy, and surgical collapse of lung [Artificia니 pnemothorax or pnuexoperitoeum]; lung transplantation; periarterial sympathectomy in terms of efficacy. As a whole, surgeons regard safety evaluation is more urgent than adequacy or efficary. In addition, otorhinolaryngological surgeons regard evaluation of their procedures more urgent than thoracic surgeons regard theirs. Conclusion : By the questionnaire to board certified physicians, we get some preliminary data for prioritisation of technologies to assess. Through the questionnaire like this, much information would be gathered for technology assessment, especially for medical procedure, if not enough. In the near future, well structured expert opinion gathering research, such as modified Delphi or nominal group technique, should be done succeedingly.

• 대한간호학회지
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• 제45권4호
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• pp.495-500
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• 2015

Purpose: The purpose of this paper was to discuss the need for translation studies in dementia care and current translational endeavors, and to provide recommendations for evolving evidence-based dementia care. Methods: A literature review yielded current evidence and translational efforts. Results: Dementia care interventions need to be implemented at various service levels. Barriers to translation include evidence gaps, lack of the use of a conceptual framework to explain the implementation process, and unsupportive funding mechanisms for applying innovations. Conclusion: There is clear evidence of the need for and benefits of evidence-based dementia care for patients with dementia, family caregivers, and care professionals. The urgent need now is finding ways to advance translational activities and facilitate future research into translation science.

• 보건행정학회지
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• 제27권2호
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• pp.103-113
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• 2017

There have been many achievements for 40 years since the introduction of compulsory health insurance. Despite many achievements, it has many challenges in health insurance. Aging, non-communicable disease, and low growth economy are threatening the sustainability of health insurance, and it is time to reform the health insurance. A long-term reform plan will be an absolute necessity for reform of health insurance and health care system. Health insurance and health care reform should be an extremely revolutionary content that completely changes the framework. This reform should deal with the philosophy of health, approach of medical education and doctor training, changing supply of medical service, the innovation of primary medical care, reform of public health system, the management of medical utilization, the integration of medical cure and care services, enhancing the benefit coverage, prohibition of covered and non-covered services, etc. Therefore, it is urgent to form a consensus on the necessity of reform, to establish the health insurance plan on this consensus, and to make efforts to make health insurance sustainable.

• 중환자간호학회지
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• 제2권2호
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• pp.68-78
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• 2009

Evidence based clinical practice guideline are designed to help healthcare practitioners evaluate and implement the increasing amount of evidence on best practice. Critical care area is one of the clinical sites where evidence based clinical practice guideline is needed most. This paper reviewed the definition of evidence based clinical practice guidelines, the development method of evidence based clinical practice guideline, and the current trends in guideline developing. Traditional method of guideline development is consensus based but it moves into evidence based development. Evidence based guideline is based on best available evidence and uses the strongest method to determine its effect on clinical outcomes. The current trends in guidelines is to develop the guideline at regional/national level and do subsequent modification to suit local circumstances. There is an urgent need of exploring the method of guideline development and adaptation which are appropriate for Korean clinical setting.

• Journal of Hospice and Palliative Care
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• 제25권1호
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• pp.50-54
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• 2022

Antibiotics are commonly prescribed medications in the hospice and palliative care setting, as well as in many other healthcare settings. The overuse or negligent use of antibiotics is associated with the harmful consequence of fostering the development of antibiotic-resistant pathogens. Thus, there is an urgent need to critically examine and audit antibiotic use in all aspects of healthcare. In the status quo, there is a lack of consistent standards and guidelines surrounding the use of antibiotics in hospice and palliative care settings, leading to significant variations in how antibiotics are prescribed and administered in end-of-life care. It is apparent that greater thought needs to go into antibiotic decisions for patients receiving hospice or palliative care, especially considering the harmful consequences of the overprescription of antibiotics. The literature suggests that many clinicians prescribe antibiotics inappropriately for patients who would not benefit from their use or prescribe them without adequate documentation. Clinicians should be deliberate about when they prescribe antibiotics and adhere to the appropriate documentation standards and procedures within their institution or community. Future research should seek to generate generalizable knowledge about which patients will benefit most from antibiotic therapy during end-of-life care.