PURPOSE: The cancellation of reception in emergency department (ED) in Korea is similar to leaving without being seen in another country. But there are differences. We studied the actual conditions and reasons for cancellation of reception in the ED in each of several hospitals. METHODS: Thirty-six emergency centers and one hundred sixty-seven emergency physicians participated in this survey. We obtained information through a questionnaire about total hospital bed counts, emergency center bed counts, number of emergency physicians, number of cancellations of reception for one day, and emergency physicians' opinions about cancellation of reception. Also, we prospectively investigated reasons for cancellation of reception for emergency physicians and patients. We recorded the reason for cancellation of reception at the time of cancellation and then interviewed the patient by telephone within 10 days after their leaving the ED. RESULTS: Nine regional emergency centers, three specialized emergency centers, twenty-two local emergency centers and two local emergency facilities were involved in this study. We surveyed patient cancellation of reception from August 1, 2008, to October 31, 2008 in our hospital. The results of our study were variable but the average of cancellation of reception was 10% of all ED patients. The most common reason for cancellation of reception was the emergency physician sending the patient to an outpatient clinic, typically because they thought the patient had mild symptoms. The most common reasons causing emergency physicians to think about cancellation of reception were mild symptoms and too long a delay time. There was a significant difference of opinion between emergency physician and patient regarding cancellation of reception (p<0.01). The emergency physicians considered the reasons to be patient factors, while the patients considered the reasons to be doctor-related factors. CONCLUSION: There are many adverse effects from cancellation of reception in an ED for both emergency physicians and patients. We should considered methods for developing a consensus on ways to improve the situation.
Admitting Department, Hospital ; Ambulatory Care Facilities ; Consensus ; Emergencies ; Emergency Service, Hospital ; Humans ; Korea ; Patient Dropouts ; Prospective Studies ; Surveys and Questionnaires ; Telephone

OBJECTIVES: To reveal differences in drug-drug interaction (DDI) alerts and the reasons for alert overrides between admitting departments. METHODS: A retrospective observational study was performed using longitudinal Electronic Health Record (EHR) data and information from an alert and logging system. Adult patients hospitalized in the emergency department (ED) and general ward (GW) during a 46-month period were included. For qualitative analyses, we manually reviewed all reasons for alert overrides, which were recorded as free text in the EHRs. RESULTS: Among 14,780,519 prescriptions, 51,864 had alerts for DDIs (0.35%; 1.32% in the ED and 0.23% in the GW). The alert override rate was higher in the ED (94.0%) than in the GW (57.0%) (p < 0.001). In an analysis of the study population, including ED and GW patients, 'clinically irrelevant alert' (52.0%) was the most common reason for override, followed by 'benefit assessed to be greater than the risk' (31.1%) and 'others' (17.3%). The frequency of alert overrides was highest for anti-inflammatory and anti-rheumatic drugs (89%). In a sub-analysis of the population, 'clinically irrelevant alert' was the most common reason for alert overrides in the ED (69.3%), and 'benefit assessed to be greater than the risk' was the most common reason in the GW (61.4%). CONCLUSIONS: We confirmed that the DDI alerts and the reasons for alert overrides differed by admitting department. Different strategies may be efficient for each admitting department.
Admitting Department, Hospital* ; Adult ; Antirheumatic Agents ; Decision Support Systems, Clinical ; Drug Interactions ; Electronic Health Records ; Emergency Service, Hospital ; Humans ; Observational Study ; Patients' Rooms ; Prescriptions ; Retrospective Studies

OBJECTIVES: This study considered whether there could be a change of mortality and length of stay as a result of inter-hospital transfer, clinical department, and size of hospital for patients with organophosphates and carbamates poisoning via National Patients Sample data of the year 2009, which was obtained from Health Insurance Review and Assessment Services (HIRA). The utility and representativeness of the HIRA data as the source of prognosis analysis in poisoned patients were also evaluated. METHODS: Organophosphate and carbamate poisoned patients' mortality and length of stay were analyzed in relation to the initial and final treating hospitals and departments, as well as the presence of inter-hospital transfers. RESULTS: Among a total of 146 cases, there were 17 mortality cases, and the mean age was 56.8 +/- 19.2 years. The median length of stay was 6 days. There was no inter-hospital or inter-departmental difference in length of stay. However, it significantly increased when inter-hospital transfer occurred (transferred 11 days vs. non-transferred 6 days; p = 0.037). Overall mortality rate was 11.6%. The mortality rate significantly increased when inter-hospital transfer occurred (transferred 23.5% vs. non-transferred 7.0%; p = 0.047), but there was no statistical difference in mortality on inter-hospital and inter-department comparison at the initial treating facility. However, at the final treating facility, there was a significant difference between tertiary and general hospitals (5.1% for tertiary hospitals and 17.3% for general hospitals; p = 0.024), although there was no significant inter-departmental difference. CONCLUSIONS: We demonstrated that hospital, clinical department, length of stay, and mortality could be analyzed using insurance claim data of a specific disease group. Our results also indicated that length of stay and mortality according to inter-hospital transfer could be analyzed, which was previously unknown.
Admitting Department, Hospital ; Carbamates ; Hospitals, General ; Humans ; Insecticides ; Insurance ; Insurance, Health ; Length of Stay* ; Mortality* ; Organophosphates ; Pesticides ; Poisoning ; Prognosis ; Tertiary Care Centers