응급환자와 비응급으로 분류된 환자간의 진료비 비교분석

고대이,김성택,이정한,문태일,김옥준,최성욱,조윤경 대한응급의학회 2003 대한응급의학회지 Vol.14 No.1

Purpose: To report the distribution of emergency department costs by category of expense and level of patient urgency. Methods: We retrospectively analyzed the cases of 36,329 patients who visited the emergency department of Pundang CHA hospital during the recent l year. the patients were divided into two groups : urgent group and non urgent group. Physician, facility, supply, pharmacy, laboratory, and radiology costs were considered. Results: The average costs were urgent visits, W96,124; noriurgent visits, W87,028. For all patients, the average costs were radiology, 29%; facility, 26%; laboratory, 21%; physician, 12%; pharmacy, 8%; supply, 4%. Conclusion: The distribution of ED costs were similiar to regardless of the urgency of the medical condition. Overall improved cost efficiency can be achieved through reductions in the Variable costs of ED.

소아응급진료실 분리운영 후 적절성의 평가

이정한,김성택,고대이,문태일,추용식,김옥준,최성욱,이규형,조윤경 대한응급의학회 2003 大韓應急醫學會誌 Vol.14 No.4

119 구급대의 간접의료지도 프로그램 만족도 조사

이창재,제동욱,고대이,최마이클승필 대한응급의학회 2014 대한응급의학회지 Vol.25 No.1

Purpose: The purpose of this study was to identify thedegree of satisfaction with indirect medical oversight programsand its determinants. Methods: Gumi 119 rescuers participated in indirect medicaloversight programs, including Emergency MedicalServices (EMS) record review, weekly visiting education,and monthly EMS conference from March 2012 to February2013. Data were collected using a mail survey with a selfadministeredquestionnaire. The degree of satisfaction withthe programs was categorized according to two groups(1=satisfied, 2=unsatisfied). Then the Mann-Whitney U testand Fisher’s exact test were performed in order to find statisticallysignificant factors influencing satisfaction. Results: Cronbach αof questionnaires was 0.869. Amongthe 59 questionnaires, 55(93.2%) were returned. No differencesin sex, age, career, EMS record review, monthly conference,linkage with direct medical direction, and improvementof confidence in ER medical team were observedbetween the two groups. Qualification, weekly visiting program,and improvement in reliability to hospital showed statisticalsignificance (p=0.017, 0.040 and 0.001, respectively). Conclusion: The level of qualification of 119 rescuers andweekly visiting education at the fire department by doctorshas had a significant influence on satisfaction with indirectmedical oversight.

응급센터에서의 Portable Radiography 수행에 의한 방사선 노출

정원주,조성훈,김옥준,고대이,김성중,최성욱,조윤경,박재완,임상욱,차동훈,이경포,김종우 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.1

To accurately assess the potential hazard of exposure to ionizing radiation form portable radiographs taken in the emergency department, a study was performed to measure such radiation at different distances from the edge of an irradiated field during portable cervical spine, portable chest radiographs, and portable anteroposterior pelvis radiographs. For all three types of portable radiographs, radiation exposure is high at the edge from the beam. However, radiation exposure is decreased at 20, 40, 80, 160㎝ away from the beam. This study confirms and supports the evidence that although radiation exposure is dependent on distance from the primary radiograph beam, exposure in the ED is minimal. Medical personnel should not have to leave a patient care area for fear of undue acute and chronic radiation exposure while portable radiographs are performed in the ED. By using protective garment and standing appropriate distance away from the patient, continuous patient care can be maintained while portable radiographs are taken in the ED.

급성 충수염 환자의 성별과 연령별 분석

이정한,문태일,임치영,추용식,고대이,김성택,배진건,김옥준,최성욱,손석우 대한응급의학회 2004 大韓應急醫學會誌 Vol.15 No.5

P u r p o s e: This retrospective study was performed to investigate epidemiological characteristics in terms of the ageand the sex-specific incidences in patients with perforated or nonperforated appendicitis. M e t h o d: The study population comprised 314 patients who underwent appendectomies for suspected acute appendicitis between March 2002 and August 2003. This study used the student t-test, the coefficient of correlation, and the Cochran-Mantel-Haenszel Chi-square statistics. R e s u l t s: The incidence of nonperforated appendicitis was higher. Perforated appendicitis occurred at almost the same incidence in both sexes. However, the incidence of perforated appendicitis was high in small children and the elderly. The statistics of this study proved that the incidence of perforated appendicitis of the elderly was considerable. C o n c l u s i o n s: We suggest that the elderly need careful examination and rapid evaluation. Also, we suggest that since perforated appendicitis has a long duration of treatment, diagnostic accuracy is needed.

인후통으로 응급의료센터로 내원한 환자에서 진단적 RSS (Rapid Streptococcal Screening) 검사의 유용성

박영태,김옥준,김의중,고대이,김기형,강경원,김현수,이동욱,최성욱 대한응급의학회 2008 大韓應急醫學會誌 Vol.19 No.6

Purpose: This paper compares a RSS (Rapid Streptococcal Screening) detection test with a throat culture. The RSS detection kit is an easier and faster way to identify the infection of Group A beta-hemolytic streptococcus (GABHS), the most common causal agent of acute bacterial pharyngitis. We also examine the clinical symptoms that are associated with bacterial pharyngitis. Methods: A throat culture and a RSS detection test were performed simultaneously to all 239 patients who were suspected of having acute pharyngitis, and visited the emergency department between September 1st, 2002, and June 30th, 2003. Then the values of the RSS detection test were analyzed comparatively on a chi square test. The correlation between Centor criteria clinical features and bacterial pharyngitis was examined through a logic regression test. Results: Comparative analysis of the results of a throat culture and RSS detection test showed a test sensitivity of 83.6%, specificity was 97.2%, and the kappa coefficient was 0.83 (95% C.I: 0.75~0.91). This suggests that the RSS detection test is valuable statistically. Conclusion: The RSS detection test is more accurate than the diagnosis of bacterial pharyngitis based on clinical features. Assuming that all patients with acute pharyngitis take antibiotics, an RSS detection test reduce of unnecessary antibiotics use.

소아중증 독사 교상 환자의 치험 1례

임치영,이정한,문태일,추용식,고대이,손석우,최성욱,김옥준 대한응급의학회 2004 大韓應急醫學會誌 Vol.15 No.2

인후통 환자에서 Rapid Streptococcal Screening Test 결과 및 Centor Criteria 교육이 항생제 처방률에 미치는 영향

김기형,김옥준,김의중,고대이,강경원,김현수,이동욱,최성욱 대한응급의학회 2009 大韓應急醫學會誌 Vol.20 No.6

Purpose: This study evaluated the effect of Rapid Streptococcal Screening Test (RSST) results on the use of antibiotics for patients with sore throat in the ER setting and the effect of education about Centor criteria for primary physicians on the use of antibiotics. Methods: Between June 2008 and January 2009, we recruited 786 patients with sore throat who visited our emergency center. Patients were classified into 2 groups according to the RSST. Centor scores and antibiotic usage were assessed. Primary physicians were educated about Centor scoring and RSST. We analyzed the use of antibiotics to evaluate the effect of education on Centor scoring and RSST. Results: RSST results significantly correlated with antibiotic usage for the RSST done on a group of patients with sore throat (p<0.001). Education of primary physicians regarding Centor scoring reduced the use of antibiotics (p<0.001) for the low risk group of patients (Centor scores<3). The use of antibiotics for the high risk group (Centor scores≥3) was not significantly reduced (p=0.6394) after education regarding Centor criteria. Conclusion: The use of an RSS test and education of primary physicians will reduce the unnecessary use of antibiotics by patients and will result in appropriate use of antibiotics for patients who need antibiotics.

구급활동일지 분석을 통한 간접의료지도의 효용성

이주택,박상현,이찬희,김영갑,제동욱,고대이,최승필,김옥준,이창재 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.6

Purpose: This study examined the effect of indirect medical oversight on the quality of prehospital emergency care by emergency medical technicians. Methods: Indirect medical oversight was applied for a year and 119 rescue run sheets were retrospectively analyzed before and after the program to study the effect of an indirect medical oversight program in one city. The general characteristics of patients who visited hospitals before and after the program were analyzed, along with patient evaluation records, personal data, outbreak patterns, transfer information, direct medical oversight, and emergency medical services (EMS) mobilization reports. In addition, by comparing medical records and the 119 rescue run sheets,changes in the accuracy of 119 rescue run reports, the adequacy of patient classification, and the adequacy of medical direction were analyzed. After gathering these data, statistical analysis was performed and the level of significance was defined as p<0.05. Results: After executing the indirect medical oversight,there was significant improvement in the accuracy of 119rescue run sheets (p<0.001) and in the consistency of severity classification in 119 rescue run sheets compared with medical records (p=0.016). The adequacy of direct medical oversight request also showed improvement after the indirect medical oversight took effect (p<0.001). However, there was no statistical significance in prehospital procedures. Conclusion: Indirect medical oversight significantly improved the quality of emergency medical service by emergency medical technicians. However, the further application and improvement of indirect medical oversight programs are required for the development of prehospital emergency medical care.

Six sigma 활동이 STEMI 환자에서 경피적 관상동맥술을 이용한 재 관류 요법을 실 시하는 시간에 미치는 영향

강경원,김옥준,최성욱,김의중,박영태,황희정,고대이,조윤경 대한응급의학회 2010 대한응급의학회지 Vol.21 No.4

Purpose: To minimize the process that acute myocardial infarction (AMI) patients have to go through when visiting the emergency room (ER), and thus to provide prompt reperfusion therapy using the six sigma protocol, a business management renovation strategy to standardize the clinical process. Methods: Analysis was done on data obtained both before and after implementation of the six sigma protocol. Data were collected from ST segment elevation myocardial infarction (STEMI) patients who visited the ER between February 2006 and March 2009 and received reperfusion therapy. For statistical analysis used we used an unpaired t-test. Results: After the six sigma protocol was put into practice,total visiting time was reduced from 124.4±76.1 minutes to 91.5±50.3 minutes, and the reduction was statistically significant (p<0.0045). Six sigma (6 σ) means 3.4 PPM, that is,among 1 million cases no more than 3.4 cases should exceed the time limit of 90 minutes from the arrival of the patient to the needle puncture, making the task hard to achieve. σscore was greatly elevated-from 1.48 σto 2.48 σand the σerror rate (the proportion of cases that exceeded 90 min) improved from 62% to 45% . Conclusion: In this study we verified that applying the six Sigma protocol significantly reduced the time to reperfusion therapy for AMI patients. The reduction in time was due to changes in software (developed from the existing system)rather than to hardware improvements such as changes in test facilities or manpower amplification. The entire process,from a patient arriving at the ER until the patient received reperfusion therapy was viewed as one systemic flow and applying the six Sigma protocol to such flow was successful as shown by the result of this study. This shows that the six sigma protocol can be applied to a medical system if configured effectively. Further, this method can be useful not only for AMI patients, but also for many other urgent procedures such as acute cerebral infarction patients who require prompt diagnosis and hemolytic therapy, when the definition of the error rate is corrected according to the specific patients groups.