Emergency Department Crowding Disparity: A Nationwide Cross-Sectional Study

차원철,안기옥,신상도,박정호,조진성 대한의학회 2016 Journal of Korean medical science Vol.31 No.8

In this study, we evaluated national differences in emergency department (ED) crowding to identify factors significantly associated with crowding in institutes and communities across Korea. This was a cross-sectional nationwide observational study using data abstracted from the National Emergency Department Information System (NEDIS). We calculated mean occupancy rates to quantify ED crowding status and divided EDs into three groups according to their occupancy rates (cutoffs: 0.5 and 1.0). Factors potentially related to ED crowding were collected from the NEDIS. We performed a multivariate regression analysis to identify variables significantly associated with ED crowding. A total of 120 EDs were included in the final analysis. Of these, 73 were categorized as ‘low crowded’ (LC, occupancy rate < 0.50), 37 as ‘middle crowded’ (MC, 0.50 ≤ occupancy rate < 1.00), 10 EDs as ‘high crowded’ (HC, 1.00 ≤ occupancy rate). The mean ED occupancy rate varied widely, from 0.06 to 2.33. The median value was 0.39 with interquartile ranges (IQRs) from 0.20 to 0.71. Multivariate analysis revealed that after adjustment, ED crowding was significantly associated with the number of visits, percentage of patients referred, number of nurses, and ED disposition. This nationwide study observed significant variety in ED crowding. Several input, throughput, and output factors were associated with crowding.

The Long-Term Effect of an Independent Capacity Protocol on Emergency Department Length of Stay: A before and after Study

차원철,신상도,송경준,조진성,Adam J. Singer 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.5

Purpose: In this study, we determined the long-term effects of the Independent Capacity Protocol (ICP), in which the emergency department (ED) is temporarily used to stabilize patients, followed by transfer of patients to other facilities when necessary, on crowding metrics. Materials and Methods: A before and after study design was used to determine the effects of the ICP on patient outcomes in an academic, urban, tertiary care hospital. The ICP was introduced on July 1, 2007 and the before period included patients presentingto the ED from January 1, 2005 to June 31, 2007. The after period began three months after implementing the ICP from October1, 2007 to December 31, 2010. The main outcomes were the ED length of stay (LOS) and the total hospital LOS of admitted patients. The mean number of monthly ED visits and the rate of inter-facility transfers between emergency departments were also determined. A piecewise regression analysis, according to observation time intervals, was used to determine the effect of the ICP on the outcomes. Results: During the study period the number of ED visits significantly increased. The intercept for overall ED LOS after interventionfrom the before-period decreased from 8.51 to 7.98 hours [difference 0.52, 95% confidence interval (CI): 0.04 to 1.01] (p=0.03), and the slope decreased from -0.0110 to -0.0179 hour/week (difference 0.0069, 95% CI: 0.0012 to 0.0125) (p=0.02). Conclusion: Implementation of the ICP was associated with a sustainable reduction in ED LOS and time to admission over a six-year period.

RSI에서 사용된 진정제의 용량은 적절한가? : 2개의 응급의료센터에서의 후향적 관찰연구

차원철,김규석,김태윤,조유환,정성구,서길준,이중의,이유진 대한응급의학회 2007 대한응급의학회지 Vol.18 No.6

Purpose: The use of rapid sequence intubation (RSI) by emergency physicians in emergency departments is increasing. Our aim was to evaluate the current practice of RSI, focusing particularly on the appropriateness of sedative dose. Methods: We retrospectively investigated RSI cases in two urban emergency centers occurring between June 2005 and May 2006. We calculated the sedative dose used per patients’weight and divided into a low dose group (less than the minimum recommended dose) and a full dose group. We investigated the differences between these two groups, including hemodynamic changes, success rates and complication rates. Results: Of 745 cases of endotracheal intubation performed, 211 cases were defined as RSI cases. The mean sedative dose was 0.29 mg/kg (±0.08 SD) for etomidate and 0.08 mg/kg (±0.03 SD) for midazolam. Sedatives were underdosed in 56.3% of etomidate cases and 82.1% of midazolam cases, for a mean underdose rate of 63.6%. Drops in SBP (systolic blood pressure) were significantly different between the etomidate and midazolam groups (-14.4 mmHg vs -22.43 mmHg, p=0.04), but there was no significant difference in SBP between low dose and full dose groups. The overall complication rate was 17.1%, was again with no significant difference between full dose and low dose groups. Conclusion: Overall, sedatives were underdosed in 63.6% of cases with midazolam more frequently underdosed than etomidate. However, the underdosing of sedatives was not significantly correlated with the first pass rate or the complication rate.

Application Strategies for Artificial Intelligence–based Clinical Decision Support System: From the Simulation to the Real-World

박숙현,차원철 대한의료정보학회 2022 Healthcare Informatics Research Vol.28 No.3

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Development and Asian-wide validation of Score for Interpretable Field triage (SIFT) predicting mortality for the Pre-hospital patient using Pan-Asian Trauma Outcomes Study (PATOS)

허세진,차원철,( Jae Yong Yu ),( Feng Xie ),( Liu Nan ),( Sun Yung Yoon ),( Han Sol Chang ),( Marcus Eng Hock Ong ),( Yih Yng ),( Sang Do Shin ),( Kentaro Kajino ) 대한응급의학회 2022 대한응급의학회 학술대회초록집 Vol.2022 No.2

Targeted temperature management is related to improved clinical outcome of out-of-hospital cardiac arrest with non-shockable initial rhythm

김석구,차원철,심민섭,황승연,신태건,박주현,윤희,조익준,최진호 대한응급의학회 2019 대한응급의학회지 Vol.30 No.3

Objective: The benefits of targeted temperature management (TTM) for resuscitated out of hospital cardiac arrest (OHCA) with an initial non-shockable rhythm are still unclear. This study examined whether TTM reduces the mortality and improves the neurological outcomes of OHCA with a non-shockable initial rhythm. Methods: This study analyzed the clinical outcome of 401 resuscitated patients with an initial non-shockable rhythm among a total of 1,616 OHCA patients who were registered in Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance. The impact of TTM was investigated after accounting for the patients’ propensity for TTM. The primary outcome was a 30-day in-hospital course with a neurologically favorable outcome defined by a cerebral performance categories scale ≤2. Results: TTM was performed in 89 patients (22%) with an initial non-shockable rhythm. Patients who has received TTM had a tendency to be younger, more likely to be female, and more likely to undergo percutaneous coronary intervention. The clinical outcome of the patients in the initial non-shockable rhythm treated by TTM was superior to those without TTM (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.27-0.46). Further analysis after propensity score matching or inverse probability of treatment weighting (IPTW) showed consistent findings (propensity score matching: HR, 0.32; 95% CI, 0.22-0.45; IPTW: HR, 0.40; 95% CI, 0.31-0.52; P<0.001, all). Conclusion: In this nationwide OHCA registry, TTM was related to an approximately three-fold better 30-day neurologically favorable survival of resuscitated patients with TTM treatment than patients without TTM in the initial non-shockable rhythm.

Injury patterns in cyclists with alcohol consumption

정다운,차원철,윤희,황승연,신태건,심민섭,조익준,김태림 대한응급의학회 2021 대한응급의학회지 Vol.32 No.2

Objective: As the cycling population grows, the lack of public awareness about the dangers of cycling while under the influence of alcohol is a signifant problem. The purpose of this study was to investigate the association between alcohol consumption and bicycle-related injuries such as traumatic brain injuries (TBI) and excess mortality ratio-adjusted injury severity score (EMR-ISS). Methods: We conducted a retrospective analysis using data collected from the Korean Emergency Department-based Injury In-depth Surveillance (EDIIS) database from 20 emergency departments during the period 2011-2016. The study subjects who had sustained bicycle-related injuries were over 18 years of age. The covariates included the mechanism, place, and time of injury. The outcomes were TBI incidence and severe and critical injury of EMR-ISS≥25. The effects of alcohol consumption on these outcomes were analyzed, and the variations in effects were determined using logistic regression. Results: Of the 24,297 individuals studied, 1,912 had alcohol-related bicycle injuries, which led to a higher proportion of single-vehicle injury incidents (alcohol 63.7% vs. non-alcohol 46.4%, P<0.001). The alcohol group had a higher rate of TBI (alcohol 11.5% vs. non-alcohol 4.6%, P<0.001) and severe and critical injury of EMR-ISS (alcohol 23.1% vs. nonalcohol 11.7%, P<0.001). TBI (odds ratio [OR], 2.72; 95% confidence interval [CI], 2.33-3.16) and severe and critical injury of EMR-ISS (OR, 2.26; 95% CI, 2.01-2.53) showed a significant association with alcohol. Conclusion: Our study showed an association of alcohol consumption with a higher incidence of TBI and severe and critical EMR-ISS. Education should focus more on the association between cycling under alcohol influence and injury severity.

A study on the effect of Chest XR image AI reading system on image reading in emergency department

윤도혁,차원철,허세진 대한응급의학회 2022 대한응급의학회 학술대회초록집 Vol.2022 No.2

A study on the effect of Chest XR image AI reading system on image reading in emergency department

윤도혁,차원철,허세진 대한응급의학회 2022 대한응급의학회 학술대회초록집 Vol.2022 No.2

새로운 중증도 분류표의 개발 및 활용

이승동,차원철,최민정,황승연,이태림,신태건,심민섭,조익준,송근정,이중의,정연권 대한응급의학회 2016 大韓應急醫學會誌 Vol.27 No.5

Purpose: Triage tags help prioritize the treatment for disaster patients based on the severity of the illness and help distribute limited resources during a time of disaster. In this study, we developed a novel triage tag and evaluated its feasibility during a hospital-based disaster drill. Methods: For the first stage, we developed a new triage tag. The most commonly used triage tags (Medical Emergency Triage-TAG and SMART tag) were analyzed. We reassembled their advantages and invented a novel triage tag (NT tag). The second stage involved an evaluation of the quality of NT tag. The NT tag was used in a hospital-based disaster drill held in a single center with 22 mock patients. After the drill, hospital staffs were asked to complete a questionnaire which included visibility, comprehensibility, and ease of use with respect to the new NT tag. A five-category Likert scale was used to quantify the answer. Results: The NT tag was successfully developed considering 6 quality indexes: visibility, expandability, flexibility, solidity, space, and fixity. Forty-two out of ninety (46.7%) subjects answered the questionnaire. Approximately 21% of participants had previous disaster drill experience and 33% had previous education of the SMART triage system. The visibility scale of the severity category was on average 3.3 (standard deviation (SD): 1.0), the comprehensiveness of the severity category was 3.6 (SD:0.9), the ease to understand patient information was 2.2-4.2, the ease to follow up symptoms and vital signs was 2.3-4.1. Eighty and percent of participants preferred to use the NT tag in a future disaster situation or disaster drill. Conclusion: We successfully developed a novel triage tag. The NT tag showed moderate feasibility.