• 정신신체의학
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• 제6권1호
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• pp.46-58
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• 1998

Objectives : This study was performed to evaluate the status of psychiatric consultation at a newly opened university hospital, to explore problems related to psychiatric consultation and to contribute for future consultation to be more systematic and more efficient. Methods: The subjects of this study were 284 patients hospitalized at Inha University Hospital between September 1, 1996 and August 31, 1997, who were referred for psychiatric consultation during hospitalization. This study was evaluated demographical characteristics of referred patients, resons for referral, recommendations by psychiatric consultant, clinical diagnoses, psychiatric diagnoses, relationship between referral time and hospitalization following the day of consultation and consultation referral types based upon psychiatrists' reports and patients' medical charts. Results : Most common patients referred to consultation were females aged 20s who visited at the department of internal medicine and related to the risk of suicidal attempts. Mood disorder was the most frequent psychiatric diagnosis, and the most common recommendations were to use psychopharmacological treatment along with outpatient visits. The 30% of subjects were referred to consultation within a day after hospitalization. In the case of consultation referral timing within two days and after three days, there was significant difference between early consultation and shorter hospitalization following the day of consultation. Most frequent type of consultation(29.6%) was categorized as IIIa type(physical complication type as a "Mending" request type). Conclusion : In review of consultation referral timing and consultation referral type of the subjects, who were referred for psychiatric consultation for one year at a newly opened University Hospital, referrals were found to be made within two days after their admission to hospital(50.7%), which was observed to be early request. We found that there was significant association between early consultation and shorter hospitalization following the day of consultation. The physical complication type(29.6%) which belongs to "Mending" request type was found to be the most frequent consultation referral type. This result indicates that more systematic psychiatric consultation is needed for the future.

• 정신신체의학
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• 제6권2호
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• pp.176-187
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• 1998

This study was performed to identify the significant variables affecting Follow-up after psychiatric consultation in General medical units and the trends of psychiatric consultation at the Hallym University hospital in Chunchon. Subjects of this study were 107 patients from April 1, 1998 to August 31, 1998, who were referred for psychiatric consultation during hospitalization. The results were as follows ; 1) Referral rate of General medical units was 7.5% and ordered Gastroenterology, Cardiology, nephrology, Other part. 2) The rate of total follow-up was 58% and the rate of No-follow-up was 42%. 3) In the cases of referral timing over admission 8th days, the days hospitalized after consultation performed were lengthened, significantly. 4) Common reasons for no follow-up of consultation were 'early- discharge' and 'patient's unwillingness to psychiatric reconsult. 5) Significant variables affecting follow-up were 'treatment recommendation', 'concordance with psychiatric drug recommendation', 'concordance with laboratory recommendation', 'total days hospitalized', 'Days hospitalization after consult was performed' and 'referral reason'.

• 정신신체의학
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• 제13권1호
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• pp.49-59
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• 2005

목적: 2001년부터 2003년까지 3년간 동안 일 종합병원 입원 환자에 대한 정신과 자문을 조사하여 이 기간 동안의 자문 의뢰의 특성을 알아보고, 최근 변화의 추세에 대하여 조사하여 이를 바탕으로 중요성이 높아지고 있는 자문조정 정신의학의 방향이나 이 분야 연구에 대한 자료를 얻고자 하였다. 대상 및 방법: 본 연구는 2001년 1월 1일부터 2003년12월31일 까지 3년간 부산 메리놀병원에 입원하여 정신과 자문 의뢰된 환자들을 대상으로 하여 실시하였으며, 정신과에 보관된 자문 목록을 바탕으로 차트를 검토하여 환자들의 자문 기록과 병록 일지를 참고하였고, 그 빈도수를 백분율로 처리하였다. 결과: 1) 전체 입원 환자에 대한 최근 3년간 정신과 평균 자문율은 1.72%이었다. 2) 최근 3년간 60세 이상 환자의 자문이 47.8%였고, 특히 70세 이상 환자가 20.2% 이었다. 3) 전체 자문 의뢰 중 내과가 72.5%로 빈도가 가장 많았다. 4) 자문 의뢰가 가장 많은 달은 3월이었으며, 12월이 가장 적었다. 5) 자문 의뢰 중 정서적인 이상 증상에 의하여 의뢰하는 경우가 가장 많았으며, 그 다음이 이학적인 이상 소견이 없이 신체적인 증상을 호소하는 경우이었으나, 점진적으로 감소하는 경향을 보였고, 약물 중독, 알콜 문제가 있는 경우 정신의학적 평가를 의뢰하는 경우는 증가하였다. 6) 자문 의뢰시 정신과적인 진단은 신체형 장애가 가장 많았으며, 우울 장애, 기질성 정신장애의 순이었다. 우울 장애와 신체형 장애, 알콜 의존의 진단은 매년 증가하는 추세이나, 불안장애, 기질성 정신장애의 진단은 감소하였다. 7) 자문 진료 후 권고 사항은 약물 치료가 가장 많았으며, 진단적인 검사를 의뢰하는 경우도 증가하였으며, 정신 치료를 권유하는 경우도 매년 증가하였다. 결론 : 본원의 정신과 자문율이 1.72%이었으며, 60세 이상의 노인 환자들이 47.8%이었으며, 이는 매년 증가하였다. 자문 의뢰의 주요 원인은 우울 등의 정서적인 이상으로 의뢰되는 경우가 가장 많았고, 내과에서 자문을 의뢰하는 경우가 가장 많았다. 자문 이후 약물 치료에 대한 권유가 가장 많았고, 그 비율이 낮기는 하였으나 정신 치료 등 정신과적인 접근을 권유하는 경우도 증가하는 경향을 보였다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제31권4호
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• pp.177-184
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• 2020

Objectives: This study aims to examine the effect of adolescent suicide survivors' experience on suicide death risk, and the effect of referral to mental health services (hereafter referral) in this regard. Methods: This study used the data of 878 suicide-deceased and suicide-attempted adolescents aged 8-19 years, managed by the Suicide and School Mental Health Institute from 2016 to 2018. Results: Regression analysis for main effects showed that although suicide experience had no direct effect on suicide death, non-referral status was associated with a greater risk of death by suicide. While the "non-suicide survivor with non-referral" and "suicide survivor with non-referral" groups showed 1.87 [adjusted odds ratio=1.87, 95% confidence interval (CI)=1.21-2.89] and 4.59 (adjusted odds ratio=4.59, 95% CI=2.02-10.42) times higher odds of suicide death, respectively, the "suicide survivor with referral" group showed no difference compared to the "non-suicide survivor with referral" group. Conclusion: From these findings, there is a need to strengthen referral to mental health services and apply complicated grief treatment to improve the mental health of adolescent suicide survivors.

• 한국응급구조학회지
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• 제5권1호
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• pp.177-198
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• 2001

The purpose of this research which was conducted by surveying the transfer consultation records from 360 medical institutions such as general hospitals, hospitals, clinics to the Emergency Medical Center at E University Hospital for six months(Jan. 1, 2000 - Jun. 30, 2000) are to standardize & complete transfer consultation record of hospitals at the 1st & 2nd referral level and to give patients transferred emergency medical center medical information services on a better quality. The conclusions and suggestions from this study were summarized as follows; (1) Examing the distribution of the referral medical consultation(transfer) sheet type, surgery part local clinic sheet types were 34.4%, medical part local clinic sheet types were 26.7%, undifferentiated local clinic sheet types were 23.9% and hospital level sheet types were 15.0%. (2) The items of the transfer consultation records had been standardized more than 75% in the order of patient's name, date, doctor's name, diagnosis, patient's status, impressions. (3) That the degree of recording completion on these items is in the order of patient's name, date, diagnosis, impressions was revealed. (4) Because the standardization and the degree of recording completion are very low in the patient's gender, age, address, electronic recording system was needed for more perfect input of initial patient informations. (5) This standardizing & complete recording on examination and medication will prevent re-examination and abuse of medication for patients transferred emergency medical center. (6) EMT Transfer System should be fixed in all medical institute for the standardizing & complete recording on care period and departure time will give many emergency patients the proper treatments at the proper time. (7) It was revealed that developing new standardized transfer consultation record & using electronic recording system are needed. (8) The complete recording & Fast Track System were needed for higher rate of bed operation at emergency medical center and more hospital profit.

• 대한치과의사협회지
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• 제57권8호
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• pp.428-436
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• 2019

In cases of a patient referral, the general dentist should communicate the patient's dental information as clearly as possible to the specialist to whom he/she is referring his/her patient. For this reason, it is necessary to write a referral letter in an accurate and complete manner. The purpose of this study is to analyze the referral letters of patients who are referred to the department of conservative dentistry in a dental university hospital. From January, 2017 to December, 2018, we gathered the information of the patients who were referred to the department of conservative dentistry in a dental university hospital with referral letter. We evaluated the fidelity of a total of 750 referral letters and recorded the information of the referral dentist and the dental clinic. The relationship between each item and fidelity was analyzed using SPSS 18.0 program. The analysis of the contents of the referral letters yielded the following results: The fidelity of the referral letter was higher when the patient was referred during the root canal treatment, or when there was a root canal filling or when there was pain during chewing. The fidelity of referral letter was low in cases where the referring clinic is close to and has cooperative relationship with dental university hospital. Among the factors affecting the fidelity, the year of graduation of the referral dentist was the most influential. This study confirmed the fact that the clinical practice of writing patient referral letters still leaves much to be desired. In order to solve this problem, it is necessary to create more clear and standardized guidelines for writing referral letters.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제16권1호
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• pp.72-78
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• 2005

목 적 : 종합병원에서의 소아청소년을 대상으로 한 정신과 자문의 임상적 특징을 알아보고자 하였다. 방 법 : 4년 동안 한 종합병원에서 소아정신과에 의뢰된 302명의 환자의 병원기록을 조사 분석하였다. 결 과 : 학령기 아동과 청소년의 소아정신과 자문비율은 $2.15\%$였다. 중, 고등학생에서는 여자에서 더 많이 자문이 의뢰되었으나 학령전기 아동에서는 남자에서 더 많이 의뢰되었다. 자문의 $50\%$가 내과와 소아과로부터 의뢰되었다. 자문의뢰의 주된 이유는 정신과적 평가$(31.1\%)$, 우울$(11.6\%)$, 그리고 불안$(11.3\%)$이었다. 가장 자주 행해진 치료 목적의 정신과적 처치는 정신과적 교육과 지지적 정신치료였다$(21.2\%)$. 결 론 : 정신과 자문 의뢰의 임상적 양상은 성인과 소아청소년 사이에 차이가 있다. 소아 및 청소년을 위한 자문서비스를 강화시키기 위하여 더 많은 연구가 필요하다.

• 대한간호학회지
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• 제48권5호
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• pp.554-564
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• 2018

Purpose: This study aimed to construct a management model for patient transfer in a multilevel healthcare system and to predict the effect of counseling with nurses on the patient transfer process. Methods: Data were collected from the electronic medical records of 20,400 patients using the referral system in a tertiary hospital in Seoul from May 2015 to April 2017. The data were analyzed using system dynamics methodology. Results: The rates of patients who were referred to a tertiary hospital, continued treatment, and were terminated treatment at a tertiary hospital were affected by the management fee and nursing staffing in a referral center that provided patient transfer counseling. Nursing staffing in a referral center had direct influence on the range of increase or decrease in the rates, whereas the management fee had direct influence on time. They were nonlinear relations that converged the value within a certain period. Conclusion: The management fee and nursing staffing in a referral center affect patient transfer counseling, and can improve the patient transfer process. Our findings suggest that nurses play an important role in ensuring smooth transitions between clinics and hospitals.

• Healthcare Informatics Research
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• 제24권4호
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• pp.317-326
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• 2018

Objectives: The demand for hospice has been increasing among patients with cancer. This study examined the current hospice referral scenario for terminally ill cancer patients and created a data form to collect hospice information and a modified health information exchange (HIE) form for a more efficient referral system for terminally ill cancer patients. Methods: Surveys were conducted asking detailed information such as medical instruments and patient admission policies of hospices, and interviews were held to examine the current referral flow and any additional requirements. A task force team was organized to analyze the results of the interviews and surveys. Results: Six hospices completed the survey, and 3 physicians, 2 nurses, and 2 hospital staff from a tertiary hospital were interviewed. Seven categories were defined as essential for establishing hospice data. Ten categories and 40 data items were newly suggested for the existing HIE document form. An implementation guide for the Consolidated Clinical Document Architecture developed by Health Level 7 (HL7 CCDA) was also proposed. It is an international standard for interoperability that provides a framework for the exchange, integration, sharing, and retrieval of electronic health information. Based on these changes, a hospice referral scenario for terminally ill cancer patients was designed. Conclusions: Our findings show potential improvements that can be made to the current hospice referral system for terminally ill cancer patients. To make the referral system useful in practice, governmental efforts and investments are needed.

• 대한치과교정학회지
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• 제53권2호
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• pp.116-124
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• 2023

Objective: The absence of a guideline to refer to developing malocclusions appropriately, may be a contributing factor to the inadequacy of timely interceptive orthodontics provision. This study aimed to develop and validate a new orthodontic grading and referral index to be used by dental frontliners to prioritize the orthodontic referral of developing malocclusion in children based on its severity. Methods: A cross-sectional study involving clinical assessment with 413 schoolchildren aged between 8.1 and 11.9 years was conducted in 2018. All the presenting malocclusion was listed and graded based on a few dental guidelines to produce the draft index. The validity and reliability of the draft index were tested using twenty study models. Face and content validation was carried out using the content validation index and Modified Kappa Statistics. Results: Fourteen dental and occlusal anomalies were identified as components of malocclusion and three grades of referral (monitor, standard, urgent) were included in the final index. The scale-level content validity index average value of 0.86 and 0.87 was obtained for content and face validation, respectively. There was moderate to excellent agreement in the Modified Kappa Statistics for both validations. Excellent inter- and intra-assessor agreement was obtained. The new index displayed valid and reliable scores. Conclusions: The Index for Interceptive Orthodontics Referral was developed and validated for the dental frontliners to identify and prioritize the developing malocclusion in children based on its severity and refer for orthodontic consultation to increase the possibility for interceptive orthodontics.