Background : There have been many studies and efforts about quality management in health services, but there were not founded quality assessment on social services. This study was designed for understood level of quality on social service, identified for correlation factors of quality assessment on social services in general and teaching hospitals in Korea. Methods : The subjects of this survey were 80 leaders of social service units. The survey data from each subjects were measured to evaluate level of quality that service provider perceived of sample hospitals. Social worker's attitude of quality assurance activities, perception of quality assurance system in that hospitals were measured. Under the method of one-way ANOVA, t-test and correlation, associated factors of quality assessment in social work service was analyzed. Results : The major findings were as following ; First, the level of quality perceived showed less score, especially the lowest was the score of quality of outcome. Second, social worker's attitude of quality assurance activities showed high score, but quality assurance system of hospitals showed less score. Third, the level of quality assurance system of hospitals, social worker's attitudes of quality assurance activities. Conclusion : The quality of social work service correlated positive hospitals's quality assurance system, social worker's attitudes of quality assurance activities. Therefore, to assure the proper level of quality, qualified for hospitals system of quality assurance, and needed to a educational program for enhanced social workers's attitudes in quality assurance activities.

Background : The doctors' strike was not only a manmade disaster but also a chance to apply a new pattern of emergency medical service for patients. We hope to propose a new pattern of emergency medical service by comparing the patterns of emergency medical service given by resident and staff during the doctors' strike. Methods : We reviewed the medical records of patients who received emergency medical service in the Emergency Department(ED) of Deagu Catholic University Hospital during 3 days a week prior to the residents' strike (July 21-23, 2000) with those of patients receiving emergency medical service during the first 3 days of the residents' strike (July 28-30, 2000). We evaluated the patient's severity, the cause of the ED visit, the performance on the laboratory study, ECG, and radiological study, the disposition, and the length of ED stay. Also, we compared the collected data by presenting doctor and by patient's severity. Results : The staff performed fewer tests admitted fewer emergent and non-emergent patients than the residents. Also, the length of ED stay was shorter in both the emergent (212.76 vs. 321.40 minutes) and the non-emergent groups (117.68 vs. 171.39 minutes) for patients presenting to staff. Conclusion : It is desirable that emergency medical service is given by staff, not by resident.

Background : Because unplanned readmissions to intensive care unit(ICU)might be related with undesirable patient outcomes, we investigated the pattern of and reason for unplanned ICU readmission to provide baseline data for reducing unplanned returns to ICU. Methods : The subjects included all patients who readmitted to ICU during the same hospitalization at a tertiary referral hospital between January 1st and June 30th 2002. Quality improvement(QI) nurse collected the data through medical records and a medical director reviewed the data collected. Results : 1) The average unplanned ICU readmission rate was 5.6%(gastroenterology 14.6%, pediatrics 12.7%, pulmonology 11.9%, neurosurgery 6.3%, general surgery 5.3%, chest surgery 3.9%, and cardiology 3.3%). 2) Among the unplanned readmissions, more than 50% of cases were from patients older than 60 years, and the main categories of diagnose at hospital admission were neurologic disease(29.9%) and cardiovascular disease(27.6%). 3) Of unplanned ICU readmissions, 41.8% had recurrence of the initial problems, 44.8% had occurrence of new problems. And 9.7% required post-operative care after unplanned operations. 4) The most common cause responsible for unplanned ICU readmission were respiratory problem(38.3%) and cardiovascular problem(14.3%). 5) About 40% of unplanned ICU readmission occurred within 3 days after ICU discharge. 6) Average length of stay of the readmitted patients to ICUs were much longer than that of non-readmitted patients. 7) Hospital mortality rate was much higher for unplanned ICU readmitted patients(23.6%) than for non-readmitted patients(1.5%) (P<0.001). Conclusions : This study showed that the unplanned ICU readmitted patients had poor outcomes(high morality and increased length of stay). In addition study results suggest that more attention should be paid to patients in ICU with poor respiratory function or elderly patients, and careful clinical decisions are required at discharged from ICU to general ward.

Background : The purpose of this study is to investigate the influencing factors on the length of emergency department stay of patients with acute myocardial infraction. Methods : we reviewed medical records of all patients who were Hospitalized with acute myocardial infraction from March 1, 2002 to February 28, 2003. Results : The average length of stay in the emergency room of the subjects was 182.74 minutes. After the emergency room treatment, 48.1% of the subjects were transferred to intensive care unit. The hospitalization through emergency room mostly took place in the office hours. There were more patients on Monday. The influencing factors on the length of stay in the emergency room of patients with acute myocardial infraction were emergency room arrival time which was classified in seasons, treatment hours of specialized doctors, medical care insurance and required time of radiologic examination. Conclusion : In order to reduce the length of emergency room stay, it might be an available solution secure enough spaces, facility, and staff of the radiologic test only for the patients of the emergency room. And the effective use of emergency facility and space, establishment of standardized treatment guideline, and provision of emergency treatment support system are also needed.

Background : Aim of this study is focused on the analysis of the needed abilities of medical representatives resulting in building up the market and increasing sales. It is to propose methods to increase this ability ensuring continuous growth in market share and profit. Methods : A survey was conducted between January 6 and May 31, 2003. Using SPSS(Version 10.0), the collected data was analyzed by Hotelling T2, factor analysis. Some hypotheses were selected to include the conclusion. Some questionnaires for physicians working in hospitals or clinics and the medical representatives working in a pharmaceutical company were created and asked to them to either prove or reject those hypotheses. The results were analyzed to find the primary factors that effect the interactions between physician and the medical representatives. These factors were also studied along with the theoretical research based on published references. Results : The results were as follows. The main reasons for the physician to meet with a medical representatives were collection of product informations needed for patient treatment and collection of informations on current medical issue and as well as personal interests. The main parameters by which physicians evaluate the medical representatives are human relationship including sincerity and manners and supply of accurate and unbiased information on products. Overall, the medical representatives' perception on the importance of medical knowledge and ability to deliver it are lower than that expected by physicians. Conclusion : Medical and pharmaceutical companies' environment are changed rapidly. And those changes forced medical representatives to set new roles and competency. In order to drive away from the past 'rule of thumb' and 'adaptation to circumstance', optimal method and systemic development to train and support the medical representatives should be quipped. They will help medical representatives to be specialists in medical knowledge and to understand the exact need of health care professions. Product competitiveness will be increased and eventually successful business can be achieved through it.