• 보건행정학회지
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• 제34권1호
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• pp.17-25
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• 2024

연구배경: 본 연구의 목적은 17개 광역시·도 내 응급의료병상 적정 분배수준과 분배수준에 따른 경제적 편익을 추정하기 위함이다. 방법: 각 지역별 응급의료병상의 적정 분배수준을 추정하기 위하여 통계청에서 발표한 '2014-2021년 사망원인통계자료', '지역·인구·성별·연령에 관한 지역통계' 그리고 '장래인구추계'를 활용하였으며, 추가적으로 건강보험심사평가원에서 발표한 '시군구별 응급실 병상 수' 자료도 활용하였다. 또한 응급의료시설 증가로 인해 감소된 예방 가능한 응급사망자들의 경제적 편익을 추정하기 위해 한국개발연구원과 한국교통연구원의 지침을 참고하여 응급사망에 따른 임금 손실비용을 계산하고 적용하였다. 결과: 응급의료병상의 적정 분배량은 경기, 서울, 경남, 경북, 부산 순으로 높았고 대전, 제주, 세종은 상대적으로 낮은 수준을 보였다. 또한 응급의료시설 증가로 인한 경제적 편익은 경기, 서울, 경북, 경남, 부산에서 가장 높은 것으로 분석되었다. 한편, 17개 광역시·도별 인구표준화를 통해 계산한 경제적 편익은 경북, 충남, 전남, 경남 그리고 부산 순으로 높은 것으로 분석되었다. 결론: 본 연구결과는 향후 지역별 적정 응급의료시설 분배를 위한 기초자료로 활용될 수 있으며, 지역 간 응급의료시설 공급의 불균형을 해소하기 위한 정책에 기여할 수 있다. 또한 지역 특성을 감안하여 응급의료시설의 분배수준을 조정하는 것은 궁극적으로 국가 재정의 효율성을 증가시키고 경제적 편익을 얻을 수 있을 것으로 판단한다.

• 보건행정학회지
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• 제23권2호
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• pp.145-151
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• 2013

Background: The objective of this study was to explore patient family's evaluation of emergency department (ED) service satisfaction and to compare these with ED staff perception of patient family's evaluation. Methods: Based on two surveys of the National Emergency Medical Center: the 2008 National Survey for Recognition and Satisfaction towards Emergency Medical Services and the 2008 Opinion Survey of Emergency Medical Service Providers, satisfaction gaps among physicians, nurses, and patient family were evaluated by Kruskal-Wallis tests and Wilcoxon-Mann-Whitney tests. Furthermore, the factors associated with satisfaction of emergency medical service were identified by ordinal logistic regression models. Results: There were statistically significant gaps among physicians, nurses, and patient family in overall satisfaction with ED visit, length of stay in ED, enough explanation, physicians/nurses kindness, and ED facilities. Age and income in the patient family model, the number of beds in hospital, job satisfaction and year of service in the physicians model, and the number of beds in hospital, job satisfaction and the number of patients per duty hour in the nurses model were statistically significant factors associated with evaluation/ perception of ED service satisfaction. Conclusion: Patient satisfaction is an important indicator of the quality of care and service delivery in the ED. To improve and understand satisfaction in ED service, a dyadic view of the evaluation of service quality and satisfaction-that is, from the perspectives of both the patient and the emergency medical service providers-should be concerned.

• 한국시뮬레이션학회논문지
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• 제18권3호
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• pp.35-45
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• 2009

응급진료센터(Emergency Medical Center, EMC)는 질병, 분만, 각종 사고 및 재해로 인한 부상으로 즉시 응급처치를 받아야 하는 환자들을 위한 장소이다. 현재 대부분의 EMC는 정규병상으로만 응급환자를 수용하여 서비스할 수 없는 관계로 임시 병상을 운영하고 있으나, 응급환자 및 보호자의 서비스 질(quality of service, QoS) 향상과 EMC의 효율적인 운영을 위하여 임시병상 사용률을 낮추는 개선이 필요한 상황이다. 본 연구에서는 임시병상 개수를 줄이면서도 응급환자의 체류시간이 증가하지 않는 개선안을 실행에 옮기는데 필요한 의사결정 정보를 응급의료학과에 제공하고자 한다. EMC 환자가 응급진료를 받는 시간보다 타부서 전문의와의 협의진료 시간과 다른 병동 입원 대기시간의 과다가 QoS 저하와 임시병상 투입의 주요 원인이 되고 있으므로 이들을 제어하는 것이 핵심이라고 할 수 있다. 본 논문에서는 EMC를 잘 묘사하는 Arena 시뮬레이션 모델을 제안하고, EMC 최적 운영 파라미터 값들을 결정하는 실험 결과를 제시하고 있다. 최적화 모델을 시뮬레이션과 연동하여 실험을 하기 위하여 Arena에 탑재된 OptQuest를 사용하였다. 실험 결과, 짧은 실행시간 안에 응급환자의 체류시간을 증가시키지 않으면서, 임시병상 개수를 줄일 수 있는 최적의 파라미터 셋을 얻을 수 있었다.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제14권2호
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• pp.25-34
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• 2008

The purpose of this study was to spatial organization feature and area composition of the over 500beds general hospital that will be expected construct in Seoul, Gyeonggi-do area after 2000year. From this study, we can suggest architectural planning for the efficiency operating of emergency medical facilities that can be used as preliminary data. The Spatial organization of emergency medical facilities are categorize into 4 session as medical examination and treatment, diagonosticradiology, staff, public and the others. We can find spatial organization system and area composition that compare area composition of 6 hospital the subject of research in a emergency medical facilities. The result of this study were as follows : spatial distribution of its field, grasping of spatial organization factor and recognize its merits and demerits should be researched in advance. Through this kind of recognizing emergency system, realistic medical local and condition architectural planning for spatial organization will be operate.

• 한국응급구조학회지
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• 제25권3호
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• pp.179-188
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• 2021

Purpose: This study aimed to identify effective cardiopulmonary resuscitation methods by comparing the fatigue of rescuers according to various positions in cardiopulmonary resuscitation situations conducted on beds in hospitals. Methods: An experimental study of students in the department of emergency medical service in H University, G Metropolitan City was conducted in four positions for applying chest pressure on mannequins on beds. Results: As a result of measuring the muscle fatigue of four muscle attachments according to the four positions conducted on the bed, the average was 3.4%, the P was significant at 0.001, and the fatigue difference was confirmed to occur depending on the attachment. An analysis of pressure depth by pose revealed that P1, P2, P3, and P4 have a depth of 58.3, 55.1, 56.4, and 56.3 mm, respectively, with P4 having the deepest depth. Conclusion: Among the various postures of the rescuer during cardiopulmonary resuscitation performed on the bed in the hospital, P1 is thought to be the most tiring, although its associated CPR quality is good.

• 한국응급구조학회지
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• 제15권1호
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• pp.25-35
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• 2011

Purpose & Method : This purpose of this paper was to show the importance of paramedics. The trauma patients receiving a temporary treatment from emergency medical technician filled out a self-administered questionnaire. The questionnaire consisted of the satisfaction for EMS. The data collection was from October 23 to November 12, 2006. The patients were in the Kyeonggi province hospital having more than 500 beds. At the time of discharge, the questionnaire forms were distributed. Results : Males showed higher satisfaction than females when they had a paramedics, and this indicated statistically significant difference(p<.05). The groups showing higher satisfaction for EMT 1 practice included patients over 40 years old, educated under high school, and income over 2 million won. Before the trauma patients were treated, they were satisfied with short waiting time less than 10 minutes. They showed higher satisfaction within 2 hours duration. Conclusion : Summing up the above result, it was found that the group treated by an emergency medical technician showed higher satisfaction than the group not treated by an emergency medical technician. Therefore, it is necessary to arrange paramedics in emergency medical centers to improve satisfaction with emergency medical services. And since it is a crucial factor that affects patient's satisfaction significantly, it is urgent to increase the roles of emergency medical technicians and lay the foundation for legal institutions.

• 보건행정학회지
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• 제19권2호
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• pp.71-84
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• 2009

Objectives : The purpose of this study is to analyze the proportion of admission via the emergency room(the rest is ER) in an emergency medical center and to examine the factors related to admission. Methods : This study used 2005 National Health Insurance claims data for admitted patients of 112 hospitals having emergency medical centers in Korea. The study sample had 2,335,610 patients. The data was classified into emergency admission and non-emergency admission. To investigate the factors affecting the type of admission, the following were included as independent variables: type of health assurance_(national health insurance beneficiaries or medical aid beneficiaries), demographic characteristics_ (sex, age), cause of admission_ (disease or injury), whether an operation was performed or not, DRG severity level, the number of beds, and the location of the hospital. Data were analyzed using the Chi-square test for the differences in emergency admission rates for each variables, and multiple logistic regression analysis was used for identifying the factors affecting admission type. Results : The proportion of admission via the ER accounted for 40.6% of the total admission among hospitals having emergency medical centers. The risk of admission via ER was relatively high for patients who were male, the aged, the injured, the surgical patients, the patients having more severe symptoms, and the patients admitted the hospitals located in metropolitan areas, and the patients admitted the hospitals having 300-699 beds. Medical aid patients were more likely admitted through the emergency room than health insurance patients after other variables ware adjusted. Conclusions and Discussion : We analyzed the proportion of admission via the ER for the total admission rate of hospitals having an emergency medical center in Korea. And we explored the factors related to admission via the ER. This proportion may be used as an indicator of the adequacy of medical utilization or low accessibility to hospitals of patients with low socioeconomic status.

• Journal of Trauma and Injury
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• 제24권1호
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• pp.37-44
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• 2011

Purpose: Recently, social interest in an organized trauma system for the treatment of patients has been increasing in government and academia and the establishment of trauma center is being considered across the country. However, establishing such a system has not been easy in Korea, because enormous experiences and resources are necessary. The objectives of this study were (1) to estimate a trauma patient's demands during the course of treatment and (2) to provide appropriate direction for trauma centers to be established in Korea. Methods: The records of 207 patients who were admitted to the Department of Trauma Surgery in Ajou University Medical Center due to trauma were retrospectively reviewed for a 1 year period from March 2010 to February 2011. Patients were reviewed for general characteristics, number of hospital days, numbers and kinds of surgeries, numbers and kinds of consultations, ISS (Injury Severity Score) and number of patients with ISS more than 15. Results: All 207 patients were enrolled. The average number of hospital days was 36.7 days. The ICU stay was 15.9 days, and the general ward stay was 20.8 days. Admitted patients occupied 9.02 beds in ICU and 11.80 beds in the general ward per day. The average number of surgeries per patient was 1.4, and surgery at the Department of Trauma Surgery was most common. Number of consultations per patient was 14.23, and consultations with orthopedic surgeons were most common. The average ISS was 18.6. The number of patients with ISS more than 15 was 141 (61.8%) and the average number of patients treated per trauma surgeon as a major trauma patient was 94.3. The number of mortalities was 20, and the mortality rate was 9.7%. Conclusion: To reduce mortality and to provide proper treatment of patients with major trauma, hospitals need some number of beds, especially in the ICU, to treat patients and to prepare them for emergent surgery. An appropriate number of trauma surgeons and various specialists for consultation are also needed.

• 한국의료질향상학회지
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• 제12권1호
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• pp.114-123
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• 2006

Background : Patients who were discharged from the emergency department(ED) may revisit. These patients are divided into two groups; one is expected scheduled condition, the other is unexpected condition. These patients of inappropriate revisits to the ED would be unsatisfied, difficult to make rapport and take legal action as a result of additional medical charges. The purpose of this study was to reduce inappropriate revisits to the ED with a new method which was developed by analyzing inappropriate revisits in 2002. Methods : This study was conducted in a tertiary hospital consisting of 1,278 beds. The most common cause of inappropriate revisits was the medical team's lack of explanation about a disease. Thus we decided that the effective method was to offer full explanations to patients to understand the clinical pathway of a disease. We made four types of stickers to explain most common 4 diseases in 2003. An emergency physician completed 'discharge explanation report' and explained it to patients in 2004. Results : In 2002 inappropriate revisited patients were 164, patients with four diseases were 79. During the same period of 2003, inappropriate revisited patients were 56 (-65.9%), four disease patients were 6 (-92.4%) and in 2004 inappropriate revisited patients were 52, four disease patients were 19. Causes of revisits were lack of explanation about a disease in 35 patients (44.3%) in 2003, and 5 patients (83.3%) in 2003, and 16 patients (84.2%). Conclusions : Application of 'explanation stickers' at discharge reduced inappropriate revisits from 34.5% in 2002 to 15.9% in 2003. Application of 'Discharge explanation report' by emergency physician reduced inappropriate revisits from 15.9% in 2003 to 13.5% in 2004. Reduction of inappropriate revisits elevated the quality of medical treatment, and decreased patients' dissatisfaction in ED.

• 한국병원경영학회지
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• 제9권1호
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• pp.46-65
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• 2004

The study was designed to investigate what effect of working time reduction which will be gradually expanded to corporate size from June, 2004 could give to medical industries, and to provide basic information for hospitals and government to prepare the policy. 276 hospitals were surveyed about medical service income and manpower realities during the first half of 2003, using a structured survey tool. Response rate was 8% and 20 hospitals were finally analyzed. The effect of working time reduction in hospital management was different to the size of hospitals and the alternative. Income to existing service income was decreased by $2.2{\sim}4.6%$ in tertiary hospitals, by $3.2{\sim}5.7%$ in general hospitals with more than 300 beds, and by $3.7{\sim}6.0%$ in general hospitals with less than 300 beds. In preparation against such decrease in income, government is required to raise insurance payment, to calculate added service charge for day-off on Saturday forenoon, to retain emergency care payment, to expand emergency care facilities, to secure duty doctors, and to support middle and small sized hospitals. Hospitals are required to give self improving efforts such as fortifying of weekday care, development of weekend care program, strengthening of care capacity and function of emergency care center, and making manpower operation efficient.