• Quality Improvement in Health Care
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• v.27 no.1
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• pp.10-19
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• 2021

Purpose: This study was designed to investigate that the prevalence of Post-traumatic stress disorder (PTSD) and occupational environmental factors that contribute to the developing of PTSD in workers who worked in emergency room in Korea. Methods: This study is a multicenter cross-sectional study that was conducted in three emergency rooms. Data was collected by self-response method through questionnaire. The Impact Event Scale-Revised was used to screen the high-risk group of PTSD. Univariate and multivariate regression analysis was used to identify the factors associated with the developing of high-risk group of PTSD. Results: Total 211 subjects responded to the questionnaire. Of these, 170 subjects experienced psychological trauma event (PTE) in the working environment. And 60 subjects classified as high risk group of PTSD, so a prevalence of high risk group for PTSD was 28.4%. Factors related to the high risk group of PTSD were the frequency of psychological trauma events experienced over the past 1 year and the high score of QIDS-SR16. Conclusion: The prevalence of high risk group for PTSD among emergency room workers in Korea is very high. This may adversely affect the safety of patients, so early screening and intervention are necessary.

• Journal of Korean Academy of Nursing Administration
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• v.9 no.3
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• pp.481-494
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• 2003

Purpose: This study was to develop nursing competencies, sub-competencies and behavior indicators according to the clinical ladder of emergency nurses. Method: index of content validation was used by 21 clinical experts. Results: This study had three phases to develop nursing competencies, sub-competencies and behavior indicators. In first phase: 12 nursing competencies and 33 sub-competencies were developed through the literature review on nursing competency and emergency nurses' job description. The content of 12 competencies and 33 sub-competencies were reviewed by 3 nursing professors. The 12 competencies and 33 sub-competencies were followed: clinical judgement and measures(6 sub-competencies), processing ability of ward works(2 sub-competencies), flexibility(2 sub-competencies), resources management(2 sub-competencies), confidence(3 sub-competencies), cooperation(2 sub-competencies), professional development power(2 sub-competencies), patient service orientation(3 sub-competencies), inclination toward ethical value(5 sub-competencies), influence power(2 sub-competencies), developing others(2 sub-competencies), self control(2 sub-competencies). In second phase, 132 behavior indicators were developed according to nurse clinical ladder: novice, advanced novice, competent, proficient. In Third phase, content validity was examined on 132 behavior indicators by 21 clinical experts. 126 among 132 indicators had over 70% agreement among experts and 6 indicators under 70% were revised. Conclusion: nursing competencies, sub competencies and behavior indicators can be used nurses' clinical performance as well as establishing proper directions for professional growth related to reward system.

• Journal of the Korea Convergence Society
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• v.3 no.4
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• pp.23-28
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• 2012

The aim of this study is to reveal the right approach and prognosis of cerebrovascular accident (CVA) by reviewing the various researches on CVAs. The reviews were done by BNBI PubMed, KMBase, RISS, and KoreaMed. Based on the articles, prevalence rate of CVA, prehospital CVA patients assessment and emergency care, and in-hospital care were analyzed. The most important scales are Cincinnati prehospital stroke scale(CPSS) and Los Angeles prehospital stroke screen(LAPSS). These two scales are the basic assessment tools for CVAs and it is necessary to perform the emergency care by way of these scales.

• The Korean Journal of Emergency Medical Services
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• v.22 no.3
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• pp.163-176
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• 2018

Purpose: The purpose of this study was to determine the effectiveness of hands-only CPR education according to the American Heart Association (2015) guideline for undergraduates with severe visual impairment, to provide basic data for expanding the subject of hands-only CPR education among the visually impaired. Methods: Twenty-one students attending four universities in C Province, aged 19 years or older, were enrolled in this study. These students had severe visual impairment and no other disabilities and have never received hands-only CPR education. This study data were collected from December 1, 2017 to January 11, 2018. The accuracy of the participants' technique was measured using Brayden Pro CPR manikin. The data were analyzed using SPSS version 24.0. Results: Hands-only CPR education was effective in increasing confidence and accuracy of chest compression among undergraduates with severe visual impairment. Conclusion: These findings suggest that individuals with severe visual impairment should be given more educational opportunities. Additionally, subsequent studies should develop equipment that helps increase accuracy by using video aids with commentary or other auditory components for the visually impaired.

• Journal of Veterinary Clinics
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• v.31 no.2
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• pp.90-94
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• 2014

This study was performed to investigate on the frequent chief complaints and the causes of dogs and cats visiting to an emergency department, and to suggest the minimum requirements for veterinary emergency clinics in South Korea. The medical records were reviewed for 2,368 dogs and 347 cats visiting the emergency department of Haemaru Referral Animal Hospital from March 2012 to August 2013. Among them, 255 dogs and 35 cats visited more than one time and each visit was considered as an individual case. Therefore, 2,784 cases of dogs and 396 cases of cats were reviewed. The medical records were analyzed according to the criteria such as signalment, chief complaints, diagnoses, hospital admission, and outcome. In dogs, vomiting, diarrhea, or both were the most common chief complaints, followed by dyspnea, trauma, seizure, and lethargy. The most common causes of emergency visits were gastrointestinal disorders, followed by neurologic, cardiovascular, respiratory, urologic, and hematologic disorders. In cats, dyspnea was the most common chief complaint, followed by vomiting, diarrhea, or both, trauma, dysuria, and lethargy. The most common causes of emergency visits were urologic disorders followed by gastrointestinal, respiratory, infectious, and cardiovascular disorders. According to the results, vomiting, diarrhea, dyspnea, and trauma were the most frequently encountered chief complaints, which accounted for approximately 48.6% of all cases in both dogs and cats. However common causes were differed between the dogs and the cats. In order to provide proper emergency service, it is required to prepare the clinicians and facilities to diagnose and stabilize these emergency patients.

• Health Policy and Management
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• v.28 no.2
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• pp.168-177
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• 2018

Background: This study investigates the potential volume and outcome association of coronary heart disease (CHD) patients who have undergone percutaneous coronary intervention (PCI) using a large and representative sample. Methods: We used a National Health Insurance Service-Cohort Sample Database from 2002 to 2013 released by the Korean National Health Insurance Service. A total of 8,908 subjects were analyzed. The primary analysis was based on Cox proportional hazards models to examine our hypothesis. Results: After adjusting for confounders, the hazard ratio of thirty-day and 1-year mortality in hospitals with a low volume of CHD patients with PCI was 2.8 and 2.2 times higher (p=0.00) compared to hospitals with a high volume of CHD patients with PCI, respectively. Thirty-day and 1-year mortality of CHD patients with PCI in low-volume hospitals admitted through the emergency room were 3.101 (p=0.00) and 2.8 times higher (p=0.01) than those in high-volume hospitals, respectively. Only 30-day mortality in low-volume hospitals of angina pectoris and myocardial infarction patients with PCI was 5.3 and 2.4 times those in high-volume hospitals with PCI, respectively. Conclusion: Mortality was significantly lower when PCI was performed in a high-volume hospital than in a low-volume hospital. Among patients admitted through the emergency room and diagnosed with angina pectoris, total PCI volume (low vs. high) was associated with significantly greater cardiac mortality risk of CHD patients. Thus, There is a need for better strategic approaches from both clinical and health policy standpoints for treatment of CHD patients.

• The Korean Journal of Health Service Management
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• v.8 no.4
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• pp.109-119
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• 2014

The purpose of this research is to determine oriental hospital staffs' education status, their knowledge, overall attitudes and self-confidence in conducting cardiopulmonary resuscitation (CPR) and how those factors influence their performance of CPR. This research was conducted from September 1st to 15th in 2014 and involved 104 participants who worked at P Oriental Hospital at Y city, and well-structured surveys were used throughout the research. The collected data underwent descriptive statics, t-test, ANOVA, Scheffe' test, Pearson correlation coefficients and stepwise multiple regression by the SPSS WIN 19.0 program. The results revealed the staffs' knowledge of CPR (r=.27, p=.007), attitude (r=.42, p=.001), and confidence in conducting cardiopulmonary resuscitation (r=.48, p=.001), which indicates all the factors are positively correlated. In conclusion, as the knowledge of CPR increased, CPR attitude and CPR performance confidence increased. We also found that a positive attitude toward CPR increases CPR performance confidence. Therefore, education in CPR should be included in workplaces. Through education, CPR performance and performance confidence can be reinforced at the time of emergency.

• Journal of Korean Clinical Nursing Research
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• v.25 no.3
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• pp.275-284
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• 2019

Purpose: The purpose of this study was to analyze the current state of home health nursing (HHN) for elders and to provide basic data on policy alternatives for establishing home medical care in the advanced general hospital. Methods: This study was conducted as a secondary data analysis, using electronic medical record (EMR) data of older patients who received HHN more than once from the S advanced general hospital between January 2016 and December 2018. Results: A total of 1,790 patients received HHN visits, with 22,477 visits being made. The mean age was 76.8±7.3 years old, 96.0% of elders had health insurance and 24.6% had orthopedics problems. Of the 1,168 people who visited emergency rooms, the most frequent symptom was pain (23.4%) and all patients visited the hospital at least once and at most 163 times outpatient care during HHN. Causative diseases were degenerative knee joint osteoarthritis (0.6%), surgery for right knee replacement (4.0%), and for dressings (9.7%) in the HHN service content analysis. Conclusion: The progress towards an aging society and the introduction of community care are expected to further enhance the need for HHN which should be able to provide comprehensive and continuous visiting health care services to the older patients. The results of this study are expected to help doctors solve problems not solved by HHN, reduce unnecessary emergency room or outpatient visits, and readmission, while at the same time contributing to the improvement of patient quality of life through efficient patient health care.

• The Korean Journal of Emergency Medical Services
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• v.15 no.3
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• pp.31-44
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• 2011

Purpose : The purpose of emergency medical services(EMS) is to save human lives and assure the completeness of the body in emergency situations. Those who have been qualified on medical practice to perform such treatment as there is the risk of human life and possibility of major physical and mental injuries that could result from the urgency of time and invasiveness inflicted upon the body. In the emergency medical activities, 119 emergency medical technicians mainly perform the task but they are not able to perform such task independently and they are mandatory to receive medical direction. The purpose of this study is to examine the recognition and request for medical direction by 119 emergency medical technicians in order to provide basic information on the development of medical direction program suitable to the characteristics of EMS as well as for the studies on EMS for the sake of efficient operation of pre-hospital EMS. Method : Questionnaire via e-mail was conducted during July 1-31, 2010 for 675 participants who are emergency medical technicians, nurses and other emergency crews in Gyeongbuk. The effective 171 responses were used for the final analysis. In regards to the emergency medical technicians' scope of responsibilities defined in Attached Form 14, Enforcement regulations of EMS, t-test analysis was conducted by using the means and standard deviation of the level of request for medical direction on the scope of responsibilities of Level 1 & Level 2 emergency medical technicians as the scale of medical direction request. The general characteristics, experience result, the reason for necessity, emergency medical technicians & medical director request level, medical direction method, the place of work of the medical director, feedback content and improvement plan request level were analyzed through frequency and percentage. The level of experience in medical direction and necessity were analyzed through ${\chi}^2$ test. Results : In regards to the medical direction experience per qualification, the experience was the highest with 53.3% for Level 1 emergency medical technicians and 80.3% responded that experience was helpful. As for the recognition on the necessity of medical direction, 71.3% responded as "necessary" and it turned out to be the highest of 76.9% in nurses. As for the reason for responding "necessary", the reason for reducing the risk and side-effects from EMS for patients was the largest(75.4%), and the reason of EMS delay due to the request of medical direction was the highest(71.4%) for the reason for responding "not necessary". In regards to the request level of the task scope of emergency medical technicians, injection of certain amount of solution during a state of shock was the highest($3.10{\pm}.96$) for Level 1 emergency rescuers, and the endotracheal intubation was the highest($3.12{\pm}1.03$) for nurses, and the sublingual administration of nitroglycerine(NTG) during chest pain was the highest($2.62{\pm}1.02$) for Level 2 emergency medical technicians, and regulation of heartbeat using AED was the highest($2.76{\pm}.99$) for other emergency crews. For the revitalization of medical direction, the improvement in the capability of EMS(78.9%) was requested from emergency crew, and the ability to evaluate the medical state of patient was the highest(80.1%) in the level of request for medical director. The prehospital and direct medical direction was the highest(60.8%) for medical direction method, and the emergency medical facility was the highest(52.0%) for the placement of medical director, and the evaluation of appropriateness of EMS was the highest(66.1%) for the feedback content, and the reinforcement of emergency crew(emergency medical technicians) personnel was the highest(69.0%) for the improvement plan. Conclusion : The medical direction is an important policy in the prehospital EMS activity because 119 emergency medical technicians agreed the necessity of medical direction and over 80% of those who experienced medical direction said it was helpful. In addition, the simulation training program using algorithm and case study through feedback are necessary in order to enhance the technical capability of ambulance teams on the item of professional EMS with high level of request in the task scope of emergency medical technicians, and recognition of medical direction is the essence of the EMS field. In regards to revitalizing medical direction, the improvement of the task performance capability of 119 emergency medical technicians and medical directors, reinforcement of emergency medical activity personnel, assurance of trust between emergency medical technicians and the emergency physician, and search for professional operation plan of medical direction center are needed to expand the direct medical direction method for possible treatment beforehand through the participation by medical director even at the step in which emergency situation report is received.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.113-118
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• 2010

Purpose: Prolonged stay in the emergency department (ED), which is closely related with the time interval from the ED visit to a decision to admit, might be associated with poor outcomes for trauma patients and with overcrowding of the ED. Therefore, we examined the factors affecting the delay in the decision to admit severe trauma patients. Also, a multidisciplinary department system was preliminarily evaluated to see if it could reduce the time from triage to the admission decision. Methods: A retrospective observational study was conducted at a tertiary care university hospital without a specialized trauma team or specialized trauma surgeons from January 2009 to March 2010. Severe trauma patients with an International Classification of Disease Based Injury Severity Score (ICISS) below 0.9 were included. A multivariable logistic regression analysis was used to find independent variables associated with a delay in the decision for admission which was defined as the time interval between ED arrival and admission decision exceeded 4 hours. We also simulated the time from triage to the decision for admission by a multidisciplinary department system. Results: A total of 89 patients were enrolled. The average time from triage to the admission decision was $5.2{\pm}7.1$ hours and the average length of the ED stay was $9.0{\pm}11.5$ hours. The rate of decision delay for admission was 31.5%. A multivariable regression analysis revealed that multiple trauma (odds ratio [OR]: 30.6, 95%; confidence interval [CI]: 3.18-294.71), emergency operation (OR: 0.55, 95%; CI: 0.01-0.96), and treatment in the Department of Neurosurgery (OR: 0.07, 95%; CI: 0.01-0.78) were significantly associated with the decision delay. In a simulation based on a multidisciplinary department system, the virtual time from triage to admission decision was $2.1{\pm}1.5$ hours. Conclusion: In the ED, patients with severe trauma, multiple trauma was a significant factor causing a delay in the admission decision. On the other hand, emergency operation and treatment in Department of Neurosurgery were negatively associated with the delay. The simulated time from triage to the decision for admission by a multidisciplinary department system was 3 hours shorter than the real one.