• Journal of Preventive Medicine and Public Health
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• 제26권4호
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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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• 제30권1호
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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.

• 한국심리학회지 : 문화 및 사회문제
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• 제24권2호
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• pp.221-250
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• 2018

본 연구는 직무배태성 개념에 기초하여 대졸 초기경력자의 이직 및 잔류요인과 이직효과를 그들의 입장에서 심층적으로 살펴보고자 했다. 이를 위해 대졸 초기경력자 20명과 심층면담을 실시했으며 그 내용을 현상학적 분석방법으로 분석하였다. 그 결과, 이직을 고려하는 요인에는 직무배태성의 구성요소 중 적합성 및 연계가 포함되어 있었다. 즉, 자신의 능력과 재능이 직무에 잘 활용되는지, 현재 업무가 자신의 진로 방향에 부합하는지 그리고 조직의 비전과 문화가 자신과 맞는지 등의 적합성과 조직 내 동료 및 상사와의 공식적 또는 비공식적 상호작용 등의 연계가 이직에 영향을 미쳤다. 반면, 잔류를 고려하는 요인에는 업무에 대한 만족 및 장기적 경력관리 고려, 조직에 대한 만족 등의 적합성과, 입사 동기나 부서 내 동료들과의 관계에 대한 만족 등의 연계, 그리고 불확실한 미래에 대한 불안, 취업상태에 대한 만족 등의 희생이 포함되어 있었다. 이직효과의 경우, 이직 이후 업무에 대한 만족과 일을 통한 성취감, 조직에 대한 만족감 및 동료와의 관계와 팀 분위기에 대한 만족이 이직으로 인한 부정적인 변화를 상쇄하는 효과가 있었다. 이러한 결과를 통해 근속기간이 짧고 직무경력이 제대로 형성되지 않은 대졸 초기경력자들의 직업생활 수준을 향상시키고 이직을 방지하기 위해서는 첫 직장에서 직무를 통해 얻는 만족감과 원만한 대인관계, 그리고 이직에 따른 비용을 고려할 필요가 있음을 확인할 수 있었다.

• 한국병원경영학회지
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• 제6권1호
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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.

• 한국융합학회논문지
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• 제8권5호
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• pp.87-96
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• 2017

이 연구는 퇴원손상심층조사 자료를 이용해 손상 및 외상 사망환자의 재원일수 특성을 분석하여 손상 및 외상으로 인한 사망 예방을 위한 기초 자료 제공을 목적으로 시행되었다. 조사대상은 퇴원손상심층조사 자료에서 2014년 1월 1일부터 12월 31일까지 퇴원한 환자 중, 치료결과가 '사망'이며, 주진단이 손상 및 사고의 외인(S00-T98)인 환자 233명이었다. 연구결과, 여자의 재원일수가 남자보다 길었다. 주진단은 기타 내부 인공삽입장치, 삽입물 및 이식편의 합병증(T85)에서 재원일수가 가장 길었다. 이상의 연구결과로 볼 때 손상으로 인한 사망 재원일수 영향 요인을 파악하여 이들을 집중적으로 관리하기 위한 정책개발이 필요한 것으로 판단된다.

• 산업경영시스템학회지
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• 제32권4호
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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%.

• 기본간호학회지
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• 제6권3호
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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.

• 문화기술의 융합
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• 제9권3호
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• pp.137-143
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• 2023

이 연구는 어린이(0-12세)손상 환자의 특성에 따른 재원일수의 관계를 규명하여, 어린이손상 환자 재원일수에 미치는 요인을 분석하고자 시행하였다. 조사대상은 퇴원손상심층조사 자료에서 2016년 1월1일부터 2020년 12월31일 까지 퇴원한 환자 중 0-12세 이하이며, 주진단이 손상 및 사고의 외인(S00-T98)인 환자 7,804명이었다. 분석은 빈도 분석 및 독립표본 t-검정, ANOVA 검정을 실시하였다. 재원일수에 영향을 미치는 요인을 알아보고자 회귀분석을 시행하였다. 연구대상자의 평균재원일수는 5.5일 이었다. 학령기(7-12세)기 아동이 학령전기(0-6세)보다 재원일수가 길었으며, 진료비 지불방법이 의료급여 및 기타보험 환자가 재원일수가 길었다. 의료기관 소재지가 수도권보다 비수도권(전라도, 경상도)일 때, 병상규모가 100-299병상인 경우 재원일수가 길었다. 내원경로는 외래인 경우 재원일수가 짧았고, 손상기전이 운수사고, 화상인 경우 재원일수가 길었다. 부진단이 있고, 주수술을 시행한 경우 재원일수가 길었으며, 퇴원후 방향이 사망인 경우 재원일수가 길게 나타났다. 이 연구는 전국 단위 자료인 퇴원손상심층조사 자료를 이용하여 우리나라 어린이 손상환자의 재원일수의 특성 및 결정요인을 파악하였다는 점에서 의의를 갖는다. 또한, 안전교육 및 예방 활동만으로도 발생을 줄일 수 있는 어린이 손상의 관련 요인 대한 적극적인 치료와 다양한 예방정책 마련을 위한 기초 자료를 제공했다는 점에서 의의가 있다.

• 한국병원경영학회지
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• 제19권4호
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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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• 제32권11호
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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.