• Journal of Preventive Medicine and Public Health
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• v.26 no.4 s.44
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• pp.650-660
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• 1993

This study aims to describe the causes of medically unnecessary hospital stay at a teaching tertiary hospital, using modified version of Delay Tool in which the causes of delay are divided into slx major categories : delay related to test scheduling, test results, surgery, medical staff, patient/family, and administration. For the analysis of hospital stay, 6,479 inpatient-days were reviewed in two medical and four surgical departments for one month. Initially inappropriate hospital stays were identified using Appropriateness Evaluation Protocol (AEP), and causes of delay listed in Delay Tool were assigned to each of them. In both medical and surgical services, the most important cause of delay was related to medical staffs, ranging from 3.6% to 51.6% of total inpatient days. Next important category was delay related to test scheduling in medical services ($4.7{\sim}9.2%$), and delay related to surgery in surgical services ($7.3{\sim}15.0%$). Among subcategories of delay related to medical staffs, delay due to conservative care was the most important cause of inappropriate hospital stay ($2.9{\sim}6.4%$). Each clinical departments had different distribution among delay categories, which could not be fully justified by their clinical charateristics. The Delay Tool would be helpful in exploring factors related to the inefficient use of hospital beds. As a measurement tool of inappropriate hospital stay, however, the Delay Tool should be refined in the definitions of categories and its contents.

• Structural Engineering and Mechanics
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• v.30 no.1
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• pp.37-66
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• 2008

This paper focuses on the nonlinear vibrations of stay cables and evaluates the dynamic characteristics of stay cables by using the nonlinear enhanced MECS approach and the approximate approach. The nonlinear enhanced MECS approach is that both the girder-tower vibrations and the cable vibrations including parametric cable vibrations are simultaneously considered in the numerical analysis of cable-stayed bridges. Cable finite element method is used to simulate the responses including the parametric vibrations of stay cables. The approximate approach is based on the assumption that cable vibrations have a small effect on girder-tower vibrations, and analyzes the local cable vibrations after obtaining the girder-tower responses. Under the periodic excitations or the moderate ground motion, the differences of the responses of stay cables between these two approaches are evaluated in detail. The effect of cable vibrations on the girder and towers are also discussed. As a result, the dynamic characteristics of the parametric vibrations in stay cables can be evaluated by using the approximate approach or the nonlinear enhanced MECS approach. Since the different axial force fluctuant of stay cables in both ends of one girder causes the difference response values between two approach, it had better use the nonlinear enhanced MECS approach to perform the dynamic analyses of cable-stayed bridges.

• Korean Journal of Culture and Social Issue
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• v.24 no.2
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• pp.221-250
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• 2018

The purpose of this study is to find out the causes of turnover, the causes of stay, and the effects of turnover of college graduates with early careers, based on the concept of job embeddedness and their stances. For this study, semi-structured interviews were conducted with 20 college graduates with early careers and the interviews were analyzed with phenomenological analytic research. The result of the study shows that the cause of turnover intention includes fit and link which are components of job embeddedness. More specifically, turnover intention of the interviewee is affected by fit which includes whether their ability and talent are used properly and whether their vision and culture fit well those of their organization, also affected by link which includes the formal or informal mutual relationship with coworkers and superiors. Stay intention, on the other hand, includes fit which contains satisfaction about work and organization, long-term career management. Stay intention also includes sacrifice which are anxiety about uncertain future and satisfaction about being employed. As an aspect of the effect of turnover, the satisfaction and fulfillment about work which are experienced after turnover by the interviewees and the satisfaction about coworkers and the team in which the interviewees are included offset the negative effect of turnover. The result also shows that organization should consider their workers' satisfaction about the first work, their amicable relationship, and turnover cost, to improve working and living standard of colleges graduates with early careers and to prevent them from turnover.

• Korea Journal of Hospital Management
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• v.6 no.1
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• pp.107-119
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• 2001

There has been pointed out that a great portion of hospitalized patients stay in hospitals longer than necessary, often even after the completion of necessary care. This causes that hospital resources are not used efficiently. In order to identify underlying forces in postponing inpatients' discharge, this study aimed to investigate reasons for long-term stay of patients admitted in general hospitals. A total of 135 patients, who were staying at 7 general hospitals in Inchon and Kyonggi-Do for more than 60 days, were surveyed with a self-administered questionnaire between April 3 and April 10, 2000. Medical reasons including incompleteness of necessary care, difficulty in receiving outpatient-based care, and being under physical therapy were the most significant factors associated with long-term stay, followed by the lack of familial resources to take care of patients after discharge. Financial problems such as inability to pay for hospital bills were not significant factors influencing long-term stay. Regression analyses were conducted for medical reasons, familial resources, and financial problems, respectively. It was shown that receiving physical therapy and the number of admission in the past were significant predictors for medical reasons. The lack of familial resources as a reason for long-term stay had a positive relationship with the degree of need for aid in daily living. It may be recommended for the hospitals to cope with administrative problems due to the patients' long-term stay, considering the reasons of it, and their characteristics. And also, institutional efforts like vitalizing the home care service systems by hospitals as the continuing care after discharge should be needed.

• Journal of the Korea Convergence Society
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• v.8 no.5
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• pp.87-96
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• 2017

This study was carried out to provide basic data for prevention of death from injuries and traumas by analyzing the characteristics of length of hospital stay of patients with injuries and traumas, utilizing in-depth investigation data of discharged injuries. The study subjects were 233 patients discharged from January 1 to December 31 in 2014 whom the final treatment result was 'death' and the main diagnosis were injuries and accidental external causes(S00-T98). According to the research findings, the length of hospital stay of females was longer than that of males. Based on the main diagnosis, the longest length of hospital stay had complication of other internal prosthetic devices, implants and grafts(T85). In conclusion, it is necessary to develop a policy to identify the factors affecting the length of hospital stays of patients and to manage them intensively.

• Journal of Korean Society of Industrial and Systems Engineering
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• v.32 no.4
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• pp.17-24
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• 2009

The purpose of this research is to find the reasons of overcrowding in the emergency department of an hospital, then to shorten the total stay time of patients. The fact that main causes of the overcrowding exist in the process of the emergency department was discovered by analysis of the data. In order to improve these process, simulation model was developed by ARENA 7.0. Staff's service time, staff's organization, process ratio, and patient's waiting time were estimated in the simulation model in consideration of the decision of the patient's course of action. Several scenarios such as the simplification of the process, the setup of dedicated pathology lab, and mixed method were suggested and evaluated. Total stay time of the patients would be reduced up to 28.45%.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.6 no.3
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• pp.522-531
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• 1999

This research identifies the ingress to egress primary factors that causes a patient to receive delayed emergency medical care. This material was collected between February 1st to 28th, 1998. Research envolved 4,118 people who visited the college emergency medical center in Kyeongido Province, South Korea. Medical records were examined, using the retrospective method. to determine the length of stay and the main cause for waiting. Results are as follows : 1. The age group with the highest admission rate was 10 and under, approximately 1,394 (33.9%). Followed by an even distribution for ages between 11-50 at 10-15% for their respective ranges. The lowest admission rate was 50 years and above. 2. From the 4,118 records examined, 3,489 received outpatient treatment (84.7%); 601 were admitted for inpatient care (14.6%); 25 arrived dead on arrival (0.6%); and 4 people died at the hospital. 3. Between 7PM to 12AM, 42.9% were admitted to the EMC. The hours from 9PM to 11PM recorded the highest admission rate and 5AM to 8AM was the lowest From 8PM to 12AM, the most beds were occupied. 4. For most patients. the average length of stay was approximately 2.2 hours. By medical department, external medicine was the longest for 2.8 hours. Pediatrics was the shortest for 1.6 hours. The average waiting period for inpatient admission was 2.6 hours. Inpatient admission for pediatrics and external medicine was 3.4 hours and 2.2 hours respectively. 5. Theses are primary factors for delay at EMC: 1) pronged medical consultations to decide between inpatient versus outpatient treatment, and delaying to be inpatient, 2) when you call physicians they are delayed to come 3) Understaffing during peak or critical hours, 4) Excessive consulting with different medical departments, 5) some patients require longer monitoring periods, 6) medical records are delayed in transit between departments, 7) repeated laboratory tests make delay the result, 8) overcrowded emergency x-ray place causes delay taking x-ray and portable x-ray, 9) the distance between EMC and registration and cashier offices is too far. 10) hard to control patient's family members. The best way to reduce EMC waiting and staying time is by cooperation between departments, both medical and administrative. Each department must work beyond their job description or duty and help each other to provide the best medical service and satisfy the patient needs. The most important answer to shortened the EMC point from ingress to egress is to see things from a patient point of view and begin from there to find the solution.

• The Journal of the Convergence on Culture Technology
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• v.9 no.3
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• pp.137-143
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• 2023

This study was conducted to analyze factors affecting the length of stay in children with injuries by determining relationships between length of stay and characteristics of children(aged 0 to 12) with injuries. 7,804 patients aged 0 to 12 who participated in the Korea Nation Hospital Discharge In-Depth Injury Surveys, got a diagnosis of sequelae of injuries and of other consequences of external causes(S00-T98), and were discharged between 1 January 2016 and 31 December 2020 were investigated. A frequency analysis, independent samples t-test, and ANOVA were performed. Also, to identify factors affecting the length of stay, a regression analysis was performed. The average length of stay for the patients investigated in this study was 5.5 days. The length of stay for school-age children(aged 7 to 12) and children who had either public or private coverage was higher than that for preschoolers(aged 0 to 6) and children who didn't have public or private coverage, respectively. The length of stay for children admitted to a hospital in a rural area(Jeolla-do or Gyeongsang-do) was higher than that for children admitted to a hospital in a metropolitan area and the length of stay for children admitted to a hospital that had 100-299 hospital beds was relatively long. However, children who first visited a hospital for outpatient care stayed relatively short in hospital and children who had been burned or injured in traffic crashes stayed relatively long in hospital. Children who got a secondary diagnosis and had a principal procedure or who died after being discharged were in hospital for a long time. The findings of this study shall be useful, as they identified characteristics related to the length of stay for Korean children with injuries and factors that determine the length of stay for those children by analyzing the national dataset, or more specifically, the data from the Korea National Hospital Discharge In-Depth Injury Surveys. The risk of child injuries can be easily reduced by taking actions to prevent them and providing safety education programs. The present study has provided essential baseline data for the provision of aggressive care for child injuries and the establishment of a range of policies for child injury prevention.

• Korea Journal of Hospital Management
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• v.19 no.4
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• pp.21-33
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• 2014

This study was conducted to propose an insight into the appropriateness of hospital length of stay(LOS) by developing a severity-adjusted LOS model for patients with pneumonia, organism unspecified. The pneumonia risk-adjustment model developed in this paper is based upon the 2006-2010 the Korean National Hospital Discharge in-depth Injury Survey. Decision tree analysis revealed that age, admission type, insurance type, and the presence of additional disorders(pleural effusion, respiratory failure, sepsis, congestive heart failure etc.) were major factors affecting the severity-adjusted model using the Clinical Classifications Software(CCS). Also there was a difference in LOS among the regional hospitals, especially the hospital LOS has not been efficiently managed in Gyeongsangbuk-do, Jeollanam-do, Jeollabuk-do, Daejeon, and Busan. To appropriately manage hospital LOS, reliable statistical information about severity-adjusted LOS should be generated on a national level to make sure that hospitals voluntarily reduce excessive LOS and manage main causes of delayed discharge.

• Journal of Chest Surgery
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• v.32 no.11
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• pp.1017-1022
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• 1999

Background: An increasing number of elderly are referred for open heart surgeries(OHS). These patients are assumed to have significantly increased morbidity and mortality because of compromised functional reserves in their vital organs. We reviewed the results of OHS patients who were 70 years old or older. Material and Method: Thirty six consecutive septuagenarians underwent OHS from 1995 to 1997. Operations were coronary artery bypass grafting(CABG) in 26 including 3 left main surgical angioplasty, valve replacement in 7, MVR+CABG in 2, and ASD closure+TAP in 1. Statistical tests were carried out to compare survivor group with nonsurvivor group in respect to risk factors including NYHA functional class, LVEF, emergent operation, IABP support, CPB/ACC time, ventilator time cardiac index, ICU stay and hospital stay for operative mortality. Result: Operative mortality rate and postoperative complication were 16%(6/36) and 50%(18/36). One-year and 3-year actuarial survival rates were 76%. Nine patients(25%) had major complications including third-degree A-V block(2), respiratory failure(1), stroke(3), renal failure requiring dialysis(3) and postoperative hemorrhage(2). The causes of death were pneumonia(1), bleeding(1), acute renal failure(1), low cardiac output(1), third-degree A-V block(1), and ventricular tachycardia(1). The univariate analysis of mortality shows that NYHA class IV, LVEF<40%, lesser values for C.I, and longer time for ventilatory support were associated with the risk factors(p value=0.03, 0.001, 0.007, and 0.014). The emergent operation, CPB/ACC time, IABP support, ICU stay and hospital stay were not significant. Conclusion: We conclude that cardiac operation can be performed in septuagenarians with acceptable outcomes when done in patients with normal to moderately depressed left ventricular function and adequate functional reserves in their vital organs.