• 한국병원경영학회지
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• 제10권2호
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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.

• 디지털융복합연구
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• 제10권3호
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• pp.219-225
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• 2012

2004년부터 시행된 국가적 사업인 퇴원손상심층조사 자료를 이용하여 100병상 이상 의료기관 퇴원환자들중 65세 이상 노인환자의 의료이용을 분석하였다. 시행 초기자료부터 2008년까지의 자료를 분석한 결과 매년 노인환자의 퇴원비율이 증가하는 것으로 나타났다. 남성보다 여성의 퇴원환자 비율이 높고 재원일수, 사망비율이 65세 미만 퇴원환자에 비하여 65세 이상 노인환자가 높은 것으로 나타났다. 입원중 수술을 경험하는 비율은 노인환자가 낮았다. 호발하는 주된 질병을 분석한 결과 순환기 계통에 해당하는 뇌경색, 협심증 그리고 호흡기 계통에 해당하는 폐암, 폐렴, 기타 만성 폐쇄성 폐질환이 많고, 기타 위암, 당뇨병, 간암, 대장암의 진단 비율이 높은 것으로 나타났다. 진단과 관련한 신경계통, 심혈관 계통 수술이 많은 것으로 분석되었다. 따라서 이러한 결과를 바탕으로 노인의 건강증진을 위한 정책수립에 있어 자원을 우선 배분하고 의료기관들은 앞으로 초고령 사회를 대비하기 위하여 노인환자의 의료이용 특성을 고려하여 경영전략을 수립하여야 할 것이다.

• 대한임상독성학회지
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• 제20권1호
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• pp.8-14
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• 2022

Purpose: This study was undertaken to investigate how sedative-hypnotics affect the occurrence and severity of the patient's symptoms. In addition, we conducted a study to determine the type of patients who reacted severely and required hospitalization; patients were accordingly classified as hospitalized patients and patients discharged from the emergency room. Methods: From January 2017 to December 2019, we investigated the demographics, drug information, history, laboratory tests, and severity of patients who visited our emergency department and were diagnosed with benzodiazepine, zolpidem, and doxylamine succinate overdose. We further compared details of hospitalized patients and discharged patients. Results: Subjects who had overdosed and visited the ED included 120 for benzodiazepine, 147 for zolpidem, and 27 for doxylamine succinate. Comparisons between the three groups revealed differences in their early diagnosis, psychiatric history, and sleep disturbance. Differences between groups were also determined for mental state, poisoning history, treatment received in the intensive care unit, and intubation and ventilator support. In cases of benzodiazepine overdose, we obtained a high hospitalization rate (40.0%), admission to the intensive care unit (24.2%), and intubation rate (18.3%). Comparisons between hospitalized patients and discharged groups showed differences in transferred patients, early diagnosis, and mental state. Conclusion: Patients poisoned by sedative-hypnotics are increasing every year. In cases of benzodiazepine and zolpidem, the hospitalization rates were high, and benzodiazepine overdose resulted in hospitalization, intensive care unit admission, and pneumonia in a majority of cases. Therefore, active treatment and quick decisions in the emergency room are greatly required.

• Journal of Chest Surgery
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• 제9권1호
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• pp.55-62
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• 1976

This is a report of 8 cases cardiac arrest developed in the operating room at Jeonbug university Hospital from January 1973 to October, 1975. Four patients of cardiac arrest developed during the elective operation, 3 during the emergency operation and the remaining one, bronchoscopy for foreign body removal under the general anesthesia. Immediate closed chest cardiac massage was performed in the 7 patients and the remaining one underwent open chest cardiac massage. Five of 7 patients with the closed chest cardiac massage regained consciousness and restored respiration, but 3 patients of these survived to be discharged. Two patients who underwent pneumonectomy for multiple lung abscess and open drainage for liver abscess, were resuscitated but did survived. The Latter died from bleeding due to rupture of the liver that developed during the closed chest cardiac massage. One patient who had open chest cardiac massage survived to be discharged without any sequele. Unsuccessful resuscitation was observed in two patients, one had a complication of malignant hyperthermia with muscle rigidity during gastrectomy for ulcer perforation and another had not firm support on the back during massage.

• 간호행정학회지
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• 제10권3호
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• pp.345-364
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• 2004

Purpose: This is develop a critical pathway as an useful alternative to the previous management system in order to restriction of medical resources, high expectation of ordinary people to health and application for DRG. Method: In order to preliminary critical pathway, we analyzed 30 cases of medical records of patients who had lobectomy and pneumonectomy at the Yonsei Medical Center in Seoul. An expert validity test was taken for the preliminary critical pathway, and clinical validity test was also done. After these processes, the final critical pathway was developed. Result: Among 10 cases, one was excluded in this study due to the complication after operation. 7 of total 9 patients were discharged earlier than the expected day, 1 patient was just discharged at the expected day, and 1 patient was discharged 4 days later than the expected day at the 12th day after operation. Conclusion: The critical pathway is developed without difficulty because the posoperative management for patients with lobectomy and pneumonectomy is uncomplicated. Therefore, if it is more researched on the clinical application, then the activity of C.Q.I. will be able to sustain the patient oriented management system.

• 한국의료질향상학회지
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• 제8권2호
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• pp.208-217
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• 2001

Background : The objective of this study is proving the basic data for developing a management system for the discharges against medical advice(AMA) by identifying the characteristics of the AMA patients of an university hospital for 10 years. Methods : By using discharge abstract data base, we divided the total discharges(435,254) into two groups, discharge against medical advice and discharge with discharge order. We confirmed the characteristics of AMA group by analyzing discharge abstract data of the both groups by SAS software V6.12 and $x^2$ test. Medical records of AMA patients in the year 2000 were reviewed to identify the reasons for AMA which we couldn't extract from discharge abstract DB. Result : The total number of AMA for 10 years were 9,358(2.15%) and the AMA rate has been continuously decreased for 10 years. Male, admission through emergency room, discharges admission via other hospital, patients without operation during hospitalization, discharges in hopeless or not improved condition showed higher AMA rate. The AMA rate was higher as the age of the patients was higher, and the average length of stay was longer in AMA patients than in those with discharge order. The AMA rate in psychiatry was highest(14.3%) and it was higher in surgery departments than those of medical or other sections. The AMA rate varied by attending physicians even in the same department and it was statistically significant. Patients with the principal diagnosis of "medical observation and evaluation for suspected diseases" showed the highest AMA rate(15.5%), and that of schizophrenia or psychosis was the nest. One hundred twenty-one patients(19.5%) out of 622 AMA in 2000 discharged against medical advice for transfer to order health care facilities. Among them 71 patients(58.7%) discharged with their medical care information, such as copies of medical record, medical certificates, summaries, etc. Written oath of the patients discharged AMA was filed in their medical records in 466 cases(74.9%) although some of them were incomplete. Conclusion : Characteristics of AMA discharge could be used as the basic data in developing a system to manage the patients who have risk factors to leave the hospital against medical advice. By reducing number of patients leaving the hospital against medical advice we can increase satisfaction of medical providers and consumers.

• 한국응급구조학회지
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• 제26권1호
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• pp.151-166
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• 2022

Purpose: The severity classification in association with the time of visit to and the appropriateness of using a public ambulance for visiting the emergency department (ED) have not been thoroughly evaluated, and we aimed to evaluate these aspects. Methods: In this descriptive research, we retrospectively reviewed and analyzed the medical records of patients who visited the ED of the B General Hospital, Seoul from January to December 2019. Results: Of the 54,297 patients who were included in the analysis, 34,629 (63.8%) and 14,065 (25.9%) visited the ED directly and through public ambulances, respectively; 10,328 (73.4%) patients who used public ambulances were discharged home. In the daytime and nighttime, 24,891 (45.8%) and 29,406 (54.2%), respectively, visited the ED. The mean length of ED stay (LoS) of emergency and non-emergency patients was 326 and 159 minutes, respectively, and of patients classified as Korean Triage and Acuity Scale levels 1 and 2 was 427 and 430 minutes, respectively, which was longer than the total of 236 minutes. Conclusion: Patients who visited the ED using public ambulances constituted nearly 25% of all ED visits, and more than 70% of these patients were discharged home. Patients with high severity had a longer mean LoS, and daytime ED visits were characterized by higher numbers and severity of patients than nighttime ED visits.

• Asian Pacific Journal of Cancer Prevention
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• 제14권1호
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• pp.149-152
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• 2013

Objective: To compare the influence of breast-conserving surgery (BCS) and modified radical mastectomy (MRM) on the psychological state of breast cancer patients. Methods: Patients receiving MRM or BCS, and fulfilling the study criteria, were recruited. Patients were required to complete a self-reporting inventory (SCL-90) on admission and 6 months after surgery and a self-rating depression scale (SDS) when discharged from hospital and 6 months after surgery. Results: A total of 70 patients received MRM and 50 BCS. Compared with the national standard, patients suffered to some extent psychological problems on admission, at discharge from hospital and at 6 months after surgery. Patients received BCS had a higher score of SDS compared with those with MRM when discharged from hospital. However, 6 months after surgery, SDS score increased in MRM and decreased in the BCS group, so the difference was significant. Conclusion: The short-term psychological state of patients receiving BCS is worse than that with MRM but superior to MRM 6 months postoperatively. BCS imposed less influence on long term psychological state of breast cancer patients compared with MRM.

• 한국응급구조학회지
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• 제24권2호
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• pp.79-88
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• 2020

Purpose: The study aimed to collect the first aid activity log data of patients who were retransferred through paramedics and to analyze the data in the hospital to improve the plan. Methods: We analyzed 434 retransferred patients, out of the 18,197 patients who visited the emergency medical center in the C area in G metropolitan city, from January 2017 through December 2018. The collected data were analyzed using the SPSS software. Results: The patients were retransferred for various reasons: 17.7% (77 cases) due to the absence of specialists, 15.0% (65 cases) required first aid, and 5.3% (23 cases) due to absence of medical department. In addition, the major medical department with the largest number of retransfer was the department of emergency medicine with 38.2% (166 cases). In the prehospital stage, 38.5% (167 cases) were classified as severe, but in the hospital stage, they were classified as mild. In addition, as a result of hospitalization and discharge, 60.4% (262 cases) were discharged. Conclusion: Most of the retransferred patients were non-emergency patients, and were discharged for mild conditions. The overcrowding in the emergency room of a tertiary hospital can be prevented by reducing the retransmission.

• 한국응급구조학회지
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• 제25권3호
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• pp.63-70
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• 2021

Purpose: The study aimed to collect data from patients who were rejected by emergency requests for transfer to a tertiary hospital through 119 EMT and to analyze the data in the hospital to improve the plan. Methods: We analyzed 4,702 cases of emergency requests made by patients who were rejected by 119 emergency assistance out of the 22,568 patients who visited the emergency medical center in the C area of G metropolitan city from January 2018 through December 2020. The collected data were analyzed using IBM SPSS Statistics Version XX (IBM Corp., Armonk, N.Y., USA). Results: The major medical department with the largest number of such cases was the department of emergency medicine, with 2,519 cases (53.6%). Simple bruises were the most common diagnosis, with 2,819 cases (61.2%). KTAS classification was the highest with 3,562 patients (75.8%) in grade 4. As for the results, 4,084 patients (86.9%) were discharged from the hospital. Conclusion: Most of the patients who were rejected by emergency requests were non-emergency patients and were discharged from the hospital. emergency requests must be rejected at public relations and sites. In addition, the law should be amended to specifically present the reasons for refusal of emergency requests.