권역응급 의료환경개선을 위한 의료 서비스 디자인 -영남대학교병원 권역응급의료센터를 중심으로-

이애리 ( Lee Aerhee ),노권찬 ( Roh Kwonchan ),이돈일 ( Lee Donil ) 한국공간디자인학회 2020 한국공간디자인학회논문집 Vol.15 No.7

(연구배경 및 목적) 우리나라의 응급의료 환경은 1960년대 이후 본격적인 근대병원이 지어지기 시작하였고, 1980년대 공공의 개념인 국가적 지원으로 응급환자 후송을 시작하였다. 1990년대에는 다양한 인재를 겪으면서 1994년 응급의료에 관한 법률이 공포되었고 이는 현대 응급의료체계구축의 시발점이 되었다. 이후 2000년대 들어서면서 응급의료체계는 선진국과 비견할 수준에 도래했지만, 응급환자를 치료해야 하는 응급실에서는 서비스 불만족과 시스템적 소통 갈등으로 또 다른 서비스 사각지대가 생기게 되었다. 이러한 문제를 해결하기 위하여 선진국에서는 의료 서비스 디자인을 도입하여 문제를 해결하기 시작했고, 우리나라의 종합병원에서도 서서히 외국 사례를 바탕으로 의료 서비스 디자인을 접목하여 응급의료센터의 문제점을 해결하기 위해 노력하고 있다. 이에 본 논문은 의료 서비스 디자인 프로세스의 적용을 통해 응급실의 다양한 문제를 해결하여 의료환경 개선 및 의료 서비스 질을 높이는 디자인방안을 제시하였다. (연구방법) 연구방법으로는 먼저 응급의료센터와 의료 서비스 디자인의 문헌 및 논문을 바탕으로 권역 응급 의료센터의 개념과 현황을 이해하고, 의료 서비스 디자인의 필요성과 중요성을 파악하였다. 다음으로 국내외 응급시설의 의료 서비스 디자인 적용사례를 조사하여 응급시설에 필요한 요소와 제공되어야 하는 의료 서비스에 대해 분석하고, 이를 바탕으로 영남대병원 응급시설의 문제점과 방향을 도출하여 의료 서비스 디자인을 적용한 사례를 정리하였다. (결과) 사례 분석 결과 국내외 우수사례에서 의료 서비스 디자인의 적용을 의료 서비스 중 치료서비스를 중점으로 의료정보전달과 병원 환경, 서비스를 적용하여 분석하였고, 이를 바탕으로 영남대병원의 응급시설에 의료정보전달, 병원 환경 그리고 서비스에 따른 문제점을 파악한 후 이 세 가지를 중점으로 해결방안을 도출하여 의료 서비스 디자인을 개발 및 적용하였다. (결론) 권역응급의료센터는 많은 환자가 방문하는 만큼 다양한 사람들이 공존하면서 의료진과 환자, 보호자 간의 커뮤니케이션이 매우 중요하다. 증가하는 폭력과 폭언을 해결하기 위해서는 단순히 시설과 인력의 측면을 넘어 의료 서비스 디자인적 접근이 중요함을 확인했다. 의료 서비스 디자인을 통해 여러 응급의료법 위반의 문제가 점차 줄어들고 있지만, 이는 국내 몇몇 종합병원 이상의 응급시설에 불과하기에, 앞으로 많은 종합병원과 중소병원에서도 도입하여 많은 성공 사례들이 나오길 기대한다. 또한, 이로 인해 의료진의 진료업무 효율성이 증가하길 기대하며 환자와 보호자의 불안감과 현재 응급시설에서 일어나고 있는 다양한 문제들이 해결되길 기대한다. (Background and Purpose) The Korean emergency medical facilities started with modern hospitals since the 1960's and urgent patient transfer began with national support, a public concept in the 1980's. The Act on Emergency Medicine was enacted in 1994 with various human disasters in the 1990's, making the starting point of the modern emergency medicine system establishment. Since then, in the 2000's, emergency medicine system became the level available for being compared with the developed countries and yet, there are other blanks such as violations and homicides against medical staffs in emergency rooms. To solve these problems, the developed countries started to solve these problems by introduction of medical service design and in Korea, general hospitals make an effort to solve emergency medical centers by applying medical service designs based on the foreign cases. Therefore, the study suggests designs for improving medical environments and medical service quality by solving various problems in emergency room through medical service design process. (Method) For research methods, based on literature and articles of emergency medical centers and medical service designs, the conceptions and the current status of regional emergency medical center are understood and necessity and importance of medical service design are figured out. By investigating the cases of medical service designs of the domestic and overseas emergency medical facilities and the medical services to be applied as well as the factors required for emergency facilities are analyzed, and then, based on them, the problems and directions of emergency facilities of Yeungnam University Medical Center are drawn and the cases of medical service designs are summarized. (Results) For the results, focusing on curing services on medical ones with medical service design in domestic and overseas cases, with medical service design, the analysis was made by applying medical information delivery, hospital environment and service, and the problems in Yeongnam University Medical Center's emergency facilities according to three were figured out and the solutions were drawn for developing and applying medical design service. (Conclusions) Regional emergency medical centers are visited by lots of patients and there are various people, with very impotance of communications among medical staffs, patients, and carers. To solve increasing violence and hate speeches, beyond simple perspectives of facilities and labors, the importance of medical service design was confirmed. Even though various problems from violation of emergency medicine laws are decreasing through medical service designs, it is just limited in the domestic university hospitals' emergency facilities. Therefore, there should be successful cases in other hospitals and clinics. Efficiency of work of medical staffs should be increased and various problems in the current emergency facilities including anxiety of patients and carers should be solved.

한 지역 권역 응급의료센터 내원환자의 이용 행태 분석

류황건,송현경,김혜숙,김태곤,Ryu, Hwang Gun,Song, Hyun Kyung,Kim, Hye Suck,Kim, Tae Gon 보건의료산업학회 2007 보건의료산업학회지 Vol.1 No.1

Currently, we have seen sudden increase of demand for emergency medical services by reason for high-speed economic development increase of traffics, etc. in this society. Consequently the government enforced & operated emergency medical system in 1991 as a link of more positive countermeasure against it, but many problem; still remain in reality. In particular, the regional emergency medical center designated by the Ministry of Health and Welfare falls short of our expectations for its essential role by the reason of such as insufficiency in professional manpower and institutions concerned in small-scale hospital, matters with transportation system, preference of large hospital, etc. Therefore, this study was conducted grasp for the actual conditions of emergency medical system based upon literature research & the preceding studies and interview research the motive of coming hospital, satisfaction & understand to the subject of 150 persons of patients and their guardians who used regional emergency center of Pusan National University Hospital, thereby examining & analysing the cause of emergency room overcrowding by non-emergency cases, one of the problem; enumerated from preceding studies. The main result of this study is as follows. First the actual condition of non-emergency patients coming hospital for examining overcrowding of emergency medical center showed that, of the patients who used the emergency medical center, non-emergency patients accounted for 49.3%, which acted as the main cause of delaying medical care for emergency cases, cases of which medical person or first-aid man decided to come hospital accounted for 36.1 %, thereby suggesting essential need for re-education & wide public information to even the professional manpower besides patients & guardians for their using emergency medical system. Second, as the result of researching patient acknowledgement with reference to their using emergency medical center, the rate of their giving right answer is no more than 60%, which means that non-emergency cases' using as such is due to the shortage of their knowledge of the said emergency medical center, which suggests us that wider P.R for emergency medical system to common people who may be one of the patients of it at any time is still in need. Third, the result of researching for finding out a future remedy of emergency medical system showed that the users who know well of the way of using emergency medical center had relatively high satisfaction of it, ones who have lesser knowledge of it lower satisfaction and users who feel in need of emergency specialized manpower feel the necessity of public information of emergency medical information center(1339) at the same time. The finding of examining the subject of study, in conclusion, showed that the degree of the patients & their guardians' understanding of emergency medical system is lower and the medical persons concerned also had no distinct difference in their understanding of it from the common people's, which suggests us for extensive enforcement of systematic education and public information in aspect of the government via various media for the purpose of effective operation of emergency medical center.

서울 지역 주민들의 1339 응급의료정보센터 이용양상에 관한 연구

이관,임현술 대한보건협회 2002 대한보건연구 Vol.28 No.1

The emergency medical system plays an important role in medical services, and this report concerns the Emergency Medical Information Center 1339 (EMIC 1339), the 119 Rescue Service, and the Emergency Medical Center. Among these, EMIC 1339 is the most important part of this system, and to study its utilization pattern, the authors reviewed reception information for the fourth quarters of 1997 & 1998, and 891 cases of medical consultation during May, 1999. In centralizing emergency calls to EMIC 1339 by means of the 119 telephone number, the use of ambulance services has been markedly decreased. In terms of medical consultations, female patients made up the majority of cases with 503 persons (56.5%), and, in terms of age distribution, the age group from 0 to 4 years was the most frequent with 271 persons (30.5%). In terms of the different departments involved, pediatrics was the most frequent with 334 cases (37.5%), followed by internal medicine with 167 cases (18.7%) and orthopedic surgery with 89 cases (10.0%). According to the Korea Standard Classification of Diseases (KCD-3), certain infectious and parasitic diseases (I) was the most frequent with 196 cases (20.0%), followed by injury, poisoning and certain other consequences of external causes (XIX) with 183 cases (20.5%). Injury, poisoning and certain other consequences of external causes (XIX) was more frequent in males with 92 cases (23.7%), but certain infectious and parasitic diseases (I) were more frequent in females with 107 cases (21.3%). In terms of reception time, the period from 9 P.M. to midnight was the busiest with 200 cases (22.4%). Especially in the case of medical consultations, the utilization pattern of patients using EMIC 1339 was similar with that of patients visiting an emergency center. So, before visiting an emergency center, it is preferable to call EMC 1339 and to obtain advice about one's health problems. In the future, the authors hope that EMIC 1339 will play a central role in the emergency medical system.

응급실환자 내원행태 및 중증도에 관한 조사 연구

유순규,최혜경,김광한 서울보건대학 1999 서울보건대학 부설 병원경영연구소 논문집 Vol.4 No.2

To solve the problem of tertiary emergency medical center. overcrowding and long hospital stay. it is very important to analyze arrival pattern of the emergency patients who visited tertiary emergency medical center and to reviewed 312 cases of patients who visited the four places emergency medical center which emergency medicine department specialist always stays in. of Seoul and Suwon teritory, from March 1 to May 31. 1997. The results were as follow : 1. Considering sexual distribution, male patients were 60.3% and female patients were 39.7% and the most common age group was 2th decade. 2. The result of symptom severity classification of patients coming emergency medical center was urgent patients 12.8%, emergency patients 29.8%, non-emergency patients 57.4% 3. The peak time of patient's enterance in emergency medical center was between 8: 00PM and 12:00 PM(26.7%), and most patients visited between 4:00 PM and 12:00 PM (out patients coming time) 4. In a week. Monday was the most crowding day (25.0%) 5. The most patients who visited emergency medical center needed surgical care due to injury & poisoning(27.9%) and second disease of them had circulatory system (17.6%) 6. The admission rate was 42.9% and 46.4% of admitted patients were non-emergency patients. 7. The rate of the urgent patients making use of 119 ambulance was 62.5%. emergency patients rate was 47.3% 8. The treatment result of patients in emergency medical center trended improving of urgent patients(improvement rate was 72.5%)

대학병원응급의료센터의 평면유형에 따른 동선효율성 연구

안수미(An, Su-Mi),손광호(Son, Kwang-Ho) 한국실내디자인학회 2014 한국실내디자인학회 학술대회논문집 Vol.2014 No.11

In the Korean modern society, urbanization, industrialization, and aging have been accelerated. More emergency patients have visited emergency medical centers, on account of frequently occurring crimes, traffic accidents, industrial accidents, and diseases. Recently, National Emergency Medical Center decided the policy of "Master Plan of Emergency Medical care", according to which emergency service is reorganized into functional based service and more reasonable hospital traffic line plan is required to provide immediate and systematic emergency treatment in golden time. Therefore, this study tried to investigate the traffic line of patients and medical staff according to plan types and draw an efficient plan type for immediate medical treatment. It looked into the basic concept through theoretical examination and analyzed the traffic line of patients and medical staff through J-graph. According to the analysis, first, there were differences in traffic line between patients and medical staff according to the spatial compositions which have the same plan type, though. Therefore, it is necessary to come up with a traffic line plan. Secondly, a corridor needs to be built to connect each relevant part depending on needs. Thirdly, medical staff needs to approach each space closely on the basis of nursing station, and a corridor for patients needs to be installed. In conclusion, it is expected that through the analysis on the traffic line system of patients and medical staff according to plan types, this study will be able to provide the efficient plan data of emergency medical centers.

경북지역 일개 응급의료센터 노인환자의 내원관련 특성과 의료이용 분석

남창석,한삼성,유왕근 보건의료산업학회 2016 보건의료산업학회지 Vol.10 No.4

Objectives : The purpose of this study was to examine the health service utilization of elderly patients who visited an emergency medical center in the Gyeongbuk region and to provide basic information for the effective management of emergency medical centers. Methods : This study analyzed the characteristics of the hospital visits and the actual situation for the use of emergency medical care of 10,264 elderly patients that visited an emergency medical center in the Gyeongbuk region from January, 2014 to December, 2014. Frequency analysis and chi-square test were done in this study. Results : This study showed that there is a difference in the characteristics of health service utilization which included hospital visits, duration of hospital visits and mode of arrival to the emergency medical center according to age, gender and other characteristics. Conclusions : Providing efficient emergency services is necessary as well as establishing an emergency medical center management plan that takes into consideration the difference in health service utilization of elderly patients.

우리나라 응급의료센터 응급구조사의 직업적 방사선 노출

이현경,박정임,Lee, Hyeongyeong,Park, Jeongim 한국산업보건학회 2017 한국산업보건학회지 Vol.27 No.3

Objectives: This study aims to investigate the occupational radiation exposures of emergency medical technicians(EMTs) in emergency medical centers in Korea. The results will provide a basis for developing prevention programs to minimize adverse health effects relating to radiation exposure among emergency medical technicians working in this area. Methods: Radiation exposure doses were measured for twenty-two EMTs working in six emergency medical centers. Thermo Luminescent Dosimeters(TLD) were placed on three representative body parts, including chest, neck, and a finger. Measurements were conducted over the entire working hours of the participants for foor weeks. Dosimeters were analyzed according to a standard method by a KFDA-designated lab. Detection rate, annual radiation exposure dose, and relative levels to dose limit were derived based on the measured doses from the dosimeters. SPSS/Win 18.0 software(IBM, US) was used for statistical analysis. Results: Detection rates were 45.5%, 36.4%, and 45.5% for the dosimeters sampled from chest, neck, and a finger, respectively. The average annual doses were $2.39{\pm}3.44mSv/year$(range 0.38-10.0 mSv/year) for the chest, $2.72{\pm}3.05mSv/year$(2.00-11.34) for the neck, and $20.98{\pm}17.57mSv/year$(1.25-53.50) for the hand dose. The average annual eye dose was estimated to $3.61{\pm}2.37mSv/year$(1.50-8.34). The exposure dose levels of EMTs were comparable to those of radiologists, who showed relatively higher radiation dose among health care workers, as reported in another study. Conclusions: EMTs working in emergency medical centers are considered to be at risk of radiation exposure. Although the radiation exposure dose of EMTs does not exceed the dose limit, it is not negligible comparing to other professionals in health care sectors.

응급의료 정보센터에서 시행된 119 구급대원에 대한 직접의료지도

박성욱,조석주,김용인,박맹렬,민문기,이성화,황순민 대한응급의학회 2011 대한응급의학회지 Vol.22 No.1

Purpose: This study was performed to evaluate the appropriateness of medical direction for the prehospital emergency treatment of 119 rescue services in an emergency information center. Methods: A total of 4,028 cases requested by 119 rescue services from January 1, 2008 to December 31, 2009 were reviewed retrospectively. Medical direction for requests of 119 rescue services constituted five categories. The appropriateness of medical direction for prehospital emergency treatment of 119 rescue services was evaluated according to area and specialty. Results: The majority of the 119 rescue service requests concerned resource information (72.4%). Medical direction for prehospital treatment comprised a small proportion of the requests (13.2%). The total appropriatenss of medical direction for prehospital treatment was 56.4% and was higher in emergency physician than non-emergency physician. The appropriatenss difference between two areas was not determined. Conclusion: The requests for prehospital emergency treatment of 119 rescue services was low. The appropriatenss of medical direction for emergency treatment was low and higher appropriatenss was observed in emergency physician.

지역응급의료센터 응급실의 공간 이용 분석 연구

정기현(Jung, Gi Hyun),권지훈(Kweon, Jihoon) 한국디지털디자인협의회 2017 디지털디자인학연구 Vol.17 No.2

본 연구의 목적은 지역응급의료센터의 사용자 이동 시뮬레이션을 통해서 동선이 집중되는 영역을 도출하는 것이다. 선행연구의 고찰과 국내 응급의료센터 내 외래 진료부문과 응급실의 설계 사례를 분석에 의한 공간 구조의 도출이 이용자의 이동을 분석함에 있어서 선행되었다. 사용자별 공간 이용 가능성의 분석은 응급실의 과밀화 확률이 높은 공간을 도출하였다. 연구 결과로 과밀화의 정도가 높은 공간은 응급실 복도로 나타났다. 신속한 진료를 위해서 응급환자와 비응급환자의 동선을 통제할 필요가 있다. 사용자가 집중되는 공간은 개별 병원에서의 복도, 로비, 홀, E.V홀, 주계단과 같은 공용공간으로 나타났다. 응급의료센터 내 공용공간에서의 사용자의 집중을 약화시키기 위해서는 공용공간을 소규모로 분산하여 배치할 것을 권장한다. 공용공간에 대하여 사용자의 통제가 필요하다. 본 연구는 과밀화에 대응하기 위한 공간 계획에 요구되는 자료를 제시하였다. This Study aimed to clarify the concentrated areas in an local emergency medical center with using user movement simulation. Review of precedent studies and spatial composition analysis followed user movement simulation. User groups contained patient group, medical staff group, administrative staff group and visitor group. A space with a high probability of overcrowding is the emergency room corridor. Emergency patient’s circulation and patient’s circulation for immediate medical care should be separated. Public spaces such as corridor, lobby and hall, elevator hall, main stairway appeared to be overcrowded at individual medical center as the study result. and User controls are needed for public spaces. It is suggested to plan small decentralized public spaces for decreasing user’s overcrowding in emergency medical centers. The analysis result of user movement simulation revealed spaces highly evaluated in overcrowding possibility.

한국의 권역별 외상센터 사업의 안정화를 위한 제언

조현민 대한의사협회 2016 대한의사협회지 Vol.59 No.12

From 2011 to 2016, 16 regional trauma centers were designated throughout the country and 9 of the 16 centers have been operating their own trauma facilities. At present, there are some differences in treatment experiences and levels according to the type and size of the trauma centers. Treating the trauma system as a part of emergency medical service, while the field of severe trauma is clearly different from the rest of emergency medical service in particular, has become a serious problem in Korea. First of all, the role of trauma centers should have been established before they are added to the trauma care system. Beyond that, manpower is the most important factor in building a trauma center. Pusan National University Hospital offers the ideal environment for a study on the relationship between trauma centers and emergency centers. Pusan National University Hospital has 2 independent emergency rooms: one each in the trauma center and emergency center. Therefore, it is possible to compare the outcomes of 2 different emergency rooms and identify the proportion of the trauma population who is transferred from the emergency center to the trauma center due to trauma severity index. Ultimately, the government and individual hospitals must support personnel in each trauma centers administratively and financially to sustain trauma centers over the long term. The purpose of this proposal is to suggest some resolutions to the problems associated with the trauma care system in Korea.