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연구논문 : 심폐소생술 불필요(DN(A)R) 동의 취득에 대한 전공의 의식조사
이태림 ( Tae Rim Lee ),신태건 ( Tae Gun Shin ),심민섭 ( Min Seob Sim ),조익준 ( Ik Joon Jo ),송형곤 ( Hyoung Gon Song ),송근정 ( Keun Jeong Song ),정연권 ( Yeon Kwon Jeong ),최병인 ( B. I Choe ) 한국의료윤리학회 2011 한국의료윤리학회지 Vol.14 No.3
This survey, which was conducted over the course of 3 months in 2009, was designed to investigate what the medical residents of one university hospital in Seoul think about DNAR orders. A total of 214 out of 468 residents (45.7%) answered the questionnaire. Participants were divided into two groups according to their experiences with taking DNAR order. There was no difference between the two groups on the definition of DNAR, its limitations, and when to issue DNAR orders. However, the two groups showed different opinions concerning who should be consulted in obtaining consent for DNAR and whether or not it was necessary to review DNAR orders. Residents who were experienced in giving DNAR orders felt more inclined to discuss the situation with the patient`s family members rather than the patient herself and thought that DNAR orders would not need to be reconsidered. These differences in opinion may result from the different experiences the two groups of residents had in actually ordering DNAR in the clinical setting. This study shows that more research and discussion is needed in order to establish the limitations and precise definition of DNAR orders.
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중증 외상 환자의 입원 결정 지연에 영향을 미치는 요인과 공동진료시스템
강문주 ( Mun Ju Kang ),신태건 ( Tae Gun Shin ),심민섭 ( Min Seob Sim ),조익준 ( Ik Joon Jo ),송형곤 ( Hyoung Gon Song ) 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.2
Purpose: Prolonged stay in the emergency department (ED), which is closely related with the time interval from the ED visit to a decision to admit, might be associated with poor outcomes for trauma patients and with overcrowding of the ED. Therefore, we examined the factors affecting the delay in the decision to admit severe trauma patients. Also, a multidisciplinary department system was preliminarily evaluated to see if it could reduce the time from triage to the admission decision. Methods: A retrospective observational study was conducted at a tertiary care university hospital without a specialized trauma team or specialized trauma surgeons from January 2009 to March 2010. Severe trauma patients with an International Classification of Disease Based Injury Severity Score (ICISS) below 0.9 were included. A multivariable logistic regression analysis was used to find independent variables associated with a delay in the decision for admission which was defined as the time interval between ED arrival and admission decision exceeded 4 hours. We also simulated the time from triage to the decision for admission by a multidisciplinary department system. Results: A total of 89 patients were enrolled. The average time from triage to the admission decision was 5.2 ±7.1 hours and the average length of the ED stay was 9.0±11.5 hours. The rate of decision delay for admission was 31.5%. A multivariable regression analysis revealed that multiple trauma (odds ratio [OR]: 30.6, 95%; confidence interval [CI]: 3.18-294.71), emergency operation (OR: 0.55, 95%; CI: 0.01-0.96), and treatment in the Department of Neurosurgery (OR: 0.07, 95%; CI: 0.01-0.78) were significantly associated with the decision delay. In a simulation based on a multidisciplinary department system, the virtual time from triage to admission decision was 2.1±1.5 hours. Conclusion: In the ED, patients with severe trauma, multiple trauma was a significant factor causing a delay in the admission decision. On the other hand, emergency operation and treatment in Department of Neurosurgery were negatively associated with the delay. The simulated time from triage to the decision for admission by a multidisciplinary department system was 3 hours shorter than the real one. (J Korean Soc Traumatol 2010;23:113-118)
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