위해사건 확인을 위한 증례검토지 개발

옥민수,이상일,김윤,이재호,이진용,조민우,김선하,손우승,김현주,Ock, Min-su,Lee, Sang-il,Kim, Yoon,Lee, Jae-ho,Lee, Jin-yong,Jo, Min-woo,Kim, Seon-ha,Son, Woo-seung,Kim, Hyun-joo 한국의료질향상학회 2015 한국의료질향상학회지 Vol.21 No.1

Objectives: The purpose of this study is to develop a case review form for detecting adverse events through a medical records review in hospitalized patients in South Korea. Methods: To develop the case review form, several literatures were reviewed, first. Through the clinical expert meeting, screening criteria were selected and case review form was developed. Result: The Korean version of case review form consisted of the review form-1 for adverse event screening and form-2 for adverse event identification. The applied methodology for the case review form is determined according to the previous studies. For example, the method used in the first stage review is nurse review. Furthermore, the National Coordinating Council for Medication Errors Reporting and Prevention index is used to categorize disability, and a scale of 1 to 6 was used in the causation scores and preventability scores, respectively. Through the clinical expert meeting, a total of 41 screening criteria were selected. Conclusion: The Korean specific case review form was developed for detecting adverse events in hospitalized patients. The results from this study can be used in a large-scale study regarding the nationwide incidence of adverse events.

환자안전 관련 법의 구조와 현황

옥민수 ( Min Su Ock ),김장한 ( Jang Han Kim ),이상일 ( Sang Il Lee ) 한국보건행정학회 2015 보건행정학회지 Vol.25 No.3

This paper reviewed structure and current status of laws related to patient safety using patient safety law matrix to promote system-atic approach in legal system of patient safety. Laws related to patient safety can be divided into three areas: laws for preventing; laws for knowing about; and laws for responding. In the case of Korea, gaps are especially prominent in the areas of laws for know-ing about and responding. Patient safety law which will be enacted in July 2016 will fill the gap in the area of laws for knowing about. This law will be comprehensive law, covering the full spectrum of laws related to patient safety. However, after reviewing cur-rent patient safety law in Korea, the following drawbacks were identified: absence of code for grasping the current patient safety level; absence of code for mandatory reporting in patient safety reporting system; and absence of code for privilege about patient safety work product. Furthermore we need wider discussions about covering issues of open disclosure, apology law, coroners sys-tem, and complaint management system in patient safety law.

근본원인분석 수행을 위한 지침

이현정,최은영,옥민수,이상일,Lee, Hyeon-Jeong,Choi, Eun-Young,Ock, Min-Su,Lee, Sang-Il 한국의료질향상학회 2017 한국의료질향상학회지 Vol.23 No.1

Root cause analysis (RCA) is systematic process for identifying contributing factors and root causes. It detects system-level vulnerabilities and prevents them from occurring in the future. In many countries, RCA guidelines have been developed and used for these purposes, and various practical tools are suggested according to stages of RCA implementation. In Korea, adverse events occur in 7.2-8.3 percent of inpatients according to studies conducted in hospitals. However, frontline staffs are suffering from lack of knowledge about RCA implementation. This study introduces RCA guidelines that may be used in hospitals to improve the quality of medical care and patient safety.

환자안전사건 조사용 근본원인분석 소프트웨어의 비교

최은영,이현정,옥민수,조민우,이상일,Choi, Eun-Young,Lee, Hyeon-Jeong,Ock, Min-Su,Jo, Min-Woo,Lee, Sang-Il 한국의료질향상학회 2017 한국의료질향상학회지 Vol.23 No.1

Root Cause Analysis (RCA) has been widely used as a structured approach to investigate patient safety incidents. RCA helps identify what, how, and why something happened, therefore preventing recurrence of incidents. Since many quality tools can be used during RCA, various formats of RCA exist. If RCAs are performed incorrectly or incompletely, they are likely to produce unusable results. To address this issue, RCA software has been developed. The use of RCA software in investigating patient safety incidents may offer several advantages, such as potential reduction in learning time, shortening of the analytic process, facilitation of collection, analysis, and presentation of data and production of meaningful RCA reports. We introduced six healthcare RCA software and compared characteristics. Results from this study will enable the RCA team to choose proper RCA software.

환자안전사건 분석을 위한 한글 근본원인분석 소프트웨어 개발

최은영,이현정,옥민수,이상일,Choi, Eun-Young,Lee, Hyeon-Jeong,Ock, Min-Su,Lee, Sang-Il 한국의료질향상학회 2018 한국의료질향상학회지 Vol.24 No.1

Purpose: The purpose of this study is to develop the Korean root cause analysis (RCA) software that can be used to systematically investigate underlying causes for preventing or reducing recurrence of patient safety incidents. Methods: We reviewed the existing guidelines and literatures on the RCA in order to figure out the RCA process. Also we examined the existing RCA softwares for investigating patient safety incidents to design the contents and interface of the RCA software. Based on the results of reviewing literatures and softwares, we developed a draft version of the Korean RCA software that can be easily used in Korean hospital settings by RCA teams. Results: The Korean RCA software consisted of several modules, which are modules for identifying patient safety incidents, organizing RCA team, collecting and analysing data, determining contributory factors and root causes, developing the action plans, and guiding evaluation. Conclusion: The Korean RCA software included optimized RCA process and structured logic for cause analysis. Thus even beginners in RCA are expected to easily use this software for investigating patient safety incidents. As software has been developed with the public financial support, it will be distributed free of charge. We hope that it will contribute to facilitating patient safety improvement activities in Korea.

환자안전사건 소통하기에 대한 인식 및 교육 효과 분석: 간호사를 대상으로 한 예비 연구

이원,최은영,표지희,장승경,옥민수,이상일,Lee, Won,Choi, Eun-Young,Pyo, Jee-Hee,Jang, Seung-Gyeong,Ock, Min-Su,Lee, Sang-Il 한국의료질향상학회 2017 한국의료질향상학회지 Vol.23 No.2

Objectives: The purpose of this preliminary study was to identify the nurses' perception regarding disclosure of patient safety incidents (DPSI) and to evaluate the effectiveness of education for DPSI. Methods: DPSI education was conducted for nurses majoring in clinical nurse specialist at an university. Before and after the education, the nurses made a questionnaire to evaluate the perception of DPSI. The questionnaires were divided into four categories: first, overall perception of the DPSI; second, recognition evaluation of the DPSI using hypothetical case, third, opinion on legal and nonlegal measures for facilitating the DPSI; and fourth, socio-demographic factors. The Wilcoxon signed rank test was performed on the DPSI questionnaire response to compare the perceptions before and after the education. Results: A total of 10 nurses participated in the education. DPSI education showed the possibility of improving the overall perception, necessity, effect, obstacle, and promotion method of DPSI, although there were also several responses where there was no statistical significance. In particular, DPSI education led to statistically significance change in the perception of obstacles for DPSI. For example, the number of respondents who agreed to the item "DPSI will increase the incidence of medical lawsuits." was 7 before education but decreased to 3 after education (P-value: .025) Furthermore, nurses' perception of DPSI from this study was generally positive regardless of education. Conclusion:In the future, it will be necessary to carry out DPSI education and training and to evaluate its effectiveness for more nurses.

일반 질 지표로서의 위험도 표준화 재입원율의 적절성

최은영 ( Eun Young Choi ),옥민수 ( Min Su Ock ),이상일 ( Sang-il Lee ) 한국보건행정학회 2016 보건행정학회지 Vol.26 No.2

The hospital readmission rate has been widely used as an indicator of the quality of hospital care in many countries. However, the transferrability of this indicator that has been developed in a different health care system can be questioned. We reviewed what should be considered when using the risk-standardized readmission rate (RSRR) as a generic quality indicator in the Korean setting. We addressed the relationship between RSRR and the quality of hospital care, methodological aspects of RSRR, and use of RSRR for external purposes. These issues can influence the validity of the readmission rate as a generic quality indicator. Therefore RSRR should be used with care and further studies are needed to enhance the validity of the readmission rate indicator.

입원 시 상병의 수집 및 활용에 관한 보건의료정보관리사의 관점: 질적 연구

표지희,최은영,오혜미,이원,김주영,옥민수,김소윤,이상일,Pyo, Jee-Hee,Choi, Eun-Young,Oh, Hae-Mi,Lee, Won,Kim, Ju-Young,Ock, Min-Su,Kim, So-Yoon,Lee, Sang-Il 한국의료질향상학회 2020 한국의료질향상학회지 Vol.26 No.1

Purpose: This qualitative study was conducted to examine the current status and problems concerning the collection of present on admission (POA) indicators and determine how to use these indicators for evaluating the quality of care and degree of patient safety. Methods: A total of 11 health information managers were divided into two groups according to the size of their hospitals. Two focus group discussions (FGDs) were conducted, one for each group, which followed a pre-developed semi-structured guideline. The verbatim transcriptions of the FGDs were analyzed. Results: The majority of participants were concerned about entering POA flags honestly because they did not know how future POA indicators would be used. In particular, for some participants, POA N was a burden that could imply a signal of mismanagement within the medical institution. In addition, the lack of awareness and indifference of physicians regarding POA indicators were some of the difficulties for POA flag entry. Although medical institutions are making efforts to improve the accuracy of POA flagging, many participants mentioned the need to develop real case-oriented POA entry guidelines to improve the accuracy of POA flagging. Conclusion: To increase the validity of POA indicators, it is necessary to increase the level of awareness of POA indicators in physicians and other medical professionals. Furthermore, efforts related to POA indicators by individual medical institutions need to be reflected in the process evaluation.

가감지급사업에 대한 요양병원의 인식도 조사

이진용 ( Jin Yong Lee ),이상일 ( Sang Il Lee ),손우승 ( Woo Seung Son ),김현주 ( Hyun Joo Kim ),옥민수 ( Min Su Ock ),조민우 ( Min Woo Jo ) 한국병원경영학회 2013 병원경영학회지 Vol.18 No.1

이 연구는 가감지급사업이 확대될 것으로 예상되는 요양병원 관계자들이 가감지급사업에 대해 어떤 시각을 가지고 있는지를 파악하기 위해 시행하였다. 요양병원 관계자들은 약 2/3 정도가 이 제도를 인지하고 있었으나, 여전히 약 1/3은 이 제도에 대해서 인지하지 못하고 있었다. 만약 심평원이 요양병원을 대상으로 가감지급사업의 도입을 고려한다면, 요양병원들의 가감지급사업에 대한 인식을 먼저 제고시킬 필요가 있겠다. 더불어 요양병원들의 가감지급사업의 찬반의견은 반반으로 팽팽히 맞서고 있었다. 반대하는 가장 큰 이유로는 제도로 인해 의도하지 않은 부작용이 발생할 가능성과 정부의 통제수단으로 변질될 것 등이 제시되었다. 이러한 요양병원들의 가감지급사업 도입에 대한 반대 이유를 좀 더 구체적으로 살펴보고, 가감지급사업을 성공적으로 수행하기 위해서는 정부, 심평원, 그리고 요양병원이 만나 서로의 의견을 교환할 수 있는 장을 마련하는 것이 필요할 것이다. 향후 요양병원을 대상으로 가감지급사업을 도입하게 된다면, 다양한 측면에서 제도 도입의 성과를 평가하고자 할 때, 이 연구결과를 활용할 수 있을 것이다. 즉, 제도 도입이 요양병원에 어떻게 영향을 주었는지 파악하는 데에 이 연구 결과가 도움이 될 것이라고 기대할 수 있을 것이다. The purpose of this study was to investigate the awareness of long-term care hospitals on pay for performance(P4P) program in Korea. We conducted a cross-sectional, self-administered, the internet based survey from September to October in 2010. The questionnaire was consisted of the levels of awareness and agreement about the program, their preferred design and its possible effects and unintended consequences etc. Among 837 eligible long-term care hospitals in Korea, 114 hospitals(13.6%) were participated in the survey. About one-thirds of long-term care hospitals were not aware of P4P, namely it is important to heighten an awareness of P4P. There were pros and cons on introduction of P4P in Korea. The two major reasons of objections of P4P were the concerns of unintended consequences and the possibility of strengthening government control by implementing P4P. In conclusion, to successfully implement P4P to long-term care hospitals, the Health Insurance Review & Assessment Service(HIRA) in Korea should obtain the long-term care hospitals`opinion as to implementation of P4P.