• Korea Journal of Hospital Management
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• v.10 no.2
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• pp.64-80
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• 2005

The objectives of this study were to identify factors associated with unexpected revisit to an emergency medical center (EMC) located in Seoul and to examine reasons for revisit. During March, June, September and December, 2002, a total of 168 patients had unexpected revisits to the EMC within 48 hours of a previous discharge. As a 1:1 matched control, we included 136 patients who: discharged from the EMC during the same time period: did not return to the EMC; had the same diagnosis and age(${\pm}5$) with the case. In this study, factors associated with unexpected revisits were defined as characteristics of a previous discharge, which were classified into three: sociodemographic, EMC visit-related, and discharge management factors. Reasons for revisit were categorized into disease, physician, patients, and system-related factors. Data were collected by medical chart review with assistance from clinicians of the EMC. Logistic regression results showed that patients who headed home after discharge without follow-up schedule had a 27.6 times higher risk of revisiting EMC than those who were hospitalized following EMC visit. Patients discharged on his own will had a 5.9 times higher risk of revisiting than those discharged following physician's advice. Patients requiring continual observation at the time of discharge were more likely to revisit by 8.7 times than those discharged with improved condition. About 69.13% of the revisits were due to disease-related factors, followed by 13.90% due to patient-related factors, 8.64% due to system-related factors, and 8.34% due to physician-related factors. It appears that the most significant factors influencing revisits are discharge management factors such as patient's condition at discharge, whether the discharge was accorded with physician's advice, and whether returning home without follow-up schedule. Therefore, appropriate discharge management is necessary to prevent EMC revisit.

• Journal of Korean Public Health Nursing
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• v.3 no.2
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• pp.5-46
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• 1989

The current medical payment Insurance Rates in Korea stipulate charges for medical treatment by the doctor, pharmaceutist, medical technician and maternity nurse. But unfortunately didn't specify those charges for nursing done by the professional nurse. Only basic nursing fee is accounted insufficiently in current medical insurance fee schedule. therefore, Being face with covering entire people by medical insurance by 1991, It seems that the problems pertaining to operating the hospital and medical insurance system would be incessantly expanded in that no mention is made of medical charges rendered by major medical producer service in the current system, For that reason, this study made an attempt to clarify the importance the professional nursing puts of the current medical payment. The purpose of this study was to accounting nursing fee which diveded into the current medical fee schedule. (Method) 1. Data collection; Importance and difficulties in nursing activities was conducted in 'S' National University Hospital. Total nursing activities were selected 72 items which included direct care and indirect care. This study was conducted to evaluating the degree of importance and difficulties according to nursing activities through questionnaire to 204 RN. and so relative difficulties (acuity) were computered because the nursing cost level of each nursing service was differently established by the equivalent coefficient according to degree of relative difficulty and time required. 2. Calculation of cost according to nursing activities; After 47 nursing activities were selected in General surgery nursing units, calculation of nursing cost was as follows Cost of Nursing activity = (relative difficulty X Average hourly wage and benefits of nurse) + material cost of nursing -t- Average nursing administration cost So, Calculated cost by nursing activities was compared to current non-insured and insurance rate. 3. Calculation of nursing cost by K - DRG ; Total of 578 patients who were hospitalized in General Surgery units from January to March 1988 ware classified by K - DRG After estimation of total nursing cost based on the K-DRG, verified the appropriateness of basic nursing fee in medical insurance rate (Results) 1. Analysis of degree of importance and difficulties were 4.16 and 3.67 based on 5 point scale. This score were judged that it is worthy specifying the nursing fee 2. The nursing cost of 47 nursing service items in general surgery patients showed that the average cost of nursing activity was \1374.5 and The lowest cost was \217 of 'oral administration nursing' item, The highest cost was \11,025 of 'saline enematill clear' item 3. The result of comparison between the calculated cost by nursing activities against the current non-insured and insurance rate showed that 13 items(27.7%) involved to payment of insurance rate, 9 items(19.1%) involved to non-insured rate, remainder 25 items (53.2%) were not charged anywhere of total 47 nursing activities 4. When calculated cost by nursing activities was 100. current insurance rate was 62.3, non-insured rate was 176.6. Therefore this showed that most of non-insured rate were higher than calculated nursing cost. The insurance rate, however, were lower than it. Reim-bursement was imputed to non-insured patients. So the current rate system became estrainged from cost system. When Remainder 25 items of nursing activities compared' to \1390 of daily basic nursing fee per patient belonged to payment as a insurance fee schedule, basic nursing fee schedule was 1-2% of calculated cost of nursing activities. Therefore it showed that nursing fee was not counted adequately in it. 5. Nursing cost by K-DRG estimated in chart review based on counting number of nursing activities and length of stay The result showed that average amount of total nursing cost was \183828.1 Comparison of nursing cost calculated by K- DRG and basic nursing fee schedule showed that only 12.3% of nursing cost was charged (Conclusion) From the above research result, It is fact that nursing prime cost should be estimated more accurately and included adequately in current medical payment system. The payment system of nursing activities should be introduced not only nursing activities of drug administration and injection fee belonged to insurance fee schedule but also most nursing activities belonged not to mekical fee schedule. Even if introducing payment system of nursing activities, It should be estimated scientific method of Accounting nursing cost So nurses could offer nursing care of good quality, thereby they could make a great contribution not merely to the convalescence of the patient but to the promotion of the people's health.

• Journal of Korea Multimedia Society
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• v.23 no.2
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• pp.155-165
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• 2020

In this paper, we propose a smart thermostat temperature set-point control method based on machine learning and rule engine, which controls thermostat's temperature set-point so that it can achieve energy savings as much as possible without sacrifice of occupants' comfort while users' preference usage pattern is respected. First, the proposed method periodically mines data about how user likes for heating (winter)/cooling (summer) his or her home by learning his or her usage pattern of setting temperature set-point of the thermostat during the past several weeks. Then, from this learning, the proposed method establishes a weekly schedule about temperature setting. Next, by referring to thermal comfort chart by ASHRAE, it makes rules about how to adjust temperature set-points as much as low (winter) or high (summer) while the newly adjusted temperature set-point satisfies thermal comfort zone for predicted humidity. In order to make rules work on time or events, we adopt rule engine so that it can achieve energy savings properly without sacrifice of occupants' comfort. Through experiments, it is shown that the proposed smart thermostat temperature set-point control method can achieve better energy savings while keeping human comfort compared to other conventional thermostat.

• Journal of the Korea Institute of Building Construction
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• v.11 no.4
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• pp.396-406
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• 2011

Execution of the finish work for high-rise residential construction occurs when a mixture of work progresses simultaneously at each floor or sector and is carried on by highly-specialized subcontractor teams. Therefore, the finish work plan requires an effective scheduling method that interfaces between the work and the teams. In order to address these issues, the TACT technique is utilized in Korea. This technique is based on Line-of-Balance and Lean construction. However, according to recent case studies, finish work using TACT technique was frequently delayed with cost overruns because the work was performed without a detailed schedule control plan outlining the relationship between architecture and mechanical, electrical, and plumbing work. This paper describes the enhanced-TACT technique which provides a detailed work flow chart and TACT work template. With improved TACT technique, this paper will contribute to improved cash flow and reduced cycle time and provide quality improvement through work continuity.

• Progress in Medical Physics
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• v.10 no.2
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• pp.95-101
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• 1999

The aims of this report are to classify the incorrect data of patients and the errors of dose and dose distribution observed in QA activities on teleradiotherapy chart, and to analyze their frequency. In our department, radiation physicists check several sheets of patient chart to reduce numeric errors before starting radiation therapy and at least once a week, which include history, port diagram, MU calculation or treatment planning summary and daily treatment sheet. The observed errors are classified as followings. 1) Identity of patient, 2) Omitted or unrecorded history sheet even though not including the item related to dose, 3) Omission of port diagram, or omitted or erroneous data, 4) Erroneous calculation of MU and point dose, and important causes, 5) Loss of summary sheet of treatment planning, and erroneous data of patient in the sheet, 6) Erroneous record of radiation therapy, and errors of daily dose, port setup, MU and accumulated dose in the daily treatment sheet, 7) Errors leading inexact dose or dose distribution, errors not administerd even though its possibility, and simply recorded errors, 8) Omission of sign. Number of errors was counted rather than the number of patients. In radiotherapy chart QA from Jun 17, 1996 to Jul 31, 1999, no error of patient identity had been observed. 431 Errors in 399 patient charts had been observed and there were 405 physical errors, 9 cases of omitted or unrecorded history sheet, and 17 unsigned. There were 23 cases (5.7%) of omitted port diagram, 21 cases (5.2%) of omitted data and 73 cases (18.0 %) of erroneous data in port diagram, 13 cases (3.2 %) treated without MU calculation, 68 cases (16.3 %) of erroneous MU, 8 cases (2.0%) of erroneous point dose, 1 case (0.2 %) of omitted treatment planning summary, 11 cases (2.7%) of erroneous input of patient data, 13 cases (3.2%) of uncorrected record of treatment, 20 cases (4.9%) of discordant daily doses in MU calculation sheet and daily treatment sheet, 33 cases (8.1%) of erroneous setup, 52 cases (12.8%) of MU setting error, 61 cases (15.1%) of erroneous accumulated dose. Cases of error leading inexact dose or dose distribution were 239 (59.0 %), cases of error not administered even though its possibility were 142 (35.1 %), and cases of simply recorded error were 24 (5.9 %). The numeric errors observed in radiotherapy chart ranged over various items. Because errors observed can actually contribute to erroneous dose or dose distribution, or have the possibility to lead such errors, thorough QA activity in physical aspects of radiotherapy charts is required.

• Journal of Korean Neurosurgical Society
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• v.63 no.3
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• pp.358-365
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• 2020

To describe how to perform urological evaluation in children with tethered cord syndrome (TCS). Although a common manifestation of TCS is the development of neurogenic bladder in developing children, neurosurgeons often face difficulty in detecting urological problems in patients with TCS. From a urological perspective, diagnosis of TCS in developing children is further complicated due to the differentiation between neurogenic bladder dysfunctions and transient bladder dysfunctions owing to developmental problems. Due to the paucity of evidence regarding evaluation prior to and after untethering, I have shown the purpose and tools for evaluation in my own practice. This may be tailored to the types of neurogenic bladder, developmental status, and risks for deterioration. While the urodynamic study (UDS) is the gold standard test for understanding bladder function, it is not a panacea in revealing the nature of bladder dysfunction. In addition, clinicians should consider the influence of developmental processes on bladder function. Before untethering, UDS should reveal synergic urethral movement, which indicates an intact sacral reflex and lack of TCS. Postoperatively, the measurement of post-void residual urine volume is a key factor for the evaluation of spontaneous voiders. In case of elevation, fecal impaction, which is common in spinal dysraphism, should be addressed. In patients with clean intermittent catheterization, the frequency-volume chart should be monitored to assess the storage function of the bladder. Toilet training is an important sign of maturation, and its achievement should be monitored. Signs of bladder deterioration should be acknowledged, and follow-up schedule should be tailored to prevent upper urinary tract damage and also to determine an adequate timing for intervention. Neurosurgeons should be aware of urological problems related to TCS as well as urologists. Cooperation and regular discussion between the two disciplines could enhance the quality of patient care. Accumulation of experience will improve follow-up strategies.

• Quality Improvement in Health Care
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• v.2 no.2
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• pp.32-45
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• 1996

Background : A critical path defines an optimal sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to better utilize resources, maximize quality of care, and minimize delays. It can be thought of as a visualization of the patient care process. In this study, a review of appendectomy patient records was undertaken to identify a critical path for the management of this treatment. Methods: For this study, records of patients under 15 or over 65 years of age were excluded ; cases where the patient was pregnant, or where complications developed were also excluded. The remaining 21 cases were divided into two categories according to the indication for appendectomy : for acute appendicitis, and for perforated appendix or drainage of periappendical abscess. The time frame for the review was from patient examination immediately prior to operation, through discharge. The study team was composed of a surgeon, research head nurse, education head nurse, surgical part head nurse, and medical recorder. Following their review of the 21 charts, the team determined an appropriate progression and schedule for an appendectomy. Result : Through the chart and literature review, the following aspects of the care process were identified as typical and tracked : monitoring/assessment, treatment, lines/drains, medication, activity, diet, tests and patient education. Conclusion : From this study, the design team determined two separate critical paths : one for appendectomy only, and one for appendectomy plus drainage. Next, these paths must be validated and fine-tuned through clinical implementation. In addition, a comparison of our design with the critical paths determined at other hospitals would be extremely valuable for advancing research in this area. Lastly, the critical path approach to improving patient care and maximizing hospital resources should be applied to other procedures.

• Proceedings of the Korean Institute of Navigation and Port Research Conference
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• 2018.05a
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• pp.318-320
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• 2018

When a ship sails on sea, it may be influenced by the environmental disturbance such as wind, wave, sea surface temperature, etc. These affect on the ship's speed, fuel consumption, safety and operating performance. It is necessary to find the optimal weather route of a ship to avoid adverse weather conditions which can put the crews in serious danger or cause structural damage to the vessel, machinery, and equipment. This study introduced how to apply A* algorithm based on sea trial test data for determining the optimal ship routes. The path cost function was modelled as a function of minimum arrival time or minimum energy depending on the time of various environment conditions. The specially modelled path-cost function and the safety constraints were applied to the A* algorithm in order to find the optimal path of the ship. The comparison of ship performances estimated by real sea trial's path and estimated optimal route during the voyage of the ship was investigated. The result of this study can be used to create a schedule to ensure safe operation of the ship with short passage time or minimum energy. In addition, the result of this study can be integrated into an on-board decision supporting expert system and displayed in Electronic Chart Display and Information System (ECDIS) to provide all the useful information to ship master.

• The Journal of the Institute of Internet, Broadcasting and Communication
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• v.12 no.1
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• pp.141-150
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• 2012

This paper suggests a critical path search algorithm that can easily draw PERT/GANTT chart which manages and plans a project schedule. In order to evaluate a critical path that determines the project schedule, Critical Path Method (CPM) is generally utilized. However, CPM undergoes 5 stages to calculate the critical path for a network diagram that is previously designed according to correlative relationship and execution period of project execution activities. And it may not correctly evaluate $T_E$ (The Earliest Time), since it does not suggest the way how to determine the sequence of the nodes activities that calculate the $T_E$. Also, the sequence of the network diagram activities obtained from CPM cannot be visually represented, and hence Lucko suggested an algorithm which undergoes 9 stages. On the other hand, the suggested algorithm, first of all, decides the sequence in advance, by reallocating the nodes into levels after Breadth-First Search of the network diagram that is previously designed. Next, it randomly chooses nodes of each level and immediately determines the critical path only after calculation of $T_E$. Finally, it enables the representation of the execution sequence of the project activity to be seen precisely visual by means of a small movement of $T_E$ of the nodes that are not belonging to the critical path, on basis of the $T_E$ of the nodes which belong to the critical path. The suggested algorithm has been proved its applicability to 10 real project data. It is able to get the critical path from all the projects, and precisely and visually represented the execution sequence of the activities. Also, this has advantages of, firstly, reducing 5 stages of CPM into 1, simplifying Lucko's 9 stages into 2 stages that are used to clearly express the execution sequence of the activities, and directly converting the representation into PERT/GANTT chart.

• Journal of the Korean Society of Marine Environment & Safety
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• v.13 no.4
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• pp.71-78
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• 2007

Towing vessels have carried out the important role and service in the maritime industry construction, such as port and sea bridge construction, fairway dredging and sea reclamation etc. Furthermore, tugboat takes the largest portion in number of vessel at the domestic registry and barges as big as the general merchant vessel, which are getting specialized and larger, are in operation. In spite of the increase of marine accidents under this situation, there has been no proper measure for the safe navigation of tugboat in the aspect of a nation. This paper aims to propose the measure for the safe navigation of tugboat according to the frequent marine accident of tugboat with sea bridge. Therefore, we show an example of the sailing schedule and operation checklist based on the analysis of statistics and precedent of marine accident and the investigation of the actual operation state of tugboat in the aspect of a contract of carriage and a personnel setup, which should be checked by the operator of tugboat, to pass through sea bridge safely and propose the safe traffic supporting system based on electronic chart system to improve the safe navigation of tugboat.