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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 9, Issue 2 - Dec 2002
Volume 9, Issue 1 - May 2002
Selecting the target year
Relationship between Characteristics of Lengthy Hospital Stay Patients, Knowledge of Transfer Needs and Their Willingness to Transfer - Strategies for the Effective Transfer of Lengthy Hospital Stay Patients -
Kang, Eun Sook ; Tark, Kwan-Chul ; Lee, Taewha ; Kim, In Sook ;
Quality Improvement in Health Care, volume 9, issue 2, 2002, Pages 116~133
Background : It is very common in Korea to take care of non-acute patients in an acute setting, due to the lack of long-term facilities. Long term hospitalization increase medical expenses and decreases the bed utilization, which can affect the urgent and emergent admissions, and eventually jeopardize the hospital financially. In this study, strategies for effective transfers to the lower levels of care, and to decrease the length of stay were presented by surveying and analyzing the patient's knowledge of the transfer needs, and the willingness to transfer those whose hospital length of stay was more than 30days. Method : The survey is subject to a group of 251 patients who have been hospitalized over 30 days in a general hospital in Seoul. Excluding those that were in the Intensive Care Unit and psychiatric ward, 214 in-patients were used as participants. They were surveyed from April 9, 2002 to April 17, 2002. One hundred and thirty seven out of 214 were responded which made the response rate 64%. Data were analyzed by SAS and SPSS. Result : Multi-variable Logistic Regression Analysis showed a significant effect in medical expenses, knowledge of referral system and the information of the receiving hospital. The financial burden in medical expenses made the patient 10.7 times more willing to be transferred, knowledge of the referral system made them 5 times more willing to be transferred, and the information of receiving hospital makes 6.5 times more willing to be transferred. Reasons for willing to be transferred to a lower level of care were the phase of physical therapy, the distance from home, the attending physician's advice and being unable to be treated as an out patient. Reasons for refusing to be transferred were the following. The attending physician's competency, not being ready to be discharged, not trusting the receiving hospital's competency due to the lack of information, or never hearing about the referring system by the attending physician. Conclusion : Based on this, strategies for the effective transfer to the lower levels of care were suggested. It is desirable for the attending physician to be actively involved by making an effort to explain the transfer need, and referring to the Healthcare Coordinating Center, which can help the patient make the right decision. Nationwide networking for the referral system is the another key factor that may need to be suggested as an alternative to decrease the medical expenses. Collaborating with the Home Health Agency for the early discharge planning and the Social Service Department for financial aid are also needed. It is recommended that the hospital should expedite the transfer process by prioritizing the cost and the information as medical expenses, knowledge of referring system and the information of the receiving hospital, are the most important factors to the willingness to transfer to a lower level of care.
Quality Assessment on Social Services in General and Teaching Hospitals in Korea
Kang, Heung Gu ;
Quality Improvement in Health Care, volume 9, issue 2, 2002, Pages 134~147
Background : As an empirical study, current research about the quality of social services carried out in general and teaching hospitals across the country. In the flux of health care reforms and market transformation, the quality of social services in the hospital becomes increasingly significant. Methods : A sample of total 80 hospitals, including general hospitals with one social worker at least and single-department hospital with two social workers or more, were identified nationwide through the registry of Korean Association of Medical Social Workers and Korean Association of Hospitals. The subjects of this survey were 80 leaders of social service units. The survey data from each subjects were measured to evaluate level of quality that service provider perceived of sample hospitals. Under the method of one-way ANOVA and multiple regression, the level of quality in social work service was analyzed. Results : The major findings were as following ; First, the level of quality perceived showed less score, especially the lowest was the score of quality of outcome. Second, the key variables of each hospital which turned out significantly different in quality of social work service were the departmental form of social work unit, unit leader's age, educational level, field experience, and job rank. Third, the level of quality of social work service correlated positively with the field experience of unit leader, the size of social work unit, the job rank of the unit leader. Conclusion : The most influential variables to the quality of social work service proved departmental form of social work unit, leader of social work unit. Therefore, to assure the proper level of quality, social work unit in hospital must be structured single, independent department in which entitled social worker is supposed to supervise and manage. And a leadership-development program for leaders in social work unit are strongly recommended.
A Study of Emergency Department Personnel's Job Satisfaction
Lee, Jeong Heon ; Shin, Im Hee ;
Quality Improvement in Health Care, volume 9, issue 2, 2002, Pages 148~163
Background : The personnel of emergency department have been under tremendous pressure to manage unexpected emergency situations and excited patients. And interpersonal conflict has existed always, because emergency department was consisted of various personnel of their own specialty. The patient's satisfaction has to come from the personnel's satisfaction. The purpose of this study was to evaluate emergency department personnel's job satisfaction and its related factors and to improve quality of emergency medical service Methods : A self-administered questionnaire survey to the emergency department personnel was conducted between September 1 and October 31, 2001. The response rate was 90.2%. Using SAS program (Version 6.12), the collected data was analyzed by frequency, ANOVA, multiple comparison, Pearson correlation procedure, and stepwise multiple regression analysis. Result : The analysis of related factors of job satisfaction showed high score of interpersonal interaction (3.246), professional prestige (3.095), autonomy (2.916), task requirements (2.701), organizational requirements (2.444), and pay (1.953) in order of item mean. Professional prestige (0.498), task requirements (0.464), and organizational requirements (0.408) were highly positive correlated with overall level of job satisfaction. The factors influencing the job satisfaction were professional prestige and task requirements which explaining efficacy were 37.6% and 32.2% respectively. The total explaining efficacy was 33.6%. Conclusion : It was found out that emergency department personnel's job satisfaction can be raised by promoting professional prestige and task requirements. The personnel of emergency department have to be satisfied through their job, and the administration of the hospital has to pay more attention to their employees' job satisfaction and it related factors.
Analysis of Factors Affecting Medication Compliance of Outpatients
Lee, Eui-Kyung ; Park, Jeong-Young ;
Quality Improvement in Health Care, volume 9, issue 2, 2002, Pages 164~175
Background : The purpose of this study was to investigate the current status of medication compliance of outpatients and to analyze the factors contributing to medication non-compliance Methods : Telephone survey was conducted to the 1,000 outpatients who visited medical institutions during the period from January 2002 to April 2002. Subjects were randomly selected from the telephone directories of the nation, and the socio-demographic characteristics of the respondents such as age, gender and region were matched based on those of outpatients in 2001. Results : The results of survey revealed that those who complied with doctors' regimen in the right way accounted for 82.4%. The compliance increased with the strong belief in the medication, less unwanted side effects and inconvenience, more severity of disease, and lower perceived health status. Compliance rate was also higher in the patients group who experienced the drug education by the pharmacists than those who did not. Conclusion : In order to improve drug compliance, drug information on efficacy, adverse reaction, drug interactions, and basic disease information are to be provided to the patients. Drug education needs to be focused not only on providing knowledge of drugs and diseases but also changing attitude on drug use of the patients.
A Study on Medical Laws and External Evaluation Criteria with Reference to the Essential Forms consisting Medical Records and to the Items for Each Medical Record
Seo, Sun Won ; Kim, Kwang Hwan ; Hwang, Yong-Hwa ; Kang, Sunny ; Kang, Jin Kyung ; Cho, Woo Hyun ; Hong, Joon Hyun ; Pu, Yoo Kyung ; Rhee, Hyun Sill ;
Quality Improvement in Health Care, volume 9, issue 2, 2002, Pages 176~197
Backgound : This study is to suggest the standardized format of the clinical sheets and the standardized items of every clinical sheet. The standardization of the medical records will increase the faithfullnes of the contents in them and it will contribute to construct the good health information system. Method : From Jan. 1st. 2001 to March 31st 2001, we gathered as many paper clinical sheets as possible by every class of institutions to review the faithfulness of the clinical contents in them. Clinical sheets of 9 tertiary care hospitals, 6 general hospitals and 56 clinics were gathered. Two experienced medical record administrators reviewed them. The review focus was to check whether the items recommend by the hospital standardization review criteria and hospital service evaluation organization were appeared in the clinical sheets and whether the contents of every item were written. Results : Tertiary care hospitals; In case of administrative data, the contents were filled well if the items were fixed. The clinical data like C.C, history,physical examiniation were filled well, but if the items were not fixed, some items were omitted. The result is that more items are to be filled if they are fixed. General hospitals Administrative data were filled more than 50%. Final diagnosis was filled about 66.7%.But other clinical data were not filled well and not many clinical related items were appeared in the sheets.In the legal point of view, the reason for visiting hosptals or the right diagnosis, patient condition at discharge could not be confirmed well.In surgery cases, surgical procedures could not be confirmed well as many surgical related information(surgery time, fluids and blood, number of sponges, biopsy, etc) were omitted. Clinics More than 70% administrative data were filled and fixed as items. Among the clinical related data, laboratory result was the most credible data. But without the right diagnosis, drug orders were given and doctors' written signatures were not appeared over 96.4%. So the clinical sheets cannot be used as a legal document. Conculusion : There was a tendency that the contents were filled well if the items were fixed in the documents, We also suggest a clinical check list to review the completeness and faithfulness of the clinical sheets. If many hospitals use the suggested clincal check list and if they make the necessary items fixed in the clinical sheets, the quality of the medical record will increase dramatically.
A Study on Anticipating Factors and Satisfaction of Local Clinics to 2nd Referral Hospitals based on Collaboration Hospital System
Kim, Dong-Il ; Kim, Hae-Joon ; Yoon, Seok-Jun ; Mun, Yeong-Bae ;
Quality Improvement in Health Care, volume 9, issue 2, 2002, Pages 198~208
Background : This research, as a part of improving management process of college hospital in this rapidly changing circumstances, is searching for the actual state of private clinics referring patients to referral center including college hospitals. Methods : This research examined the sense of satisfaction and requesting degree in using referral center and by analyzing the correlation and differences among factors such as primary factors regarded as selecting ones in referring patients to a referral center in college hospital and expecting factors expected to be supported to patients and cooperative hospitals. Results : The main researched results are as follows. First, as for the primary factors, the differences between cooperative and uncooperative hospitals revealed the fact that choosing target hospital in accordance with cooperative relation and convenient process in referring patients are important. Second, satisfaction rates, analyzed from the paired t-test revealed kindness and convenience as the top priorities, while sending patients back again and benefit of supporting such as the use of facilities were revealed as the least satisfactory aspects, despite the fact that they should be fulfilled through actual service. Conclusion : The recognition of the practitioner is examined and analyzed in this research by examining primary factors in selecting college hospitals, expecting factors expected to be supported to patients and satisfaction degree, which are expected to be used as basic materials for the development of referral center of college hospitals.
An Analysis of Fall Incidence Rate and Its Related Factors of Fall in Inpatients
Kim, Chul-Gyu ; Suh, Moon-Ja ;
Quality Improvement in Health Care, volume 9, issue 2, 2002, Pages 210~228
Background: The purpose of this research was to examine the fall incidence rate and its related factors of fall in inpatients. Methods: The data were collected from the 138 fall incident reports in one tertiary hospital in Seoul from April 1st 1999 to September 30th 2001. The Fall Incident Report Form was originally developed based on that of Massachusetts General Hospital revised in 1995. And this was modified for this survey by the collaborating work of QI team including researcher and department of nursing service of this particular hospital. The contents of Fall Incident Form were general characteristics of patient. factors related to fall. types and places of fall. circumstances, nursing interventions. and outcome. Results: 1) The incidence rate of fall was 0.08% of total discharged patients and 0.081 per 1000 patient-day. This incidence rate is much lower than that of several hospitals in USA. This finding might result from the different incidence report system of each hospital. 2) The characteristics of fall-prone patient were found as follows. They were mostly over 60 years old, in alert mental status, ambulatory with some assistance, and dependent on ambulatory device. The types of diseases related high incidence rate were cerebrovascular disease(3.2), hypertension(1.6), cardiovascular disease(1.4), diabetes(1.3) and liver disease(0.6). 3) The majority of fall events usually occurred m bed. bedside(walking or standing) and bathroom in patient room. Usually they were up on their own when they fell. And there were more falls of elderly occurred during night time than day or evening. 4) 63.8% of fall events resulted in physical injuries such as fracture and usually the patients had diagnostic procedures and some treatment(ex. suture) which caused additional cost to the patients and their families. 5) The found risk factors of fall were drugs(antihypertensive drug, diuretics) and environmental factors like too high bed height, long distance of bedside table and lamp switch, and slippery tile of bathroom floor. Conclusion: Considering these results, every medical and nursing staff should be aware of the risk factors of patients in hospital, and should intervene more actively the preventive managements, specially for the elderly patients during night. Therefore, it is recommended that the development of Fall Prevention Programs based on these results.
Evaluation of Pharmacist Intervention Program for Dosage Adjustment and IV-to-PO Conversion for
Hwang, Bo Young ; Oh, Jung Mi ;
Quality Improvement in Health Care, volume 9, issue 2, 2002, Pages 230~240
Background : The purpose of this study was to develop, implement and evaluate the pharmacist intervention program designed to identify and correctly adjust the dosage of
-receptor antagonists (
) in renally impaired patients and promote timely conversion of
from IV to PO therapy. Methods : The study population consisted of renally impaired patients who received
therapy from April 9 to May 8, 2001 at Hallym Medical Center. Each morning a specifically developed software program identified patients with serum creatinine (Scr) greater than 1.2 mg/dl or age greater than 65 years. The pharmacist, then screened the pharmacy profiles of the identified patients to determine if the patient was on
. For these patients on
with renal impairement the creatinine clearance (CrCl) was calculated using Cockroft & Gault equation. The pharmacist determined the proper dosage for each identified patients based on the calculated CrCl and the oral dosage that would be appropriate for whom IV therapy was no longer indicated. Result : A total of 149 cases (101 patients) were monitored during the study period. The dosage was inappropriately prescribed for renal function in 61 of 149 cases (41%), and of those, pharmacist made recommendations for 58 cases of which 33 cases (57%) were accepted by the physicians. The administration route of H2RA was inappropriately used as IV in 22 of 53 cases (42%), and pharmacist made recommendations for those 22 cases of which 15 cases (68%) were accepted. Conclusion : Monitoring of patients with renal dysfunction by a pharmacist improved the dosing of
and a dosing program of patients with renal impairment would be of benefit to other clinicians and institutions seeking to optimize patient care.