• 대한수혈학회지
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• 제23권2호
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• pp.136-144
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• 2012

배경: 신선동결혈장은 응고인자의 보충을 위한 치료적 투여를 주된 목적으로 하지만, 실제로 적응증이 아닌 경우에도 부적절하게 사용되는 경우가 종종 있다. 방법: 년 2010년 7월부터 2011년 6월까지 1년간 세브란스병원 혈액은행에서 출고된 신선동결혈장의 적정 사용에 대한 평가를 시행하였다. 평가기준은 2009년 대한수혈학회에서 발간한 수혈가이드라인과 세브란스병원의 수혈적정성 평가 전산시스템에 기초하였다. 결과: 신선동결혈장은 1년 간 총 1,949명에게 4,982회에 걸쳐 17,733단위가 출고되었고, 이 중 1,990회(총 건수의 39.9%)가 부적절 수혈로 평가되었다. 진료과별 사용 건수는 소화기내과 등의 내과 계열이 흉부외과나 일반외과 등의 외과 계열보다 많았다. 그러나 부적절 사용 비율은 외과 계열이 내과 계열보다 높았다. 질병분류별 사용건수와 이들의 부적절 사용 비율은 유사한 양상을 보였는데, 종양, 소화 계통의 질병, 순환 계통의 질병군이 높은 사용 건수와 부적절 사용 비율을 보였다. 결론: 수혈의 적정성 유지를 위해서는 각 의료기관에서 수혈 적정성이 항상 평가되고, 그 결과를 임상의사들에게 정기적으로 피드백하는 과정이 중요하며, 이와 더불어 신선동결혈장 수혈 적응증에 대한 새로운 고찰이 필요할 것으로 사료된다.

• 대한임상검사과학회지
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• 제54권1호
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• pp.73-77
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• 2022

혈액제제(BPs)는 한정적인 자원이다. 혈액제제는 가장 적절하게 사용되어야 하지만 근거 기반 없이 무분별하게 사용되고 있는 것이 사실이다. 본 연구는 헤모글로빈 수치를 기준으로 혈액제제의 사용 적절성을 평가하는 것을 목적으로 하였다. 2020년 11월 1일부터 2021년 10월 31일까지 병원에서 수행된 혈액 공급 데이터는 병원의 디지털 종합의료정보시스템을 활용하였다. 총 제공 건수는 21,303건이었고, 진료과별로 사용하는 농축적혈구제제의 공급 중 헤모글로빈 수치(>7.0 g/dL)의 경우는 1,173건으로 나타났다. 수혈의 오남용은 사회적 비용을 증가시키고, 수혈의 적절성은 더욱 중요해지고 있어, 각 의료기관은 수혈지침 평가지표를 검토하고, 수혈지침의 혈액제제 방출 현황 및 수혈지침의 교육프로그램을 점검하여 적절성을 평가해야 할 것으로 사료된다.

• 대한임상검사과학회지
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• 제55권1호
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• pp.65-70
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• 2023

헌혈을 중심으로 하는 혈액 관리보다 혈액의 사용을 적절히 관리하는 것이 중요하다. 수혈용 혈액 현황의 관리, 수혈의 적정성에 대한 평가, 수혈 관련 부작용의 발생 감시 및 대응, 그 밖에 수혈관리에 필요한 업무를 수행하는 수혈관리실의 역할을 통해 개선효과를 살펴보았다. 수혈관리실의 개설·운영을 통해 수혈적정성 평가 업무를 효율적으로 관리할 수 있지만 혈액의 적정성 평가에 시간이 소요되고 수혈관리실 전담인력이 모든 혈액의 적정성을 평가하기에는 어려운 단점도 있다. 앞으로 한국형 환자 혈액관리(patient blood management, PBM)를 도입해 의료기관 내 안전하고 적정한 수혈관리 구현을 위한 수혈관리실과 수혈관리위원회를 정착시키고, 인력을 교육해야 하는 의료기관의 참여가 필수적이다.

• Journal of Information Processing Systems
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• 제18권3호
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• pp.302-310
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• 2022

Efficient use of limited blood products is becoming very important in terms of socioeconomic status and patient recovery. To predict the appropriateness of patient-specific transfusions for the intensive care unit (ICU) patients who require real-time monitoring, we evaluated a model to predict the possibility of transfusion dynamically by using the Medical Information Mart for Intensive Care III (MIMIC-III), an ICU admission record at Harvard Medical School. In this study, we developed an explainable machine learning to predict the possibility of red blood cell transfusion for major medical diseases in the ICU. Target disease groups that received packed red blood cell transfusions at high frequency were selected and 16,222 patients were finally extracted. The prediction model achieved an area under the ROC curve of 0.9070 and an F1-score of 0.8166 (LightGBM). To explain the performance of the machine learning model, feature importance analysis and a partial dependence plot were used. The results of our study can be used as basic data for recommendations related to the adequacy of blood transfusions and are expected to ultimately contribute to the recovery of patients and prevention of excessive consumption of blood products.

• 대한임상검사과학회지
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• 제36권2호
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• pp.158-162
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• 2004

The over-preparation of blood for elective surgery causes some problems such as returning of blood, inefficient task and loss of reagents. In recent blood transfusion practice, there has been changing patterns of blood use in elective surgery as various side effects of transfusion have become known and operation techniques are developed. This study was performed to evaluate the optimal utilization of blood for various elective and/or emergency surgery. We surveyed the quantity of blood transmitted to wards, returned to blood bank, and the number of crossmatching test done for the elective surgery of the patients at the D. University Hospital, the tertiary teaching hospital from August 1, 2001 to October 31, 2001. Crossmatched to transfusion ratio (C/T ratio) was calculated, in which C means the unit of accomplished crossmatching test and T means the unit of transfused blood component. The unit of transfused blood was analysed in terms of issuing time, sex, age, clinical department, and blood component type. The usage of bloods for the emergency surgery was also analyzed. In our study, C/T ratio was highest on Monday (1.54) and Tuesday (1.53), and higher in female patients(1.54) than in male patients (1.32). No significant relationship was observed between age groups. Among clinical departments, thoracic and cardiovascular surgery showed the highest C/T ratio (1.54). From above results, we could be sure that the management of transfusion practice was relatively appropriate in recent years, although the entire introduction of type and screen (T&S) method was desirable. If the T&S method is performed, the C/T ratio would be almost 1.00 and it would also relieve the duty of blood bank.

• 간호행정학회지
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• 제13권2호
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• pp.199-207
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• 2007

Purpose: Clinical characteristics and medical cost were analyzed according to the surgical procedures for intertrochanteric fracture in aged patients to assess the appropriateness of treatment expense and to find possibility of reducing the medical cost. Method: Variable for the statistical analysis were; the clinical characteristics, medical cost according to the surgical procedures, the treatment success rate, the total medical expense, and the average expense per case. SAS Package Version 8.02. was used to analyze the relevant data. Results: Operative procedures differ significantly according to the gender and by the location of institution. Only significant clinical variables according to the operative procedure were duration of general anesthesia and amount of blood transfusion. Average cost per treatment was the highest in the bipolar hemiarthroplasty followed by the gamma nail and hip compressing screw. Average cost for bipolar hemiarthroplasty was significantly higher than other surgical procedures. Conclusions: The difference in hospital costs for treatment of intertrochanteric fracture originates from the utilized surgical procedures, mostly by the materials used. The method of surgical treatment should be carefully determined by the purpose of the surgery, in order to improve the quality of medical care and also to reduce the hospital cost.

• Journal of Trauma and Injury
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• 제23권2호
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• pp.75-82
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• 2010

Purpose: In Korea, trauma is the $3^{rd}$ most common cause of death. The trauma treatment system is divided into pre-hospital and hospital stages. Deaths occurring in the pre-hospital stage are 50% of the total death, and 20% of those are deaths that are preventable. Therefore, the purpose of our study is to calculate the preventable death rates caused by trauma in our current pre-hospital system, to analyze the appropriateness of the treatment of traumatized patients and to draw a conclusions about the problems we have. Methods: The study was done on traumatized patients who expired at the emergency department from January 1, 2005, to December 31, 2009, at the Korea University Medical Centers in Anam, Guro and Ansan. The data on the patients were reviewed retrospectively based on characteristics, conditions on admission and trauma severity. The patient's RTS (revised trauma score) and ISS (injury severity score) was calculated. Preventable death rate was calculated by TRISS (the trauma score-injury severity score). Results: A total of 168 patients were enrolled. All patients were intubated and underwent CPR. Of the total, 72% patients were male, and traffic accidents were the most common form of trauma (52.4%), falls being second (28.6%). Head injury, solitary or multiple, was the most common cause of death (55.4%). Thirty-eight (38, 22.6%) deaths were preventable. The 22.6% preventable death rate consisted of 15.5% potentially preventable and 7.1% definitely preventable deaths. Based on a logistic regression analysis, the relationship between the time intervals until transfusion and imaging and death was statistically significant in the hospital stage. In the pre-hospital stage, transit time from the site of the injury to the hospital showed a significant relationship with the mortality rate. Conclusion: One hundred sixty-eight (168) patients died of trauma at the 3 hospitals of Korea University Medical Center. The TRISS method was used to calculate the preventable death rate, with a result of 22.6%. The only factor that was significant related to the preventable death rate in the pre-hospital stage was the time from injury to hospital arrival, and the time intervals until transfusion and imaging were the two factors that showed significance in the hospital stage. Shortening the time of treatment in the field and transferring the patient to the hospital as quickly as possible is the most important life-saving step in the pre-hospital stage. In the hospital stage, the primary survey, resuscitation and diagnosis should proceed simultaneously.