응급실 환자 과밀화 요인의 분석

장문준,장석준,이한식 대한응급의학회 1992 대한응급의학회지 Vol.3 No.2

The overcrowding and congestion of a university hospital's emergency department is not only from shortage of admission room but from multiple factors. This kind of phenomenon restrict quality and property of treatment of emergency department patients. Once patient visit emergency department, patient goes through a physical and laboratory examinations, then decided whether patient could be either admit or discharge from emergency department or transfer to other hospitals. In a course of process many factors can delay a medical examination and treatment of emergency department patient. Therefore overcrowding and congestion of emergency department is growing from bad to worse. In this article, by analyze the time required for emergency department patient to go through a process from initial arrival to leave emergency department. Authors made an analysis and present with followed suggestions for improvement in an emergency department. We investigated factors for delay of examination and treatment in emergency department, therefore, causing overcrowding phenomenon, for 4, 194 patients visited Young Dong Severance Hospital emergency department from September 1st, 1991 to October 31th, 1991. The results were as follows : 1) Distribution of department was Internal medicine, Emergency department and Pediatrics in order. 2) In 24 hour period, 1,546(36.9%) patients visited during evening hours. For 3,246 patients, 90% of them spent less than 10 minutes for receipt. 3) In time interval between receipt and notification to each department, 42.2% in 10 minutes, more than 90% was within 1 hour. 4) For routine laboratory results, 1,423 patients(63%) spent between 1 to hours and 8.5% of them spent more than 2 hours. 5) For routine radiologic examination, 2,098 patients (63%) spent between 10 to 30 minutes and 4.1% spent more than 2 hours. 6) For 200 patients(36.6%), waiting time for special radiologic examination was between 1 to 2 hours and 7% waited more than 4 hours. 7) In time interval between notification and initial assessment of each department, 1,789 patient(42.7%) took less than 10 minutes and more than 1 hour for 5.;2% of patients. 8) Admission rate was 20.7%(869 patients) and for 203 patients it took less than 1 hour but for 12% of patient more than 12 hours for admission order. 9) 31% of patient was to transfer to admission room within 1 hour, 20.1% of patient was after 24 hour. 10) In time interval between receipt and discharge, 878 patient(26.6%) took 1 to 2 hours and 5.1% more than 24 hours.

응급실 내원 노인정신과 환자의 특징

고영주(Young Ju Ko),전진숙(Jin Sook Cheon),변현우(Hyun Woo Byun),이지상(Ji Sang Lee),김강률(Kang Ryul Kim),오병훈(Byoung Hoon Oh) 대한생물치료정신의학회 2010 생물치료정신의학 Vol.16 No.2

Objectives : The numbers of geriatric patients visiting emergency department have been increasing with the increase of geriatric population, especially among those with psychiatric problems. The aims of this study are to know the frequency and trend of visiting emergency department among elderly psychiatric patients, to analyse their demographic and clinical characteristics, and to identify related factors. Methods : Among elderly psychiatric patients with age over 60(N=276) who had visited Emergency Medical Center, Kosin University Gospel Hospital from 2000 thru 2009, medical records or electronic medical records of 187 cases were analysed by three psychiatrist who were blind to those patients. Results : 1) The numbers of elderly psychiatric patients were gradually increasing for 10 years versus total numbers of patients(0.18% in 2000, 0.25% in 2009) and versus total numbers of geriatric patients(0.81% in 2000, 0.87% in 2009). However, The increase of elderly psychiatric patients versus total numbers of psychiatric patients became so rapid as 2.5-3 times in 2006(7.58% in 2000, 27.54% in 2009). 2) Most frequent demographic and clinical characteristics of the elderly psychiatric patients visiting emergency department for 10 years were sixties(66.9%), urban dwellers(92.5%), visting during weekdays(67.9%) and stay for 6-24 hours(43.3%)(p<0.05, respectively). The managements were resulted in discharge against medical advice(30.5%), admission to other department(26.7%), discharge after management(19.8%), admission to psychiatric ward(16.6%), transfer to other hospital(3.7%) and being expired(2.7%). 3) The most frequent reasons for visiting emergency department of elderly psychiatric patients were suicidal attempt(13.4%), pain(10.7%), consciousness change(10.7%), continuos alcohol drinking(10.2%) in order. The most frequent psychiatric diagnoses were alcohol dependence(20.9%), depression(19.3%), adjustment disorder(11.2%), delirium(10.7%), anxiety disorder(9.6%) and dementia(8.6%). The most frequent comorbities were cardiovascular diseases(27.3%), hepatic and gastrointestinal diseases(13.9%), neurological diseases(12.3%), endocrinological diseases(10.7%), respiratory diseases(8.6%), renal and urinary diseases(7.5%) and cancer(7.0%) in order. 4) There was significant correlation between psychiatric diagnosis and gender of elderly psychiatric patients visiting emergency department. The causes were significantly correlated with route, arrival time and stay hours. The route of visiting emergency department was significantly correlated with arrival time and stay hours. There was significant correlation between stay hours and management in the emergency department. Conclusion : Elderly psychiatric patients required much time and resources in the emergency department. To solve the rapidly growing problems related to the emergency care for the elderly psychiatric patients, analysing data of visiting emergency department at first and then active preparation of medical personnel shoud be preceded.

응급실 환자의 간호 만족도에 관한 연구 - 3차 의료기관을 중심으로 -

양진주 中央醫學社 1999 中央醫學 Vol.64 No.1

미국의료시설 응급부의 시대적 변천과 공간적 특성에 관한 연구

이수경 ( Lee Sukyung ),최윤경 ( Choi Yoonkyung ) 한국의료복지건축학회(구 한국의료복지시설학회) 2018 의료·복지 건축 Vol.24 No.3

Purpose: This study aims to examine spatial characteristics of emergency department Chronologically through case studies; and to consider the social implication of these spatial changes. Methods: In this study, a total of eight emergency departments, one for each period, were selected in order to analyze the spatial characteristics. The spatial maps of Space Syntax were employed for analyzing case studies. Results: The spatial configuration of emergency department has been changed from five or more emergency department specialties to four or less specialties such as psychiatric, pediatrics, emergency, and trauma. In the case of care initiation area, the concentrated arrangement mode was switched from the distributed arrangement mode. The spatial maps indicate that it can be seen that the tree structure changes to an annular structure emphasizing the connection between the spaces in the emergency department. This shows that the space efficiency, safe, visual control and flexibility in the planning of the emergency department are important factors affecting the spatial structure of the emergency department. Implications: In the future, it is expected that Korean emergency department will be more focused on efficiency, safe, visual control, and flexibility in the planning as in the case studies of the United States.

A Comparative Analysis of Disaster-Related Curriculum between Emergency Department and Nursing Department

Ji-Yeon Jung(정지연) 한국컴퓨터정보학회 2019 韓國컴퓨터情報學會論文誌 Vol.24 No.10

본 연구는 응급구조학과와 간호학과에서 실시되는 재난관련 교육과정의 현황을 비교 분석하기 위한 서술적 조사 연구이다. 연구 분석대상은 인터넷 홈페이지를 이용하여 전국의 응급구조학과가 개설되어 있는 41개 대학을 대상으로 조사하였으며, 교육과정이 등재되어있지 않은 학교와 간호학과가 없는 학교를 제외하고 나머지 30개 대학을 연구대상으로 하였다. 연구 자료는 인터넷 홈페이지를 이용하여 교육과정을 수집하여 분석하였다. 키워드 ‘재난’, ‘재해’,‘응급’을 이용하여 만든 교과목을 조사하였으며, 교육과정은 재난관련 교과목의 개설현황, 전공 · 교양 분류, 학년, 학점, 이론 및 실습 시간 시수, 총 과목 개설수를 빈도와 백분율로 산출하였다. 연구결과는 재난관련 교과목 개설 현황은 응급구조학과는 29개교(96.7%) 간호학과 19개교(63.3%)였다. 개설 현황은 응급구조학과 2학년, 간호학과는 4학년이 가장 많았으며, 전공선택으로 2학점 개설이 가장 많았다. 본 연구결과를 토대로 재난에 대처할 수 있는 능력을 기르기 위해서는 재난현장에 맞는 지식과 술기가 필요하며 보건의료자원의 역할에 맞는 교육과정이 완성되어야 할 것이다. This study is a descriptive research to compare and analyze the current status of disaster-related curriculum between emergency department and nursing department Research and analysis targets were 41 universities which include the emergency department in South Korean by using the universities’ internet homepage, finally 30 universities were researched by removing the universities which doesn’t upload the curriculum on their homepage, have emergency department or have nursing department. The research data were collected and analyzed by using the universities’ internet homepage. The Keyword is ‘Disaster’, ‘Catastrophe’, and ‘Emergency’ to search the name of the subjects. The curriculum calculated as a percentage of frequency by using the status of disaster-related subjects opening, classification of major education, grade, credit, number of class, practical hours, and the total number of subjects. According to the study, 29 universities (96.7%) of emergency department and 19 universities (63.3%) of nursing department has the disaster-related subjects in their curriculum. The current status of the class opening is emergency department at second grade and nursing department as fourth grade. As a subject of major, two credits are the common class credits. Based on the results of the study, knowledge and skills and training courses are necessary to develop the ability to cope with disasters in the disaster field. The curriculum that matches the role of health care resources will be required.

응급실 간호사의 알코올문제 관련 실무경험

김성재,양정운 알코올과 건강행동학회 2019 알코올과 건강행동연구 Vol.20 No.2

Objective: The purpose of this qualitative study was to explore the experience of emergency department nurses regarding the care of patients with alcohol problems in order to identify their recognition and attitudes about alcohol problems and alcoholism prevention strategies suitable in emergency department settings. The study question is ‘What about emergency department nurses’ experience with alcohol problems. Methods: The participants included 10 female nurses who are currently working or have worked in emergency department for more than three years. Individual interviews were conducted for a minimum of 30 minutes to less than an hour, and the collected data was analyzed in accordance with the qualitative content analysis proposed by Elo and Kyngäs. Results: The results revealed 5 categories: ‘Recognition and attitude toward alcohol problem’, ‘Clues to aware alcohol problems’, ‘Medical and surgical problems related to alcohol’, ‘Barriers to practice of alcoholism prevention’and ‘Interventions to prevent alcoholism in emergency department’. We found that emergency department nurses had negative attitudes toward people with alcohol problems. And also they recognized that interventions to prevent alcoholism were outside the scope of emergency care practices. Conclusion: Emergency department nurses had the ability to identify patient with alcohol problems and a high recognition of the needs of preventive approaches to alcohol problems. The results can be used to develop the education program for emergency department nurses and guidelines for prevention of alcoholism.

응급실 재원시간과 관련된 환자의 특성

정설희,황지인 한국보건행정학회 2009 보건행정학회지 Vol.19 No.3

The length of stay in emergency departments has been used as a quality indicator to reflect the overall efficiency of emergency care. Identifying characteristics associated with length of stay is critical to monitor overcrowding and improve efficient throughput function of emergency departments. This study examined the level of waiting time for initial assessment by physician and length of stay in emergency departments. Furthermore, we investigated the characteristics of patients' attendance associated with length of stay. An observational study was performed for a sample of 1,526 patients visiting ten nation-wide emergency departments. A structured form was designed to collect information about patients’ demographics, route of admission, time and mode of arrival, triage level, cause of attendance, initial assessment time by physician, departure time, and disposition. Multiple regression analysis was performed to determine factors associated with length of stay. The average length of stay was 209.4 minutes (95% confidence interval [CI]=197.1-221.7), with a mean waiting time for initial assessment of 5.9 minutes (95% CI=5.1-6.7). After controlling for emergency department characteristics, increasing age, longer waiting times, attendance due to diseases, higher acuity, multiple diagnoses(≥2) and requiring admission or transfer to other health care facilities were positively associated with length of stay in emergency departments. The findings suggest that both patients' characteristics and the flow between emergency departments and parent hospitals should be taken into account in predicting length of stay in emergency departments.

첨단·신기술분야 학과개편 동향과 정책적 시사점

이혜선,엄미정 부산대학교 교육발전연구소 2022 교육혁신연구 Vol.32 No.2

Purpose: The purpose of this study is to propose the policy implication for supporting the education and training of engineers in the new emerging technology fields in universities by examining the recent department reorganization trends and their concrete contexts. Method: This study was conducted through a mixed methods research to identify the trends and the context of engineering department reorganization. Using data of the 2011 and 2021 department names from the higher education statistics survey of KEDI, researchers divided the engineering departments into four types according to their names: existing department, high-tech department, subdivided department, and convergence department. The classification result of department names was compared and analyzed by year, degree, and so on. Researchers also interviewed four heads of the engineering department who reorganized their department in the new emerging technology field. Results: The results showed that the number of departments with names related to new emerging technologies has increased rapidly compared to the last 10 years ago. Based on the results of the interview, researchers also verified that social contexts and policy support were driving the reorganization of engineering departments forward to new emerging technology fields. However, it was confirmed that the appropriate direction and specific guidelines for supporting the department reorganization were insufficient. Conclusion: Based on these results, researchers proposed several issues and political implications to support the training of engineers in the new emerging technologies in universities. 연구목적: 본 연구의 목적은 공학계열 학과를 중심으로 첨단·신기술분야로의 학과개편의 구체적인 현황과 맥락을 살펴보고, 이를 토대로 대학의 첨단·신기술분야 인력양성을 내실화를 위한 정책적 시사점을 모색하는 것이다. 연구방법: 연구목적을 달성하기 위해 혼합연구방법을 활용하여 공학계열 학과개편 동향을 분석하였다. 이를 위해, KEDI 「고등교육통계조사」의 2011년과 2021년 학과명 데이터를 활용해 공학계열 학과를 기존학과, 첨단학과, 세분화학과, 융복합학과의 4개 유형으로 구분하고, 연도별·학위급별·학과 분류별 학과명 현황을 양적 측면에서 비교 분석하였다. 또한, 최근 첨단·신기술분야로의 학과개편을 추진한 공학계열 학과장을 4명을 대상으로 한 면담조사를 통해 학과개편의 현황과 요구사항을 질적 측면에서 조사·분석하였다. 연구결과: 학과명 분석 결과, 10년 사이 학과명에 첨단·신기술을 직·간접적으로 반영한 학과 수가 크게 증가했다. 또한, 면담조사에서 최근의 첨단·신기술분야에 대한 사회적 관심과 정책적 지원이 공학계열 학과들의 첨단·신기술분야로의 학과개편을 추동하는 동인으로 나타났으나, 학과개편의 추진과정에서 학과개편의 방향이나 내용, 방법 등에 관한 지침은 충분하지 않았던 것으로 나타났다. 논의 및 결론: 이러한 결과를 바탕으로, 대학을 통한 첨단·신기술분야의 공학인력양성을 지원하기 위한 정책적 시사점을 제안하였다.

Clinical Characteristics of Acute Drug Intoxication in Emergency Department

In Byung Kim,Sung Pil Chung,Seung Whan Kim 대한의생명과학회 2004 Biomedical Science Letters Vol.10 No.3

The number of acute drug intoxication who visiting to emergency department which is located near urban and rural area concomitantly is inclined to increase slightly. The purpose of this study was the investigation of methods and strategies of management of acute drug intoxication in emergency department. Clinical trials were done on 92 cases of acute drug intoxication visiting to Emergency Department of Chungnam National University Hospital during 4 months from April to July 2003. 1. The total number of acute drug intoxication during this period was 92 patients, which presented 0.95% of all the emergency department visiting patients during the study. The intentional ingestions were observed in 84 cases (91.3%). 2. The maximal point of age distribution was 4th decade. The number of that was 21 cases (22.8%). 3. The number of patients who had ingested benzodiazepines and doxylamine succinates was 26 cases (28.2%), organophosphorus was 20 (21.7%), paraquat was 10 (10.8%), others were 36 (39.3%). 4. Five kinds of polydrug ingestion was observed in 3 cases, four kinds was observed in 3, three kinds was observed in 5 and co-ingestion of alcohol was observed in 28 cases (30.4%). 5. The mortality was occurred in 4 cases, 2 of them were caused by paraquat, 1 of them was caused by organophosphorus (OP), 1 of them was caused by acetic acid. 6. The gastric larvage as a mean of treatment modality was done in 57 cases (61.9%). The use of activated charcoal was done in 8 (8.69%). The maintenance of tracheal intubation was done in 6 (6.52%). 7. The mean observational period in emergency department was 8 hours 42 minutes in benzodiazepine and doxylamine succinate group, 21 hours 46 minutes in OP, 20 hours 39 minutes in other germicidal except OP, 23 hours 9 minutes in paraquat group. Without a drug information and intoxication center in Korea, We should minimize the exhaustion of medical resources by establishment of determinant criteria which can be seen in relatively less-complicated cases of acute drug intoxication. Thus, we should consider the introduction of simple toxicology treatment protocol and toxicologic observation unit in emergency department as possible means to reduce economical and social burdens.

지방의료원 응급부 배치 및 영역구성에 관한 연구

윤우용,채철균 대한건축학회 2020 대한건축학회논문집 Vol.36 No.6

The purpose of this study is to present current status analysis data for establishing standards for emergency medical facilities at regionalpublic hospitals. This study analyzed the scale, location, circulation and relationship of each zone in the emergency department to presentbasic data for establishing guidelines. The methods of this study are as follows. The function and distribution of emergency medicalfacilities by type, through literature surveys of literature, zone composition of facilities through behavioral analysis of users, analysis ofzone relationship and net area by drawing analysis. The location and zone configuration of the emergency department should be givenpriority to factors such as efficiency of the operation, infection control, and patient privacy, and the results of this study are as follows. 1)Location and relationship of departments: It is desirable for the emergency department to be located adjacent to the relevant departments,such as the imaging department, the surgical department, intensive care unit, or to be linked by an internal corridor. 2) Zone configuration:The emergency department consists of major zone, auxiliary zone, support zone, and access zone based on the user's behavior. It isdesirable to place each zone in the order of access, main, and auxiliary zones from the external space and the support zone is locatedwhere it is easy to access other zones. 3) Area composition: The area ratio and the area per bed for each zone in the emergencydepartment are as follows. Major zone, 53.4%, 9.3m²/bed, auxiliary zone 10.8%, 1.9m²/bed, support zone 23.3%, 4.2m²/bed, access zone12.5%, 0.6m²/bed. This study focused on the relevant departments and location relationships, user’s behavior, zone composition and netarea. Based on this, follow-up studies will be conducted on the composition of the required rooms in the zone, user’s behavior by type ofrequired rooms, relationship and the appropriate size for each required room. 우리나라 응급의료체계는 많은 부분을 민간에 의존하다보니 공공분야에 있어 양적인 부족과 함께 지역적 편차가 존재한다. 최근 의료시설 내 진료환경에 대한 인지도가 높아짐에 따라 이에 대응하는 시설유형별 물리적 환경에 대한 계획기준 수립이 지속적으로 요구되고 있다. 본 연구는 현재 운영중인 지방의료원 응급의료시설을 대상으로 규모, 위치, 동선, 영역, 영역별 연관관계 등을 분석하여 향후 요구되는 지방의료원 응급의료시설 기준수립을 위한 기초자료 제시