• Journal of Trauma and Injury
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• v.37 no.1
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• pp.60-66
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• 2024

Purpose: This study investigated changes in interpersonal violence and utilization of trauma recovery services during the COVID-19 pandemic. At an urban level I trauma center, trauma recovery services (TRS) provide education, counseling, peer support, and coordination of rehabilitation and recovery to address social and mental health needs. The COVID-19 pandemic prompted considerable changes in hospital services and increases in interpersonal victimization. Methods: A retrospective analysis was conducted between September 6, 2018 and December 20, 2020 for 1,908 victim-of-crime patients, including 574 victims of interpersonal violence. Outcomes included length of stay associated with initial TRS presentation, number of subsequent emergency department visits, number of outpatient appointments, and utilization of specific specialties within the year following the initial traumatic event. Results: Patients were primarily female (59.4%), single (80.1%), non-Hispanic (86.7%), and Black (59.2%). The mean age was 33.0 years, and 247 patients (49.2%) presented due to physical assault, 132 (26.3%) due to gunshot wounds, and 76 (15.1%) due to sexual assault. The perpetrators were primarily partners (27.9%) or strangers (23.3%). During the study period, 266 patients (mean, 14.9 patients per month) presented before the declaration of COVID-19 as a national emergency on March 13, 2020, while 236 patients (mean, 25.9 patients per month) presented afterward, representing a 74.6% increase in victim-of-crime patients treated. Interactions with TRS decreased during the COVID-19 period, with an average of 3.0 interactions per patient before COVID-19 versus 1.9 after emergency declaration (P<0.01). Similarly, reductions in length of stay were noted; the pre-COVID-19 average was 3.6 days, compared to 2.1 days post-COVID-19 (P=0.01). Conclusions: While interpersonal violence increased, TRS interactions decreased during the COVID-19 pandemic, reflecting interruption of services, COVID-19 precautions, and postponement/cancellation of elective visits. Future direction of hospital policy to enable resource and service delivery to this population, despite internal and external challenges, appears warranted.

• Health Policy and Management
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• v.5 no.2
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• pp.35-69
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• 1995

The managerial environment of hospitals in Korea characterized by low levels of medical insurance fees is worsening by increasing government regulations as to the utilization of medical services, rising costs of labor, material, and medical equipments, growing patient expectations concerning the quality of services, and escalating competitions among large hospitals in the market. Hospitals should seek for their survival strategies in this harsh environment and they should have information about costs of their products in doing so. However, it has not been available due to the complexity of the production process of hospital services. The objectives of this study were to develop a service-based cost accounting model and to apply the developed model to a study hospital to obtain cost information of hospital services. A model commonly used for the job-order product cost accounting in the manufacturing industry was modified for the use in hospitals in Korea. Actual costs, instead of standard costs, incurred to produce a unit of services during a given period of time were estimated in the model. Data required to implement the model included financial information, statistics for the allocation of supportive cost center costs to final cost centers, statistics for the allocation of final cost center costs to services, and the volume of each services charged to patients during a study period. The model was executed using data of a university teaching hospital located in Seoul for the fiscal year 1992. Data for financial information, allocation statistics fo supportive service costs, and the volume of services, most of them in electronic form, were available to the study. Data for allocation statistics of final cost center costs were collected in the study. There were 15 types of evaluation and management service, 2, 923 types of technical service, and 2, 608 types of drug and material service charged to patients in the study hospital during the fiscal year 1992. Labor costs of each of seven types of pesonnel, material costs of 611 types of drugs and materials, and depreciation costs of 212 types of medical equipments, miscellaneous costs, and indirect costs incurred in producing a unit of each services were estimated. Medical insurance fees for basic services such as evaluation and management of inpatients and outpatients, injection, and filling prescriptions, and for operating procedures were found to be set lower than costs. Infrequent services which use expensive medical equipments showed negative revenuse as well. On the other hand, fees for services not covered by the insurance such as CT, MRI and Sonogram, and for laboratory tests were higher than costs. This study has a significance in making it possible for a hospital to obtain cost information for all types of services which produced income based on all types of expenses incurred during a given period of time. This information can assist the management of a hospital in finding an effective cost reduction strategy, an efficient service-mix strategy under a given fee structure, and an optimum strategy for within-hospital resource allocations.

• Quality Improvement in Health Care
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• v.3 no.2
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• pp.86-97
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• 1997

Background : It is a primary goal for hospital personnel to improve the quality of patient care. In Korea the concept of quality assurance has been spread over the last five years. Many hospitals have implemented quality assurance programs that fit their own philosophy and needs. As a result, they are supposed to have different experiences and attitudes toward quality assurance. To investigate their diversity will be helpful to have a direction to the future and to enhance the quality assurance activities in Korean hospitals. Objectives : The aim of this study is to obtain information about hospital personnel's attitude and opinion toward quality assurance in hospitals. Methods : A questionnaire was developed which consisted of five parts; the general characteristics of respondent, the concepts of quality assurance, need for quality assurance program, current status of quality improvement activities, and participation in programs. Using the registry of Korean hospitals, 102 hospitals with more than 400 beds were selected. Questionnaires were mailed to hospital staffs of each hospital; top managers, clinical department heads, registered nurses, medical recorders, and administrators. Results : Of 2038 questionnaires sent, 877 were returned, giving response rate of 44%. Most respondents(70%) regarded quality assurance as efforts to provide patient with care in highest quality and to improve effectiveness or resource utilization. Ninety-nine percent of respondents agreed to need for quality assurance in their hospitals. There were current quality improvement programs implemented in the department of 553 respondents(62%), and most of the(85%) have participated in at least one program. Lack of motivation was pointed out as a barrier to implement the programs. Conclusion : Although most respondents have known of the concept and need for quality assurance, this study suggests that education and motivation of hospital personnel be needed to activate the quality assurance programs in hospitals.

• International Journal of Computer Science & Network Security
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• v.24 no.7
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• pp.11-23
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• 2024

Triage is a practice of accurately prioritizing patients in emergency department (ED) based on their medical condition to provide them with proper treatment service. The variation in triage assessment among medical staff can cause mis-triage which affect the patients negatively. Developing ED triage system based on machine learning (ML) techniques can lead to accurate and efficient triage outcomes. This study aspires to develop a triage system using machine learning techniques to predict ED triage levels using patients' information. We conducted a retrospective study using Security Forces Hospital ED data, from 2021 through 2023 during Hajj period in Saudia Arabi. Using demographics, vital signs, and chief complaints as predictors, two machine learning models were investigated, naming gradient boosted decision tree (XGB) and deep neural network (DNN). The models were trained to predict ED triage levels and their predictive performance was evaluated using area under the receiver operating characteristic curve (AUC) and confusion matrix. A total of 11,584 ED visits were collected and used in this study. XGB and DNN models exhibit high abilities in the predicting performance with AUC-ROC scores 0.85 and 0.82, respectively. Compared to the traditional approach, our proposed system demonstrated better performance and can be implemented in real-world clinical settings. Utilizing ML applications can power the triage decision-making, clinical care, and resource utilization.

• Korea Journal of Hospital Management
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• v.17 no.4
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• pp.1-20
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• 2012

The purpose of this study is to find out the job satisfaction of the korean medical clinic workers, and understand the factors that affect the satisfaction thereby increasing the efficiency of human resource management and providing the basic data to establish the management strategy. We visited 50 korean medical clinics which were chosen randomly from the korean medical clinics in the city of Changwon, Gyungnam. First, we explained the purpose of the study and survey contents to the surveyees, then distributed the Questionnaire and collected them. The data analysis was done statistically using the SPSS WIN IBM 20.0 program. The results were as follows: Professional career, interpersonal relationship, work autonomy, and overall job satisfaction showed significant differences depending on ages. While satisfaction of interpersonal relationship showed significant difference depending on final education. Depending on marriage status, while married persons showed significantly high satisfaction on professional career, interpersonal relationship, work autonomy, administration, and overall job satisfaction, there is no significant difference on income satisfaction. The number of years worked in the current clinic showed significant difference on administration satisfaction. Also, daytime working hours showed significant difference on administration and overall job satisfaction. The work area showed significant difference on overall job satisfaction. The income level showed significant differences on professional career, administration, and overall job satisfaction. From this study, it was confirmed that demographic characteristics and work environment factors showed significant differences on overall job satisfaction of workers in korean medical clinics. Therefore, in order to facilitate efficient manpower utilization and organization efficiency maximization, and motivation of human resources, a detailed plan should be developed to improve working environment and take demographic characteristics into consideration.

• Korea Journal of Hospital Management
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• v.14 no.1
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• pp.62-98
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• 2009

A systematic review of the literatures was conducted to evaluate the effect of clinical practice guideline. The 77 studies were identified from a computerized search of published research on MEDLINE, Science-Direct and Blackwell synergy from January, 1997 to October, 2007. The main search terms were "clinical practice guideline" and "effectiveness", "clinical practice guideline" and "impact", "clinical practice guideline" and "evaluation". These studies were assessed the Quality twice by one Qualified expert and converted into weighted scale. The 63 studies were eligible inclusion criteria and subdivided into type of effect. Final indicator using for policy effect of clinical practice guidelines were classified as 4 categories; "improvement of outcomes" in 81 studies, "betterment in practice patterns" in 68 studies, "rationalization in resource utilization" in 84 studies and "cost containment" in 31 studies. The vote-counting method, one of meta-analysis method, was applied to summarized the effect of clinical practice guidelines and test statistically. From results of meta analysis, all indices were statistically significant. In conclusion, this meta-analysis showed that introduction of clinical practice guidelines were resulted positive outcomes in health policy.

• Journal of Korean society of Dental Hygiene
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• v.17 no.1
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• pp.169-179
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• 2017

Objectives: The present study is aimed at comprehending the organizational setup of clinical dental hygienists and to establish an organizational setup that fits their roles. Methods: The survey data of 776 clinical dental hygienists who understood the purpose of the study and agreed to write the questionnaire was utilized. Statistical analysis was performed using SPSS Ver. 20.0 program and the significance level was 0.05. Results: The presence of an organizational setup in dental hygienists was surveyed as being higher, with university dental hospital (89.86%) showing the highest. However, the presence of position terms was highest in dental hospitals with 76 subjects (38.78%). Standards for positions most commonly followed hospital regulations in the case of general hospitals (48.42%), whereas they were often based on service period in the case of dental hospitals (48.90%). Salary standards were most commonly determined by service period in all institutions. The job satisfaction of dental hygienists was significantly different according to social status and financial satisfaction depended on having organizational hierarchy for those who work in university dental hospitals. Conclusions: The results of the present study show that dental hygienists who work in organizational setups mostly enjoy high satisfaction in terms of job satisfaction. In other words, the study shows that systemizing the organizational setup of dental hygienists within dental institutions is required, and additional research to achieve efficient human resource management within the organization is necessary as well as institutional utilization of the results of the present study.

• Quality Improvement in Health Care
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• v.7 no.1
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• pp.32-45
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• 2000

Background : Critical pathway is an optional sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to minimize delays and resource utilization, and to maximize quality of care; abbreviated versions of case management plans that show critical outcome and key incidents that occur in a predictable and timely fashion to achieve an appropriate length of stay. This study is to develop a critical pathway for vaginal delivery and cesarean section to assess the degree of contentment of the patients and medical personnel and to implement clinical application to see how we could meet the need to guide patients to achieve continuum of care. Method : Critical pathways were developed for normal vaginal delivery and casarean section. LOS(length of stay) target for vaginal delivery was 1 day after delivery & 5 days after C-section. It was distributed to the mother at the OPD and explained thoroughly. It was applied when patients got into the Labor & Delivery Floor. We applied total of 42 patients (30 normal deliveries & 12 C-sections) from February to March, 2000. We performed patient satisfaction survey to all 42 patients, 24 nurses, and 7 residents for internal customer satisfaction. Results : Twenty six patients out of 42 responded to the survey. Twenty one patients out of 26 answered satisfactory. Eighty four percent of 21 respondents replied Critical pathway worked very well. Treatment column got the most compliance. Eleven out of 31 employees thought critical pathway is very helpful for the patient care. Eighteen people didn't see any difference. In their opinion, treatment got the least compliance, which is the contrary to patients opinion. Fifty eight percent of respondents thought that critical pathway can expedite early discharge. Conclusion : Patient satisfaction was higher than we expected but we still need to revise the form. It is recommended to analyze the cost and variance check in the future.

• Health Policy and Management
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• v.33 no.2
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• pp.185-193
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• 2023

Background: This study focuses on the establishment and operation of a stroke patient hotline program to help patients and their caregivers determine when acute neurological changes require emergency attention. Method: The stroke hotline was established at the Gyeonggi Regional Cerebrovascular Center, Seoul National University Bundang Hospital, in June 2016. Patients diagnosed with stroke during admission or in outpatient clinics were registered and provided with stroke education. Consulting nurses managed hotline calls and made decisions about outpatient schedules or emergency room referrals, consulting physicians when necessary. The study analyzed consultation records from June 2016 to December 2020, assessing consultation volumes and types. Outcomes and hotline satisfaction were also evaluated. Results: Over this period, 6,851 patients were registered, with 1,173 patients (18%) undergoing 3,356 hotline consultations. The average monthly consultation volume increased from 29.2 cases in 2016 to 92.3 cases in 2020. Common consultation types included stroke symptoms (22.3%), blood pressure/glucose inquiries (12.8%), and surgery/procedure questions (12.6%). Unexpected outpatient visits decreased from 103 cases before the hotline to 81 cases after. Among the 2,244 consultations between January 2019 and December 2020, 9.6% were recommended hospital visits, with two cases requiring intra-arterial thrombectomy. Patient satisfaction ratings of 9-10 points increased from 64% in 2019 to 69% in 2020. Conclusion: The stroke hotline program effectively reduced unexpected outpatient visits and achieved high patient satisfaction. Expanding the program could enhance the management of stroke-related neurological symptoms and minimize unnecessary healthcare resource utilization.

• Journal of Korean Neurosurgical Society
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• v.51 no.4
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• pp.208-214
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• 2012

Objective : Discal cyst is rare and causes indistinguishable symptoms from lumbar disc herniation. The clinical manifestations and pathological features of discal cyst have not yet been completely known. Discal cyst has been treated with surgery or with direct intervention such as computed tomography (CT) guided aspiration and steroid injection. The purpose of this study is to evaluate the safety and efficacy of the percutaneous endoscopic surgery for lumbar discal cyst over at least 6 months follow-up. Methods: All 8 cases of discal cyst with radiculopathy were treated by percutaneous endoscopic surgery by transforaminal approach. The involved levels include L5-S1 in 1 patient, L3-4 in 2, and L4-5 in 5. The preoperative magnetic resonance imaging and 3-dimensional CT with discogram images in all cases showed a connection between the cyst and the involved intervertebral disc. Over a 6-months period, self-reported measures were assessed using an outcome questionaire that incorporated total back-related medical resource utilization and improvement of leg pain [visual analogue scale (VAS) and Macnab's criteria]. Results : All 8 patients underwent endoscopic excision of the cyst with additional partial discectomy. Seven patients obtained immediate relief of symptoms after removal of the cyst by endoscopic approach. There were no recurrent lesions during follow-up period. The mean preoperative VAS for leg pain was $8.25{\pm}0.5$. At the last examination followed longer than 6 month, the mean VAS for leg pain was $2.25{\pm}2.21$. According to MacNab' criteria, 4 patients (50%) had excellent results, 3 patients (37.5%) had good results; thus, satisfactory results were achieved in 7 patients (87.5%). However, one case had unsatisfactory result with persistent leg pain and another paresthesia. Conclusion : The radicular symptoms were remarkably improved in most patients immediately after percutaneous endoscopic cystectomy by transforaminal approach.