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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 4, Issue 2 - Dec 1997
Volume 4, Issue 1 - May 1997
Volume 3, Issue 2 - Mar 1997
Selecting the target year
의료의 질 향상 무엇이 문제인가?
Kim, Se-Cheol ;
Quality Improvement in Health Care, volume 3, issue 2, 1997, Pages 2~4
의료의 질 향상 무엇이 문제인가?
Park, Hun-Gi ;
Quality Improvement in Health Care, volume 3, issue 2, 1997, Pages 6~12
의료의 질 향상 무엇이 문제인가?
Park, Hyeon-Ju ;
Quality Improvement in Health Care, volume 3, issue 2, 1997, Pages 14~15
QA의 경제적 가치 규명과 혁신으로서의 QA의 필요성
Choe, Seon-Ho ;
Quality Improvement in Health Care, volume 3, issue 2, 1997, Pages 16~18
적정 수준의 의무기록이란 어떤 요건들을 만족하여야 하나?
Kim, Ok-Nam ;
Quality Improvement in Health Care, volume 3, issue 2, 1997, Pages 20~24
Study on patients of infectious diseases administered with vancomycin or teicoplanin - Assessment of fitness of antimicrobial administration -
Chang, Chul Hun ; Son, Han Chul ; Hwang, Kyu Yon ; Park, Kwang Ok ; Yang, Ung Suk ;
Quality Improvement in Health Care, volume 3, issue 2, 1997, Pages 26~35
Background : Glycopeptide antibiotics are the only drugs for treatment of infections due to beta-lactam-resistant Gram-positive bacteria. As the incidence of infection and colonization with vancomycin-resistant enterococci(VRE) rapidly increases, the hospital infection control practices advisory committee(HICPAC) recommends prudent vancomycin use to detect, prevent and control infection and colonization with VRE. Methods : The inpatients admitted from September to December, 1996 in Pusan National University Hospital, with Gram-positive bacterial infections were evaluated retrospectively to see whether the administrations of glycopeptide antibiotics were appropriate or not, upon comparison with the recommendations for preventing the spread of vancomycin resistance by HICPAC. Results : Teicoplanin has been chosen more frequently than vancomycin of the glycopeptide antibiotics. The indications of administration of glycopeptides in patients with pneumonia, wound infections, sepsis, and in febrile or neutropenic patients with malignancies were appropriate, but the use of glycopeptides for elimination of merely colonized bacteria in the oral cavity could not be excluded. Inappropriate use of glycopeptides was 10.6%, and inappropriately long-term use without positive culture for beta-lactam-resistant Gram-positive organisms was about 40% of total days of drug use. Conclusion : It seems essential for the quality assurance committee to make a plan in teaching the HICPAC recommendations to the medical practitioners who prescribed the glycopeptides inappropriately or used for irrelevantly long to his patient, monitor and survey their use of glycopeptides prospectively and periodically, and if there are repeated inappropriate prescriptions, a certain penalty would be given to the practitioners.
Development of a Clinical Practice Guideline : Benign Prostatic Hyperplasia
Yu, Seung-Hum ; Chai, Soo Eung ; Kim, Chun-Bae ; Kang, Myung Geun ; Song, Jae Mann ; Lee, Eun Sik ; Lee, Jung Gu ; Lee, Tchun Yong ; Hong, Sung Joon ;
Quality Improvement in Health Care, volume 3, issue 2, 1997, Pages 36~51
Background : Clinical practice guidelines define "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" and help to improve patient care. The purpose of this study is to develop a clinical practice guideline for the most effective diagnoses and treatments of benign prostatic hyperplasia based on patient preference and clinical need. Methods : For this research project, extensive literature searches (208 articles) were conducted. As well, critical reviews and syntheses (meta-analysis) were used to evaluate empirical evidence and significant outcomes of the BPH literature. Questionnaires about clinical practice for BPH patients were distributed and consensus meetings were undertaken to grasp variations in clinical practice and to reach agreement on the guideline's development. The guideline was promoted under the sponsorship of the Korean Medical Association and the Korean urological Cancer. Society. For the task, the Benign Prostatic Hyperplasia Guideline Panel was composed of multidisciplinary experts in the field. Results : BPH is a disease that affects a patient's quality of life. This Clinical Practice Guideline was developed for the typical man over age 50 with symptoms of prostatism, but with no significant medical morbidities such as diabetes or other known causes of voiding dysfunction, such as urethral stricture or neurogenic bladder. The guidelines detail the relative benefits and obstacles associated with all diagnostic and treatment approaches, including watchful waiting. Conclusion : This guideline provides a cornerstone for our medical association. It represents the most current scientific knowledge regarding the development, diagnosis, and treatment of BPH. It will be revised and updated as needed.
Nursing Delivery System Improvement Plan in A Hospital
Lee, Jin-Hi ; Lee, Sung-Ae ; Ham, Yong-Hee ; Yang, Myong-Ju ; Kim, Ok-Sohn ;
Quality Improvement in Health Care, volume 3, issue 2, 1997, Pages 52~59
Background : In many Nursing Delivery System, Nursing Department at D Hospital had used to traditional nursing practice model what is called functional activities based system. It has a lot of merit that carried out specialized and rapid works but tend to ignore indivisual professional responsibility and task-based work assignments. In addition this system showed high turnover rates due to heavy workload, timesum of handing over duties, lack of support from peers and interstaff communication. So we performed conversion of Nursing Delivery System to My Patients Nursing Care System for providing comprehensive nursing to patient and reducing turnover rates and increasing job satisfaction to nurse. Method : 1. 1st step(96.4.9): Detected the problem of Nursing delivery System and estabilished improving planning 2. 2nd step(96.4.26): Visited other hospital on job training 3. 3th step(96.4.29): Discussed to premonitoring problem after conversion Nursing Delivery System and prepared structure 4. 4th step(96.5.6): My Patients Nursing Care System practical application 5. 5th step(96.7.20): Held complementary meeting 6. 6th step(96. 7): The other ward application 7. 7th step(96. 10): Extended application to whole wards Results: 1. Workload: (1) reduction(55.6%) (2) addition(44.4%) 2. Strong points after conversion: (1) decreased timesum of handing overduties (35.2%) (2) increased responsibility(33%) (3) broaden nurse's outlook to duties(14.8%) 3. Shortcoming after conversion: (1) understanding difficulties except my patient(57.8%) (2) weak teamwork(23.3%) (3) intensive stress to low grade nurse(12.2%) 4. Effective complemental way: (1) manpower(76.7%) (2) conversion of though (8.9%) (3) education(14.4%) 5. Patient's satisfaction: (1) satisfaction(64%) (2) no effect(36%) 6. Physician and peer's satisfaction: (1) satisfaction(12.5%) (2) dissatisfaction(21.6%) (3) no interest(44.3%) 7. Nurse's satisfaction: (1) satisfaction(74.7%) (2) dissatisfaction(5.5%) (3) unknown(20.5%) 8. Want to continued: (1) want(76.4%) (2) try to any other system(18%) Conclusion : Even though Nursing Delivery System conversion still has many problem, we gained more merits than traditional nursing delivery system. So we suggest that My Patients Nursing Care System should be encouraged for comprehensive nursing care and satisfaction to nurses.
Predictability of the completeness of medical recording of quality of care for inpatients
Park, Un Je ; Park, Eal Whan ;
Quality Improvement in Health Care, volume 3, issue 2, 1997, Pages 60~68
Background : Medical records are used to assess clinical performance of physicians and quality of care. The contents which are written in medical records are considered as the objective evidences to know what the doctors think about the patient's problems. But the problem to use medical records as the assessment tools is the incompleteness of medical recording. The purpose of this study is to know if the completeness of medical recording is correlated to quality of care for inpattients and it can predict physicians's quality of care. Method : 32 clinical physicians reviewed 200 patients' medical records who were selected randomly from the inpatients who were admitted to the university hospital during July, 1995 and June, 1996. The reviewers used the structured evaluation questionnaires which were composed of two part. One part evaluated the completeness of the medical recording and the other evaluating appropriateness of diagnosis and treatment processes. We summated the scores of each items and calculated percentile scores. Results : The mean percentile score of completeness of the medical recording was 67.9% in 1995 and 79.8% in 1996. The mean percentile score of appropriateness was 52.2% in 1995 and 69.5% in 1996. This change between 1995 and 1996 was statistically significant. In non-surgical patients, the percentile scores of the completeness and those of the appropriateness were correlated positively and this correlation was statistically significant(p<0.05). In surgical patients, the positve correlation between the completeness and the appropriateness was also statistically significant(p<0.05). Discussion : In conclusion, the completeness of medical recording is considered as the good predictor of the quality of care for inpatients.
Reducing the Disposal of Unused Blood in the Operating Room
Cho, Moon Su ; Lee, Yeoung Sook ; Yu, Il Me ;
Quality Improvement in Health Care, volume 3, issue 2, 1997, Pages 70~85
Background : 6.1% of red blood cells and whole blood issued to the operating room was not transfused to the patients and discarded in Seoul National University Hospital in 1994. Objectives : We planned to set up an effective management program of blood in the operating room and we investigated whether this program could reduce the disposal rate of blood. Methods : We made a guideline of blood management in the operating room through a workshop. The guideline was revised after a preliminary application. The revised guideline was applied for 5 months from May to September in 1996. The disposal rate was compared before and after the installation of the new program. Results : 5,336 units of blood were issued to the operating room for 5 months. Disposal rate of red blood cells and whole blood was markedly reduced from 6.2% in May to 2.1% in September(p<0.05). The average disposal rate was 3.7% during the five months. Conclusion : We were able to reduce the disposal of unused blood in the operating room through the development and the application of a new blood management program.
Quality Improvement Activity in Hospitals and Its Acceptance among Hospital Personnels
Hwang, Jeong-Hae ; Cho, Sung-Hyun ; Kim, Chang-Yup ; Seo, Juag-Don ; Han, Man-Chung ; Lee, Jeong-Ye ;
Quality Improvement in Health Care, volume 3, issue 2, 1997, Pages 86~97
Background : It is a primary goal for hospital personnel to improve the quality of patient care. In Korea the concept of quality assurance has been spread over the last five years. Many hospitals have implemented quality assurance programs that fit their own philosophy and needs. As a result, they are supposed to have different experiences and attitudes toward quality assurance. To investigate their diversity will be helpful to have a direction to the future and to enhance the quality assurance activities in Korean hospitals. Objectives : The aim of this study is to obtain information about hospital personnel's attitude and opinion toward quality assurance in hospitals. Methods : A questionnaire was developed which consisted of five parts; the general characteristics of respondent, the concepts of quality assurance, need for quality assurance program, current status of quality improvement activities, and participation in programs. Using the registry of Korean hospitals, 102 hospitals with more than 400 beds were selected. Questionnaires were mailed to hospital staffs of each hospital; top managers, clinical department heads, registered nurses, medical recorders, and administrators. Results : Of 2038 questionnaires sent, 877 were returned, giving response rate of 44%. Most respondents(70%) regarded quality assurance as efforts to provide patient with care in highest quality and to improve effectiveness or resource utilization. Ninety-nine percent of respondents agreed to need for quality assurance in their hospitals. There were current quality improvement programs implemented in the department of 553 respondents(62%), and most of the(85%) have participated in at least one program. Lack of motivation was pointed out as a barrier to implement the programs. Conclusion : Although most respondents have known of the concept and need for quality assurance, this study suggests that education and motivation of hospital personnel be needed to activate the quality assurance programs in hospitals.