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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
> Journal Vol & Issue
Quality Improvement in Health Care
Journal Basic Information
Journal DOI :
The Korean Society of Quality Assurance in Health Care
Editor in Chief :
Volume & Issues
Volume 1, Issue 2 - Dec 1994
Volume 1, Issue 1 - May 1994
Selecting the target year
Medical Records in Quality Assurance
Kang, Jin Kyung ;
Quality Improvement in Health Care, volume 1, issue 1, 1994, Pages 6~12
A Recent Expirience on Quality Improvement in Asan Medical Center
Hong, Changgi D. ; Lee, Sang-Il ;
Quality Improvement in Health Care, volume 1, issue 1, 1994, Pages 14~19
Shin, Young-Soo ;
Quality Improvement in Health Care, volume 1, issue 1, 1994, Pages 20~25
Q.A. ACTIVITY DEVELOPMENT - A GLOBAL PERSPECTIVE
Collopy, Brian T. ;
Quality Improvement in Health Care, volume 1, issue 1, 1994, Pages 26~31
Drug Use Evaluation of Vancomycin in Pediatric Patients (II) -The effect of Approval for Vancomycin Use
Lee, Jeongmin ; Lee, Soonsil ; Kim, Youngjoo ; Shin, Wan Gyoon ; Lee, Byung Koo ; Lee, Hoan-Jong ;
Quality Improvement in Health Care, volume 1, issue 1, 1994, Pages 32~43
The 'Pharmacy and Therapeutic Committee' decided to restrict the use of vancomycin which was categorized into restricted antimicrobials, among general, reserved and restricted antimicrobials. The committee also established prescribing guidelines of vancomycin in Seoul National University Hospital, May, 1991. Especially, the restricted antimicrobials should be used after approval by infectious disease specialist physician. A retrospective drug use evaluation (DUE) on vancomycin has been conducted to compare with the previous vancomycin DUE study in 1990. 'Criteria for DUE on vancomycin' was modified from Am J Hosp Pharm. Total 65 charts of patients were retrospectively reviewed from July 1991 to June 1992 in Seoul National University Children's Hospital. The justification of use was improved from 56% to 75% comparing with the previous study. In analyzing process indicators, several criteria including body temperature monitoring, WBC monitoring and use of concomitant antibiotics were well documented, but serum creatinine monitoring, culture and sensitivity test and level monitoring were infrequently performed, while the accepted level has been improved. Accepted level for appropriate initial dosage and duration of therapy were decreased. In outcome analysis, blood culture after discontinuing the drug was relatively well documented compared with the previous study. As the results, the approval vancomycin use was shown to be effective and rational in antibiotic therapy. And it is suggested that the above findings should be communicated to the medical staff, and a active intervention, such as feedback control, also be necessary for rational drug use.
Drug Use Evaluation on Ceftazidime
Kim, Sang Hyun ; Choi, Hyun Suk ; Kim, Hyang Suk ; Shin, Wan Gyoon ; Shon, In Ja ; Cho, Nam Chun ; Choi, Kang Won ;
Quality Improvement in Health Care, volume 1, issue 1, 1994, Pages 44~54
A drug use evaluation (DUE) program has been defined as an "authorized a quality assurance process designed to ensure that drugs are used appropriately, safely, and effectively". A retrospective DUE study on ceftazidime has been conducted by reviewing patients charts following criteria for drug use evaluation established by Am.S.Hosp.Pharm. Total 60 charts of patient treated with ceftazidime in Seoul National University Hospital from Jan. 1.1993 to July.31.1993 were retrospectively reviewed. As a result, 44 cases(73%) were met with the criteria for the justification of use. In analysing process indicators including culture and sensitivity test, CBC, LFT, history of anaphylaxis monitoring before initial dose, vital sign monitoring were relatively well documented showing the accepted level above 80%, while appropriated dose were infrequently documented with low accepted level. In outcome analysis, blood culture after discontinuing drug were rarely documented, with accepted level of 46%. For using effectively and safely, ceftazidime is recommended to be administrated to optimal indication, and monitored actively for preventing adverse effect.
An Integrative Way of Process Analysis for Better Total Quality Management: Focusing on Drug Entity
Kim, Myeng-Ki ;
Quality Improvement in Health Care, volume 1, issue 1, 1994, Pages 56~65
Total quality management has been a focus of concern in recent years since some dissatisfaction with the results from implementation of quality assurance programs in the U.S. Many managerial methodologies and innovation guidelines from academic disciplines have been applied to promote TQM programs in the health field. This paper consists of two folds of aspects: firstly to examine TQM's managerial philosophy by comparing with the newly introduced managerial concepts in Business Reengineering; and then to introduce a method for an integrative way of process analysis, Entity Life-Cycle Diagram (ELCD) modeling. The analysis method was compared with Process Map, which is a well-known method for BR applications. To show effectiveness of ELCD modeling, a case of application was introduced using 'drug' as a target entity. With having TQM issues in mind, the result was reflected in designing Entity Relation Diagrams. The results of ELCD modeling turn out to be helpful in designing database related to quality monitoring, in that many monitoring check points can be identified in a systematic way and that queries cross-sectional over organizational boundaries can be generated with a consistent view focusing on the drug use as a single process. Full evaluation of the analysis method remains to be studied until the completion of the information system under construction. But as long as TQM is based on a process-oriented view and needs supports from information system, ELCD can be one of the appropriate choice as a tool for the process analysis.
A Comparative Study on Hospital Accreditation Programme -United States of America, United Kingdom, Canada, Australia, Republic of Korea
Shin, Young-Soo ; Lee, Sin-Ho ; Kim, Su-Kyeong ; Lee, Young-Sung ;
Quality Improvement in Health Care, volume 1, issue 1, 1994, Pages 66~94
Hospital Accreditation Programme(HAP) has been introduced in many countries in the world for these recent years. This article reviews the HAP in the aspects of the organization, survey and evaluation process, evaluation criteria, and its impact to the hospital quality improvement. The nations included in this study are USA, UK, Canada, Australia, and Korea. To carry out this comparative study, the authors have reviewed articles and accreditation manuals having been issued in many countries. An expert panel of medical doctor, nurse, pharmacist, administrator, and specialist in health facilities formulated a study framework. The results of this study enhance understanding about hospital accreditation activities according to each nation's health care system. In recent years, the Korean government has launched the plan to improve the quality of health services by strengthening the hospital accreditation programme. This study results can provide useful information in development and implementation of the national hospital accreditation programme in Korea.
Applicability of Appropriateness Evaluation Protocol and Delay Tool
Shin, Youngsoo ; Kim, Yong-Ik ; Kim, Chang-Yup ; Kim, Yoon ; Kim, Eun Gyung ; Song, Yun Mi ; Lee, Young Seong ;
Quality Improvement in Health Care, volume 1, issue 1, 1994, Pages 96~108
Background: An appropriate use of hospital beds can improve productivity of hospital significantly. The authors' previous study revealed that approximately one third of Korean hospital bed days and one sixth of admissions were inappropriately used, when it was measured by Appropriateness Evaluation Protocol(AEP) and Delay Tool modified into Korean situation by the authors. This study aims to evaluate applicability of the instruments in a new hospital. More specifically the study aims to measure appropriateness of the instruments used by newly trained nurse reviewers at a new hospital setting. Methods: In order to evaluate applicability of these instruments, agreement rates of the scores recorded by newly trained nurse reviewers with by skilled nurse reviewer and also compared with the scores recorded by physician's implicit decision were assessed. Agreement rates were derived from concurrent application of AEP and Delay Tool to 52 admissions and 104 patient days from internal medicine, pediatrics, and general surgery of one university hospital. Overall agreement rate, specific nonacute agreement rate, and kappa statistics were used to indicate level of agreement. Results: Overall agreement rates on appropriateness between newly trained nurse reviewers and skilled nurse reviewer were 100% in admission and 98% in bed days. Overall agreement rates on reason for inappropriateness between newly trained nurse reviewers and skilled nurse reviewer were 96% in admission and 91% in bed days. Overall agreement rates between newly trained nurse reviewers and physician reviewer were 86% in admission and 87% in bed days. Conclusion: Results indicated that AEP and Delay Tool were applicable to a new hospital in detecting inappropriate utilization of beds and reasoning of the inappropriateness. These instruments could contribute to enhance efficiency of hospital use, through continuous monitoring of level of inappropriate hospital use at national or individual hospital level.
COMPLETION RATE OF THE MEDICAL RECORDING: PROBLEMS AND MEASURES FOR IMPROVEMENT
Kim, Sae Chul ; Kim, Min Soon ;
Quality Improvement in Health Care, volume 1, issue 1, 1994, Pages 110~118
As the first step to improve the medical recording for the hospitalized patients, we tried to identify problems of completion rate of the medical recording and made the completion rate of the medical recording within due date known to the public in the hospital and commended the best Department and resident officially. The results were as follows: 1. The average number of the medical recordings per a recorder by years of residency(average number to quorum) was 293.3(398.8) in 1st year, 82.5(68.1) in 2nd year, 21.2(8.3) in 3rd year, and 20.5(1.9) in 4th year-residents. There was only 2 residents who prepared the medical recordings more than the average of 125.6 recordings per a resident. 2. Among 13 Departments, the medical recording was wholly put in charge of the 1st year-resident in 6 Departments. The duty was shared with the 2nd year-resident in 5 Departments and the 3rd year-resident in 1 and the 4th year-resident in Only 1 Department. 3. The more the cases requiring the medical recording, the lower the completion rate(80% less than 100 recordings, 70% in 100-299, 60% in 300-399 and 33.3% in more than 400). 4. There was no difference in the completion rate of the medical recording before(1991) and after(1993) a public nitice(1992). However, 4 Departments showed improvement of 21-45% in the completion rate, and no case was found where billing for medical assurance was postponed due to delayed completion of the medical recording. 5. The completion rate was relatively low(72-78%) from January to March. The main reasons were shortage of men power due to preparation of board examination, attendance to military duty, and lack of training in the medical recording for the new 1st year-residents. 6. The official commendation of the best Department and resident by letters did not improve the completion rate of the medical recording. In conclusion, The main reason of the low completion rate of the medical recording was the fact that the 1st year-residents were almost exclusively responsible for the medical recording. Hence, it is mandotory that this practice gets staffs' attention to improve the completion rate. Public notice of the completion rate of the medical recording shows prompt improvement of the completion rate. Prize money rather than commendation by a letter for the best Department would also be more effective to improve the quality of medical recording.
Activities of Quality Assurance in Gastroenterology Division
Yang, Ung-Suk ;
Quality Improvement in Health Care, volume 1, issue 1, 1994, Pages 120~123
Quality Assurance in Polysomnography - A Korean experience and critical suggestions
Jeong, Do-Un ;
Quality Improvement in Health Care, volume 1, issue 1, 1994, Pages 124~131
Polysomnography is an essential methodology for diagnosing and following up sleep disorders and doing researches on human sleep. Sleep medicine, mainly with the utilization of polysomnographic techniques, has developed itself as one of the promising fields in the 21st century medicine. Korea is not an exception in importing and developing sleep medicine into the conventional medicine. However, it still remains to be clarified what polysomnography is for and how it should be done, considering the relatively recent introduction of sleep medicine into Korea. The author, being a board-certified sleep medicine specailist, having experienced spreading out sleep medicine within Korea for the past four years, and having recently set up a major sleep study facility in Korea at Seoul National University Hospital, attempts in this introductory critical article to review the essential issues related to quality assurance in polysomnographic study of human sleep. Also, unconditional introduction of "automated" sleep scoring system, which has been found to have significantly reduced reliability in various studies including the author's own, is critically reviewed. The author suggests that quality assurance and training program should be initiated and established by a responsible sleep medicine-related organization such as the Korean Association of Sleep Medicine and Psychophysiology.