Six Sigma혁신 활동을 통한 응급센터 체류시간 단축

배진건,김옥준,최성욱 대한응급의학회 2008 大韓應急醫學會誌 Vol.19 No.1

Purpose: The aim of this study was to improve overcrowding in an emergency department with the six sigma process. The authors evaluated possible factors that might delay patients’ length of stay and suggest possible means for improvement. Methods: We measured time spent in each step of emergency clinic care and investigated possible reasons for delay. The time spent in each step was measured again after change were made to address possible causes of delay. The difference in time between before and after the change were analyzed. Results: According to the steps of ‘measure’ and ‘analyze’ in six sigma, greatest delays occurred in obtaining laboratory test results and explaining overall status to patients. After practicing an improvement plan, total time spent in the emergency department decreased from 467 minutes to 364 minutes (p=0.000), and the six sigma level increased from 1.145 to 1.450. Defects per million opportunities (DPMO) decreased from 638,554 to 520,095. Conclusion: Through six sigma improvement, the length of stay in an emergency department can be reduced. This can not only bring more satisfaction to patients, but it can also improve overcrowding of emergency department clinics through increased hospital bed turnover.

응급의료센터로 내원한 패혈쇼크 환자에서 각 중증도 점수체계의 예후 도구로서의 유용성 평가

이형주,정태녕,이재영,배진건,김의중,최성욱,김옥준,조윤경 대한응급의학회 2012 대한응급의학회지 Vol.23 No.6

Purpose: The aim of the study was to validate abbreviated mortality in emergency department sepsis (MEDS) scoring system by comparing it with original MEDS score and to assess the prognostic value of other prognostic factor for sepsis patients including multiple organ dysfunction score (MODS), sepsis-related organ failure assessment (SOFA)score, and serum procalcitonin level. Methods: Adult patients visiting emergency department (ED) with evidence of septic shock were enrolled to the study. MEDS score, MODS, and SOFA score were calculated based on initial clinical data. Receiver-operating characteristics (ROC) analyses were used to assess the prognostic factors for predicting mortality. Kaplan-Meier survival analyses (KMSA) were used to determine whether the prognostic factors had correlation with survival time. Results: Only MODS showed significant predicting power for mortality (p=0.003, area under curve=0.625). Estimated median survival of all the patients calculated by KMSA was 11.0(standard error 1.7) days, and predefined criteria of all prognostic factors showed significant differences in survival time. Conclusion: MEDS, abbreviated MEDS, MODS, and SOFA scoring systems were useful factors for predicting survival time of septic shock patients visiting ED.

응급의료센터로 내원한 급성담낭염 의심환자에서 합병된 급성담낭염 발생의 예측요인 탐색

박홍인,박재욱,심명보,배진건,제상모,정태녕,김의중,최성욱,김옥준 대한응급의학회 2015 대한응급의학회지 Vol.26 No.4

Purpose: The aim of the study was to determine the factors associated with complicated acute cholecystitis of initial clinical findings during an emergency department (ED) visit, and to use them as a guideline for consideration of early and active surgical intervention, to improve the prognosis of acute cholecystitis. Methods: Medical records of adult patients diagnosed and treated in the ED as acute cholecystitis were reviewed retrospectively. Clinical findings including demographic data, past medical history, symptoms, physical exam, and laboratory test results were included in the analysis. A case associated with gall bladder empyema, gangrene, perforation, hydrops, or failure of initial laparoscopic approach was defined as complicated acute cholecystitis. Factors showing significance in univariate analyses were included in binary logistic regression analysis for prediction of complicated acute cholecystitis. Results: Age, sex, hypertension history, anorexia, body temperature, white blood cell count (WBC), aspartate aminotransferase, creatinine, total bilirubin, amylase, and lipase were significant in univariate analyses, and included in multivariate analysis. Age (p=0.039), male sex (p=0.004), and WBC (p=0.019) were significant in multivariate analysis. Conclusion: Age, sex, and initial WBC of patients diagnosed and treated in the ED as acute cholecystitis were independently associated with complicated acute cholecystitis.

요양병원에서 전원된 노인환자의 재원기간에 관련된 요인 분석

박재욱,박홍인,심명보,이창재,배진건,제상모,정태녕,김의중,최성욱,김옥준 대한응급의학회 2015 대한응급의학회지 Vol.26 No.2

Purpose: The number of geriatric patients transferred from long-term care hospitals to emergency department (ED) is increasing because the number of long-term care hospitals has increased significantly in recent years. Only a few studies showing the characteristics of geriatric patients transferred from long-term care hospitals to ED have been reported. We assessed factors affecting length of hospital stay in geriatric non-trauma patients transferred from longterm care hospital to ED. Methods: This study was a retrospective review of the medical records of 143 patients who were transferred from long-term care hospital to ED. Admitted patients were classified according to two groups (general ward group and intensive care unit group). Univariate analyses were performed relating initial vital signs and laboratory methods for prediction of the length of hospital stay. Cox proportional hazard analysis was then derived, with all variables in the final model significant at p<0.05. Results: A total of 189 patients were enrolled in the study. Results of univariate analysis for Glasgow Coma Scale, heart rate, oxygen saturation, white blood cell count, segmented granulocyte percent, erythrocyte sedimentation rate, and C-reactive protein were significant. In multivariate analysis results for oxygen saturation (p=0.014, hazard ratio=1.065) and segmented granulocyte percent (p=0.025, hazard ratio=0.975) were significant. Conclusion: Higher oxygen saturation and lower segmented granulocyte percent are independent factors leading to earlier discharge from the hospital in geriatric non-trauma patients transferred from long-term care hospitals.

일개 응급의료센터에 내원한 15세 미만 소아 발열 환자에서 프로파세타몰 정맥주사의 해열 효과

천지만,제상모,박광호,배진건,정태녕,김의중,최성욱,김옥준 대한응급의학회 2015 대한응급의학회지 Vol.26 No.1

Purpose: Fever is one of the most common symptoms in children visiting the emergency department. When oral antipyretics use is limited, IV antipyretics may be necessary for control of fever. In this study, we examined the current status of use and antipyretic effect of propacetamol, a precursor of acetaminophen, in fever management for children of age younger than 15 in an emergency center. Methods: We reviewed medical records of 101 patients who were prescribed IV propacetamol from September 1st to December 31st in 2013. Among these patients, 59 children received propacetamol via intravenous injection for control of fever. We investigated variable data including age, sex, weight, chief complaint, reason for use of intravenous propacetamol, history of liver disease, and body temperature before the injection. In addition, to examine the antipyretic efficacy of IV propacetamol, we thoroughly investigated administration dose, number of injections, use of other antipyretics, other antipyretic therapy (ex. like tepid massage or ice bag), fever clearance time, etc. Results: Intravenous propacetamol at a dose of 26.16 mg/kg was used in 59 patients and fever was controlled under 38 C within 2 hours in 39 patients (66.1%). Fever was relieved under 38 C within 4 hours or general condition was improved in 49 patients (83.0%). Conclusion: In this study, we examined the antipyretic efficacy of intravenous propacetamol in management of fever for children younger than 15 years of age in an emergency center. Optimized uses of intravenous propacetamol according to age and weight were effective for pediatric patients with fever who cannot swallow oral medications.

응급센타에서 시행한 혈액배양 검사의 유용성

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

P u r p o s e: This study was conducted to derive and validate a clinical prediction rule for blood cultures obtained in the emergency department. M e t h o d s: We conducted a retrospective chart review of patients with a fever who underwent blood cultures from August 2002 through July 2003. The student t-test, coefficient of correlation, ROC (receiver operatics characteristic) curve, and Chi-square statistics were used for the analyses. R e s u l t s: Included in the study were 108 patients, of whom 47 were men and 61 were women. The mean age was 4 5 . 3 0±26.21 years old. The most common diagnoses were pneumonia and acute gastroenteritis. The usefulness of blood cultures in the emergency department was statistically significant in patients with fever or with higher levels of band form. C o n c l u s i o n: We determined that blood cultures are uncommonly useful for febrile patients and that a need rule is needed for the use of blood cutures in the emergency d e p a r t m e n t

응급의료센터로 내원한 60세 이상의 고령의 상부위장관출혈 환자에서 Glasgow- Blatchford 점수 체계를 이용한 초기 위험도 계측의 적절성

박광호,이창재,천지만,배진건,제상모,정태녕,김의중,최성욱,김옥준 대한응급의학회 2015 대한응급의학회지 Vol.26 No.1

Purpose: Upper gastrointestinal bleeding (UGIB) is one of the most common causes of emergency department (ED) presentation which can lead to a fatal condition. Many clinical scoring systems intended to predict the prognosis of UGIB patients were developed and validated, including Glasgow-Blatchford score (GBS) and Rockall score (RS). In particular, GBS has shown its superiority in prediction of mortality, the necessity of endoscopic intervention and admission, compared with other scoring systems, in recent studies. However, GBS does not include the age of the patient as its component and has clearly shown its efficacy only in subjects under age 70. Hence, we aimed to assess whether GBS could also be used in old age UGIB patients as a useful risk stratifying method as in younger age. Methods: UGIB patients who visited our ED for one year were retrospectively enrolled in the analysis. Medical records of the subjects were reviewed, and their GBS and clinical RS were calculated. Receiver-operating characteristics (ROC) curve of each score in prediction of high risk UGIB was drawn and area under curve (AUC) was calculated. Correlation analysis of each score and hospital length of stay was also performed. To assess the validity of each score for use in old age patients, all analyses were also performed in subgroups of age over 60 years, and under that. Results: ROC curves suggest that GBS has significant detecting power for high risk UGIB in overall subjects, subgroups of age over 60 and under (p=<0.001 for all, AUC= 0.919, 0.935, 0.901, respectively). Otherwise, clinical RS only showed significant results in overall group and subgroup of age over 60 with lower AUC. Conclusion: GBS may also be used safely as an initial risk stratifying method in old age UGIB patients visiting the ED, as in other age groups.

상부 위장관 이물질 섭취를 주 증상으로 응급실에 내원한 성인 환자 경과에 대한 고찰

심명보,박재욱,박홍인,배진건,제상모,정태녕,김의중,최성욱,김옥준 대한응급의학회 2015 大韓應急醫學會誌 Vol.26 No.5

Purpose: The purpose of this study is to search for factors which can help in deciding on proper treatment for patients who visit the Emergency department (ED) with symptoms of foreign body ingestion. Methods: This study was a retrospective review of medical records of ED patients with primary symptoms of foreign body ingestion. The patients’ demographic data, elapsed time since the ingestion, type of foreign body, symptoms, and the method of removal were analyzed. Receiver operating characteristic (ROC) curve was used for analysis of whether these factors can be used to decide on proper treatment. Results: Among 321 patients, a foreign body was removed successfully in 285 patients and the foreign body was not found in the remaining 36 patients. Of the successfully treated cases, 76 were removed grossly, 133 were removed using a laryngoscope, 74 were removed with endoscopy, and 2 were removed spontaneously. Comparing the group in which a foreign body was found and the other group, there was a significant difference in elapsed time since the onset of symptoms (p=0.013) and the type of foreign body (p=0.001). There was no significant reliable factor which can predict the existence of a foreign body. Conclusion: There was no significant factor which can predict the existence of a foreign body. Considering that the foreign body was found in most suspected patients, and that numerous patients in which a foreign body was not found had shown signs of complications due to foreign body, constructive treatment should be advocated.

25-hydroxyvitamin D Levels was not Associated with Blood Pressure and Arterial Stiffness in Patients with Chronic Kidney Disease

Kyung Mi Park,전학훈,배진건,최유범,양동호,정혜윤,이미정,이소영 전해질고혈압연구회 2017 Electrolytes & Blood Pressure Vol.15 No.2

Background: We investigated the effect of vitamin D deficiency on cardiovascular risk profiles in an Asian population with chronic kidney disease (CKD). Methods: A total of 210 participants (62 non-dialysis CKD patients and 148 hemodialysis [HD] patients) were enrolled between December 2009 and February 2010. Vitamin D deficiency was determined using the serum 25-hydroxyvitamin D [25(OH)D] concentration. Blood pressure and arterial stiffness were measured. Subjects were divided into groups according to 25(OH)D concentration based on a cut-off of 13.5 ng/mL in non-dialysis CKD patients and 11.3 ng/mL in HD patients. Results: The mean age was 61.7±12.3 years in non-dialysis CKD patients and 57.0±12.7 years in HD patients. In the non-dialysis CKD group, mean estimated glomerular filtration rate (eGFR) was 29.7±15.4mL/min/1.73m2. Mean 25(OH)D concentration was 13.6±7.8 ng/mL in non-dialysis CKD patients and 11.3±6.7 ng/mL in HD patients. More than half of the subjects had vitamin D deficiency (67.6% in non-dialysis CKD patients and 80.4% in HD patients). There were no significant differences in systolic blood pressure, pulse pressure, and arterial stiffness between higher and lower 25(OH)D groups among non-dialysis CKD and HD patients. Multivariate analysis revealed that female sex (odds ratio [OR]: 5.890; 95% confidence interval [CI]: 2.597-13.387; p<0.001) and presence of diabetes (OR: 2.434; 95% CI: 1.103- 5.370; p=0.028) were significantly associated with lower serum 25(OH)D levels in HD patients. Conclusion: The prevalence of vitamin D deficiency was high in both nondialysis CKD patients and HD patients. Serum 25(OH)D concentration was not a significant factor associated with blood pressure and arterial stiffness among non-dialysis CKD and HD patients.

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.