No abstract available.
Hospital Medicine ; Korea

PURPOSE: The purpose of this study is to understand the workforce and the workload of emergency physicians based depending on their experiences. METHODS: This study analyzed the results of the 2015 Korean Emergency Physician Survey performed between August and October 2015. RESULTS: Of the total 1,418 emergency physicians, 437 (30.8%) answered the questionnaire. One thousand one hundred twenty emergency physicians currently work in the emergency room and 415 (37.1%) of them responded to the questionnaire. There were 29,324 annual visitors to the emergency rooms in which the emergency physicians who responded to the questionnaire work, of which, 5,693 (19.4%) were hospitalized. Full time equivalent (FTE) per institution was 4.29, assuming that only one emergency physician was on duty in the each emergency room at any given time of day. Currently, the average number of physicians per institution is 4.3; therefore, the ratio of FTE to emergency physicians is about 1. However, according to the Korean Emergency Medicine Association, one emergency physician should treat 2.5 patients per hour. Based on this, the corrected FTE value should be 5.79, and the ratio of FTE to emergency physicians needs to be 0.74. CONCLUSION: Based on this research, it is expected that emergency physicians will have a strategy for proper manpower supply.
Emergencies* ; Emergency Medicine ; Emergency Service, Hospital ; Humans

OBJECTIVE: To obtain sharable and reusable knowledge among various hospital information systems, it is essential to represent each term with standard terminology. To support knowledge representation for interoperable clinical decision support system for hypertension management, the feasibility of SNOMED CT was evaluated. METHODS: Concept matching was conducted using the method of direct matching, post-coordinated matching and general matching. For semantic matching, the SNOMED CT hierarchy was considered, and for raising the mapping rate, preferred terms and synonyms were used. RESULTS: Excluding the recommendation concepts that were not used in clinical data, finally 182 concepts were evaluated in terms of concept matching. Seventy two percent of the concepts was directly matched to pre-coordinated concepts in SNOMED CT. For the post-coordinated matching and the general matching to broader meaning, 9.3% and 18.7% were covered respectively. CONCLUSION: The direct coverage of SNOMED CT was moderate to high level for representing guideline knowledge concepts without loss of semantics. To supplement the coverage, it is inevitable to consider defining local concepts for implementing hypertension management systems.
Hospital Information Systems ; Hypertension ; Logic ; Semantics ; Systematized Nomenclature of Medicine

PURPOSE: Thoracic ultrasonography (US) is an emerging tool for diagnosing pneumothorax (PTX), and the possible application of color Doppler to ultrasonography is another new development. The aim of this study is to analyze the possible contribution of color Doppler to thoracic US and to the estimation of pneumothorax volume. METHODS: Patients who were admitted to emergency department underwent chest X-ray and thoracic US with color Doppler. They were also evaluated by computed tomography, if needed, US was performed at four chest sites by emergency medicine faculty and resident, and concordance between color Doppler and lung sliding was analyzed. The number of sites with abnormal findings was correlated with the volume of PTX at each sites. Statistical analysis was performed with Pearson correlation. RESULTS: Sixty-three of 151 PTX cases were included in our study. The sensitivity of US was for PTX detection was 92.1% (58 of 63), and the concordance between color Doppler and lung sliding was 99.4%. The number of sites per patient with abnormal findings increased with the average volume of the PTX. The average PTX volume in the 5 cases with normal findings was 7.0%, which is a smallsized PTX. CONCLUSION: The use of color Doppler is not more accurate than lung sliding, but it may helpful in diagnosing PTX. The volume of a PTX is proportional to a patient's number of sites with abnormal US findings.
Emergency Medicine ; Emergency Service, Hospital ; Humans ; Lung ; Pneumothorax* ; Thorax ; Ultrasonography

In modem medical industries as in others, it has been emphasized by many experts such as Dr. Mayer and Dr. Donabedean that there should be quality assurance activities applying statistical knowledges in the processes of medical management and medical staff themselves for the better medical care and customer satisfaction. Three of our quality assurance programs for the purpose of shortening the treatment time In the department of emergency medicine in Keimyung University, Dong-San Medical Center had been carried out during the period of June 94 through December 95. Our methodology was mainly the process emphasized ; finding the causes of delaying factors in various processes related to the works of nurses, doctors, laboratory services, radiology services etc. in the emergency room, holding various meetings among the related groups with genuine discussions, notifying the new results in each step, encouraging the positive ones and also applying the new leadership technics. During the period of June 94 through December 95(for 1.5 years), the average E.R. patient treatment time from registrations to dispositions had been reduced by about 2 hours (from 5 hours 3 minutes to 2 hours 5 minutes) and its variations among the different specialities had been narrowed down to significant degree (p<0.05) revealing the preprogram base line standard deviation of 2.43 to 1.28 in post program through continuous quality assurance programs. It was also noted that the successful results of Q/A program have been closely related to the fact that the process should be designed and redesigned repeatly as needed and that all the participants related were actively involved in the planning and redesigning processes.
Emergency Medicine ; Emergency Service, Hospital ; Humans ; Leadership ; Medical Staff ; Modems

A hospitalist-run acute medical unit (AMU) opened at a tertiary care hospital on August 2015 for the first time in Korea. Patients visiting the emergency department (ED) with acute medical problems are admitted to the AMU. They stay in that unit for less than 72 hours and are discharged or transferred to specialty wards if longer treatment is necessary. We reviewed 19,450 medical admissions through the ED from January 2014 to September 2016. The median length of stay (LOS) significantly decreased from 10.0 days (interquartile range [IQR], 5.5–16.7) to 9.1 days (IQR, 5.1–15.0) (P < 0.001) after the establishment of the AMU. The median waiting time in the ED significantly shortened by 40% (P < 0.001). Future studies on the impact of AMU on in-patient morbidity, mortality, re-admission rate, and patient or staff satisfaction are necessary.
Emergencies* ; Emergency Service, Hospital* ; Hospital Medicine ; Hospitalists ; Humans ; Korea ; Length of Stay* ; Mortality ; Tertiary Healthcare*

BACKGROUND: For effective and systematic management of patients in the emergency department (ED), the data on patient arrival and status in DE of Yeungnam University Hospital were evaluated, MATERIALS AND METHODS: During the seven days form Apr. 1 to. 7 , 1998, the general patient information such as onset time and place, factors associated with transportation. causes of admission, cared department and patient disposition were recorded. RESULTS: Total of 464 patients visited the ED during the seven days, and the mean number of patients per day was 66.3 Male to female ratio was 1:0.71. Daily staying patients were 17.3 and 83.6 patients were cared totally each day. The methods of transportation and distribution of patients according to region and event were as follows: visit by walk (57.3%), transportation by car(58.0%),place of event in residence(85.3%), regional distribution in Taegu(81.5%), and direct visit(97.4%). Cause of admission due to diseases was 74.6%. The percentages of department which cared the patients were internal medicine 26.6%, pediatrics 16.8%, orthopedics 8.6%, neurology 8.2%, neurosurgery 7.8% and other department including emergency medicine 8.2%, respectively. Patient dispositions were admission 38.4%, discharge 61.0% and death on arrival(DOA) 0.6%, but referred-patient-to -another-hospital was zero. CONCLUSION: Improvements in several aspects of ED's caring system such as "fast tracking" system and reinforcement of disease and trauma caring system, would be helpful for effective management of emergency patients.
Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Female ; Humans ; Internal Medicine ; Male ; Neurology ; Neurosurgery ; Orthopedics ; Pediatrics ; Transportation

A hospitalist system was introduced in Korea in September in 2016 to improve the quality of in-patient care and to cope with the shortage of medical residents. This study aimed to outline the current situation of internal medicine hospitalist and to suggest a development strategy. By May 2019, the number of hospitalists in Korea had increased to 124. Patient safety issues, resident law, and the shortage of medical residents has led to an increase in the demand for hospitalists in Korea. Internal medicine hospitalist care in Korea has been associated with patient satisfaction, length of stay, and waiting time in emergency departments. There are three different hospitalist ward models in the Korean health care system, and each hospital needs the model that fits its specific situation. In the general ward model, the role of the hospitalist is similar to that of the chief residents because the wards are categorized into nine subspecialty areas, such as internal medicine (including gastroenterology, pulmonology, and cardiology). In the short-term admission ward model, patients are usually turned around within 72 hours; therefore, the hospitalist is able to care for patients independently. After that, patients are discharged or admitted to a specialty ward. In integrated care model, patients from all specialty areas are admitted to the same ward; therefore, hospitalists care for patients independently. In this model, consultation with specialists is required. There were strengths and weaknesses in each model. Therefore, the models should be considered based on the hospital's function. This study found some problems in the present hospitalist system, including undefined roles and responsibilities, unclear future employment prospects, burnout due to patient' severity of illness, and inadequate payment systems for weekend and night work. To further develop the hospitalists system in Korea, the Korean government, the Korean associated of internal medicine, hospitals, and hospitalists must work together to solve the present problems.
Delivery of Health Care ; Emergency Service, Hospital ; Employment ; Gastroenterology ; Hospital Medicine ; Hospitalists ; Humans ; Internal Medicine ; Jurisprudence ; Korea ; Length of Stay ; Patient Safety ; Patient Satisfaction ; Patients' Rooms ; Pulmonary Medicine ; Specialization

As the largest research-oriented specialty department in national traditional Chinese medicine hospitals, the Department of Critical Care Medicine in Guangdong Provincial Hospital of Chinese Medicine insists on the development mode combined with clinical medicine and scientific research. By taking clinical and basic researches for integrative medicine preventing and treating acute myocardial in-farction and sepsis as a breakthrough, authors explored key problems of Chinese medicine in improving the prognosis related diseases and patients' quality of life. In recent 3 years our department has successively become the principal unit of the national key specialties cooperative group of critical care medicine (awarded by State Administration of Traditional Chinese Medicine), the key clinical specialties (awarded by National Health and Family Planning Commission), and Guangzhou key laboratory construction unit, and achieved overall lap in clinical medical treatment, personnel training, scientific research, and social service.
Biomedical Research ; China ; Clinical Medicine ; Critical Care ; Hospital Departments ; organization & administration ; Humans ; Integrative Medicine ; Medicine, Chinese Traditional ; Quality of Life

OBJECTIVE: Especially in emergency departments (EDs), a lack of internal medicine (IM) residents in charge causes difficulties in medical care and ED overcrowding. Thus, protocols without IM residents in EDs is needed. This study aimed to investigate changes in medical care when emergency medicine residents replaced the roles of IM residents. METHODS: This study was conducted at a single-site ED of a university medical center. The study group contained patients admitted to the IM department between September and December 2015, during which IM residents were absent in the ED. The control group contained patients admitted to the IM department between September and December 2014, during which IM residents were present in the ED. Changes in medical care between the presence and absence of IM residents in the ED were studied by comparing admission rates from the ED, length of ED stay, duration of hospitalization, and concordance of diagnoses between admission and discharge by the IM department. RESULTS: The study group contained 2,341 patients; the control group contained 2,215 patients. Admission rates from the ED increased by 53.4% (95% confidence interval [CI], P < 0.001); lengths of stay decreased by 15.1% (95% CI, P < 0.001); and durations of hospitalization in the pulmonology department decreased by 38.4% (95% CI, P=0.001). Concordance of diagnoses between admission and discharge decreased by 14.2% in the cardiology department (95% CI, P=0.021). CONCLUSION: Lengths of stay were reduced without critical declines in diagnostic concordance rates when emergency medicine physicians, instead of IM residents in the ED, decided upon admissions of IM patients.
Academic Medical Centers ; Cardiology ; Diagnosis ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Hospitalization ; Humans ; Internal Medicine* ; Length of Stay ; Pulmonary Medicine