The Effect of Systematic Approach to Tracheostomy Care in Patients Transferred from the Surgical Intensive Care Unit to General Ward

Yooun-joong Jung,Younghwan Kim,Kyuhyouck Kyoung,Min Ae Keum,Taehyun Kim,Dae seong Ma,Suk-Kyung Hong 대한중환자의학회 2018 Acute and Critical Care Vol.33 No.4

Background: The aim of this study was to investigate the effects of using a systematic approachto tracheostomy care by a clinical nurse specialist and surgical intensivists for patientswith a tracheostomy who were transferred from the surgical intensive care unit (SICU) to thegeneral ward. Methods: In this retrospective study, subjects were limited to SICU patients with a tracheostomywho were transferred to the general ward. The study period was divided into a preinterventionperiod (January 1, 2007 to December 31, 2010) and a postintervention period (January1, 2011 to December 31, 2014), and electronic medical records were used to analyze andcompare patient characteristics, clinical outcomes, and readmission to the SICU. Results: The analysis included 44 patients in the preintervention group and 96 patients in thepostintervention group. Decannulation time (26.7±25.1 vs. 12.1±16.0 days, P=0.003),length of stay in the general ward (70.6±89.1 vs. 40.5±42.2 days, P=0.008), length of totalhospital stay (107.5±95.6 vs. 74.7±51.2 days, P=0.009), and readmission rate of SICU decreaseddue to T-cannula occlusion (58.8% vs. 5.9%, P=0.010). Conclusions: Using a systematic approach to tracheostomy care in the general ward led toreduction in decannulation time through professional management, which resulted in ashorter hospital stay. It also lowered SICU readmission by solving problems related to direct Tcannula.

Status and Needs of Continuing Education for Trauma Nursing

( Yooun-joong Jung ),( Suhyun Kim ),( Sangmi Noh ),( Eunkyoung Seo ),( Soyoung Jung ),( Jiyoung Kim ) 대한외상학회 2019 大韓外傷學會誌 Vol.32 No.3

Purpose: This study was conducted to status and needs for continuing education for trauma hospital nurses in Korea. Methods: Thirty nurses from the seven level I trauma center hospitals or trauma treatment systems were randomly selected and surveyed. The survey was conducted from March 1 to May 31, 2017. Categorical data were analyzed with Pearson chi-square tests and Continuous variables were analyzed with ANOVA. Results: Only 86 out of 204 nurses had received continuing education (42.1%). The current status of continuing education programs, delivering institution (p<0.001), education method (p<0.001), education period (p=0.003), number of participants (p=0.007), and instructors (p=0.014) were also significantly different from trauma center to trauma center. There were 108 (52.9%) nurses who responded that continuing education programs were “needed” 92 (45.1%) and “very much needed 16 (7.8%). According to each trauma center’s characteristics were significantly differences in the need for continuing education (p=0.089), subject selection method (p<0.001) and the number of continuing education sessions (p=0.043) depending on the hospital. Conclusions: It is necessary to consider differences between the hospitals to develop continuing education programs that reflect the needs of nurses, in order to improve the efficiency of and satisfaction with the educational programs.

Characteristics and Risk Factors for Delirium in The Surgical Step-Down Unit

Yooun-joong Jung,Soyeon Yoon,Jinjoo Kim,Yoon Jung An,Jeonghui Ok 대한외상중환자외과학회 2023 Journal of Acute Care Surgery Vol.13 No.3

Purpose: This study aimed to investigate the incidence rate, types and risk factors for delirium in patients admitted to the surgical Step-Down Unit (SDU). Methods: This study was a retrospective study of the electronic medical records of patients admitted to a surgical SDU from February 2020 to July 2020. The delirium assessment was conducted using the short Confusion Assessment Method (a tool that allows quick and easy screening of delirium) and the incidence and risk factors for delirium were determined. Results: Among a total of 227 patients in the study, the incidence rate of delirium was 35 cases (16.7%). It predominantly occurred on the first day (n = 16, 45.7%) and the second day of admission (n = 15, 42.8%). The peak occurrence of delirium was between 14:00 and 22:00 (n = 30, 85.7%). The most common type of delirium was hypoactive (n = 19, 54.3%). The results of multiple logistic regression analysis indicated that the factors influencing the occurrence of delirium in the surgical step down unit (SDU) were age, hypertension, stroke, white blood cell count, and the use of restraints. Conclusion: Considering the characteristics of high-risk groups for delirium in the surgical SDU, it is necessary to establish nursing practice guidelines to minimize delirium.

외상환자의 치료에서 외상 전문간호사 도입 결과

정윤중 ( Yooun Joong Jung ),김영환 ( Young Hwan Kim ),김태현 ( Tae Hyun Kim ),금민애 ( Min Ae Keum ),마대성 ( Dae Sung Ma ),경규혁 ( Kyu Hyouck Kyoung ),김정재 ( Jung Jae Kim ),홍석경 ( Suk Kyung Hong ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

Purpose: Ongoing treatment and care, as well as initial stabilization, are required for trauma patients. With increasing number of sickest trauma patients and shortage of surgeons, the need for advanced practice nurse to provide and coordinate trauma care has been greater. The purpose of this study is to analyze the effect of hiring a trauma clinical nurse specialist and its influence on the treatment of trauma patients. Methods: Based on the employment of the clinical nurse specialist in December 2010, the patients were divided into two groups: patients admitted from January 1, 2010 to November 30, 2010 and patients admitted from December 1, 2010 to December 31, 2011. Retrospectively, data were collected using electronic medical records. The general characteristics, clinical courses, and ICU re-admission rates, collaboration (transfers to other departments and collaborative surgery) were compared. Results: To have a clinical nurse specialist on the trauma team resulted in a statistically significant reductions in the length of general ward hospital stay (p<0.05), the ICU re-admission rate, (p<0.03), the lead-time before transfer to other departments (p<0.05). Conclusion: The clinical nurse specialist, as a professional practitioner, improved the quality of treatment through early detection and management of problems. In addition, as a coordinator, the clinical nurse specialist maintained a cooperative relationship with multi-disciplinary medical personnel. The trauma clinical nurse spe-cialist contributed to the treatment of trauma patients positively through a decrease in ICU re-admission rate and length of hospital stay. (J Trauma Inj 2012;25:254-260)

신체적 억제대 지침 개발 및 사용 효과

정윤중,김혜현,김은한,김지연,차세정,김유진,강정은,정연화,정영선,김영환,경규혁,홍석경,Jung, Yooun-Joong,Kim, Hea-Hyun,Kim, Eun-Han,Kim, Ji-Yeoun,Cha, Se-Jung,Kim, You-Jin,Kang, Jung-Eun,Chung, Yeon-Hwa,Jung, Young-Sun,Kim, Young-Hwan,Kyou 한국의료질향상학회 2014 한국의료질향상학회지 Vol.20 No.1

Objective: The objective of this research was to develop a guideline for more effective use of physical restraint on patients in the intensive care unit and training the nurses on it and applying it on clinical practice to assess its effectiveness. Method: This research analyzed the before and after effect of the development of a guideline for physical restraint by dividing the category into nurse and patient. In the case of nurse, a comparison of knowledge and nursing service regarding the use of physical restraint from before the training on physical restraint guideline(Jan. 2011) and after the training on physical restraint guideline(Dec. 2011) was made. In the case of patient, a comparison of physical restraint usage rate and average usage time, the number of unplanned extubation cases were compared from before the use of physical restraint (Jan.~Apr. 2011) and after the use of physical restraint (Sep.~Dec. 2011) were made. Result: After the training on the physical restraint guideline, the knowledge of the nurse and the nursing practice showed notable improvement by (p<0.000) and (p<0.048) respectively and in patient, physical restraint usage rate and average time of usage decreased by (p<0.001) and (p<0.001) respectively. And despite the decrease in the number of cases in which the physical restraint was used, the number of unplanned extubation cases remained the same. Conclusion: Physical restraint guideline training and guideline usage can be stated to have brought out positive effect in both the nurse and patient. In order to maintain such positive effects, continuous training is necessary and continuous revaluation is necessary, regarding knowledge and nursing practices.

Abdominal wall defect with large duodenal disruption treated by a free tissue flap with a help of temporary expandable metallic stent

Jung-Hoon Park,Suk-kyung Hong,Ho-Young Song,Eun Key Kim,Sung Koo Lee,Yooun Joong Jung 대한외과학회 2013 Annals of Surgical Treatment and Research(ASRT) Vol.85 No.5

Abdominal wall defect with large duodenal disruption after penetrating abdominal injury is a rare emergency situation that can result in life-threatening compli cations. We report on a 64-year-old man who had abdominal wall defect with large duodenal disruption after penetrating abdominal injury. The patient presented with intra-abdominal exsanguinating bleeding, duodenal disruption, and multiple small bowel perforation. The rarity of this complex injury and its initial presentation as a posttraumatic large duodenal disruption with abdominal wall defect warrant its description. The present case indicates that combining a free tissue flap with a covered expandable metallic stent can effectively and successfully repair an abdominal wall defect that is associated with a large duodenal disruption.

Successful Management of Potential Non-Heart-Beating Donor with Extracorporeal Membrane Oxygenation -A Case Report-

Young Hwan Kim,Gui Yun Sohn,Yooun Joong Jung,Kyu Hyouck Kyoung,Suk-Kyung Hong 대한중환자의학회 2012 Acute and Critical Care Vol.27 No.4

Hemodynamics of a brain-dead donor can change rapidly during management. It frequently leads to loss of the donor or deterioration of organ functions. Various efforts have been made not to lose potential donors. Extracorporeal membrane oxygenation (ECMO) and non-heart-beating donation (NHBD) are good examples of such efforts. A 47 year-old woman with a history of hypertension, diabetes mellitus and atrial fibrillation was diagnosed with cerebral infarction and hemorrhage. Cardiopulmonary resuscitation was performed three times before transfer to our hospital. Her family agreed to organ donation. ECMO was applied due to her unstable vital signs, which made the first declaration of brain death possible. However, considering the deteriorating vital signs and expected cardiac arrest, it was decided to switch to NHBD under the family’s consent. All life-support devices including ECMO were turned off in the operation room. After cardiac death was declared, the harvesting of liver and kidneys was performed with perfusion through an ECMO catheter. The liver and kidneys were successfully transplanted to three recipients.

외상환자의 보험체계에 따른 진료비 분석

박희성 ( Hee Seung Park ),정윤중 ( Yooun Joong Jung ),김영환 ( Young Hwan Kim ),김태현 ( Tae Hyun Kim ),금민애 ( Min Ae Km ),경규혁 ( Kyu Hyouck Kyoung ),김정재 ( Jung Jae Kim ),홍석경 ( Suk Kyung Hong ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

Purpose: In Korea, the nation`s medical expenses were 12 billion won in 2010. The medical costs for individuals can also be overwhelming. If a patient has sustained severe trauma, his/her insurance company responsible may pay only part of the medical bills. In Korean, there are diverse types of medical insurance, such as health insurance, automobile insurance, and industrial accident compensation insurance. And each insurance system has a different type of payment system. Our study will be essential for establishing the optimal medical expense payment system. Methods: From January to December 2011, we retrospectively reviewed the medical charts of 161 patients who were admitted to our hospital`s emergency room after having undergone severe trauma. Of those 161 patients, 125 were retrospectively reviewed. Written permission was obtained from all of the patients. We analysed the demographic characteristics, clinical outcomes, data of the trauma, type of the patient`s insurance, and the entire bill when the patient was discharged. Results: Seventy-one patients had health insurance, 48 automobile insurance, and six industrial accident compensation insurance. High-deductible insurance included health insurance and industrial accident compensation insurance, with the deductibles up to 20.6% and 19.1%, respectively. We attempted to analyze the cause of the high deductible rate. In patients with health insurance, medicines, primarily sedatives, pain killers, antibiotics, and fluids. comprised a large proportion. On the other hand, industrial accident compensation insurance deducted for a high-grade hospital room charge. Conclusion: We found that medical expenses were diverse according to the type of insurance. In particular, health insurance forced patients to pay too much of the medical expenses. Therefore, in Korea we should try to identify the insurance problems and improve the wage system. (J Trauma Inj 2012;25:178-187)

유미복막증이 동반된 복부장기 손상

김영환 ( Young Hwan Kim ),정윤중 ( Yooun Joong Jung ),홍석경 ( Suk Kyung Hong ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.3

Chyloperitoneum or chylous ascite after trauma is a rare condition. It can develop after direct injuries of lymphatic vessels or cisterna chyli. Though isolated chyle duct injury has sometimes been reported, chyloperitoneum is generally accompanied by various kinds of damage to other intraabdominal organs. There``s still no established therapeutic protocol regarding the treatment of chyloperitoneum when it is accompanied by the serious injuries of intraabdominal organs. We describe a 66-year-old male with serious intraabdominal organ injuries after blunt trauma. In our case, chyloperitoneum developed due to the injuries to the mesenteric lymph vessels and compression of cisterna chyli by hematoma around aorta. (J Korean Soc Traumatol 2012;25:105-108)

Assessing the Appropriate Energy Expenditure Requirement Using Indirect Calorimetry for Liver Transplant Recipients

Seok-Joon LEE,Hak-Jae LEE,Yooun-Joong JUNG,Suk-Kyung HONG 대한외과학회 2018 대한외과학회 학술대회 초록집 Vol.2018 No.11