BACKGROUND AND OBJECTIVES: Noise levels and room acoustic parameters at a tertiary referral hospital, Seoul National University Hospital (SNUH) in Korea, are investigated. MATERIALS AND METHODS: Through a questionnaire, acoustically problematic rooms are identified. Noise levels in emergency rooms (ERs) and intensive care units (ICUs) are measured over about three days. Acoustically critical and problematic rooms in the otolaryngology department are measured including examination rooms, operating rooms, nurse stations, receptions, and patient rooms. RESULTS: The A-weighted equivalent noise level, L(Aeq), ranges from 54 to 56 dBA, which is at least 10 dB lower than the noise levels of 65 to 73 dBA measured in American ERs. In an ICU, the noise level for the first night was 66 dBA, which came down to 56 dBA for the next day. The noise levels during three different ear surgeries vary from 57 to 62 dBA, depending on the use of surgical drills and suctions. The noise levels in a patient room is found to be 47 dBA, while the nurse stations and the receptions have high noise levels up to 64 dBA. The reverberation times in an operation room, examination room, and single patient room are found to be below 0.6 s. CONCLUSIONS: At SNUH, the nurse stations and receptions were found to be quite noisy. The ERs were quieter than in the previous studies. The measured reverberation times seemed low enough but some other nurse stations and examination rooms were not satisfactory according to the questionnaire.
Acoustics ; Ear ; Emergency Service, Hospital ; Intensive Care Units ; Korea ; Noise ; Nursing Stations ; Operating Rooms ; Otolaryngology ; Patients' Rooms ; Seoul ; Suction ; Tertiary Care Centers

The purpose of this paper is to introduce standardization activities of nursing documentation for special nursing units following standardization efforts for general nursing units last year. Modified Delphi approach with expert panel was used to identify essential nursing documents and data set for each units. Expert panel was consisted of head nurses or charge nurses of each special nursing unit from 8 tertiary hospitals with more than 500 beds in Seoul. the secretary-general of Clinical Nurses Association and a faculty of College of Nursing. The exiting nursing forms of seven special nursing units, which include Emergency room, Intensive care unit, Operating room, Respiratory intensive care unit. Delivery floor. Nursery and Dialysis room, were analyzed and prototypes of the standard nursing forms and guidelines were developed. The clinical field test was done with the help of Clinical Nurses Association. At the field test 3.744 clinical staff nurses from 20 tertiary hospitals with more than 500 beds in Korea were involved and provided feedback. Finally public hearing was held and more than 600 nurses from 116 hospitals attended and provided feedback. Through these process consensus of nursing community was attained for standard documents and data items. The result is available at http://nursing.snu.ac.kr/standard/ through internet.
Consensus ; Dataset ; Dialysis ; Emergency Service, Hospital ; Hearing ; Intensive Care Units ; Internet ; Korea ; Nurseries ; Nursing* ; Nursing, Supervisory ; Operating Rooms ; Seoul ; Tertiary Care Centers

PURPOSE: After intubation, it is recommended that, to sustain airway patency, about 10ml of air be infused to seal the airway and to prevent complications. At this step, sustaining a proper pressure level (18~24 mmHg) is most important because excessive pressure can cause diverse complications. We carried out a series of investigations to find a way to sustain a constant pressure level. METHODS: We gathered the cases of intubated patients for 6 randomly selected days during 2003 at HanGang Sacred Heart Hospital. Included were cases from emergency room, the intensive care unit, and the operating rooms; 30 cases were enrolled for this investigation. We used a cuff pressure control REF 701 (Tracoe(r), Mainz, Germany) to trace the cuff pressure. First, we measured the amount of air that was infused into the cuff and the cuff pressure. Then, we measured the amount of air after a proper level of cuff pressure had been achieved. RESULTS: We have found that out of the 30 cases investigated the recommended pressure level was maintained in 4 cases. The average cuff pressure was 40.9 mmHg with 10.2 cc of air and 69.0 mmHg, the largest value, was reported in one case. However, when recommended pressure level was maintained (18 mmHg), the average amount of air was reduced to 7.9 cc. CONCLUSION: The results reveal that it may not be possible to sustain the recommended pressure level by "infusing about 10 ml of air,"and that may cause complications.
Emergency Service, Hospital ; Heart ; Humans ; Intensive Care Units ; Intubation ; Operating Rooms

OBJECTIVES: Nurses' turnover has a negative influence on the nursing staff, as well as on the hospital organization as a whole. In an effort to reduce the turnover of nurses, the conditions causing turnover intentions can be identified and managed. The research is conducted to identify the association among verbal abuse, social support, and turnover intentions for special unit nurses. METHODS: A survey was conducted in 105 registered nurses who worked in the following areas at Kyonggi province hospital: operating room, intensive care unit, and anesthesia department. The questionnaires included questions in the following areas: verbal abuse by doctors, supervisors, and colleagues social supports by supervisors and colleagues and turnover intention. The survey was distributed and analyzed based on nurses' responses. RESULTS: Operating room nurses had the highest turn over intentions. The verbal abuse by doctors and supervisors were highest in the operating room. Verbal abuse by supervisors had a significantly positive association with turnover intentions. Verbal abuse by doctors and by colleagues was not associated with the intention to leave. Finally, the social support by supervisors had a significant negative association with turnover intentions. Social supports by colleagues did not affect turnover intentions. CONCLUSIONS: For nurses working at special units, verbal abuse and social support by supervisors had a significant association with turnover intentions. It is important for supervisors to make an effort to reduce nurses' turnover intentions by reducing verbal abuse and by increasing social support.
Anesthesia Department, Hospital ; Humans ; Intensive Care Units ; Intention ; Nursing Staff ; Operating Rooms ; Questionnaires

BACKGROUND: Endotracheal intubation is accomplished for safe airway establishment, anaesthesia and operation in operating room, intensive care unit and emergency room mostly. Therefore, it will be beneficial that we predict and provide against difficult airway. With this view, our study was planned and carried out. METHODS: For 251 patients with ASA physical status I or II undergoing general aneathesia, the correlation between their age, sex, height, weight, BMI (body mass index), Samsoon & Young classification and laryngoscopic grades by Cormack & Lehane was investigated. RESULTS: Laryngoscopic grades were correlated significantly with patients' age and Samsoon & Young classification. Endotracheal intubation succeeded all, but, 8 patients (3.2%) were difficultly intubated with cricoid cartilage compression and stylet-using. CONCLUSIONS: Before intubating the trachea, it is desirable that patient' age, Samsoon & Young classification and the extent of neck's movement are assessed.
Classification ; Cricoid Cartilage ; Emergency Service, Hospital ; Humans ; Intensive Care Units ; Intubation, Intratracheal* ; Operating Rooms ; Trachea

No abstract available.
Equipment and Supplies, Hospital ; Hospital Design and Construction ; Human ; Infant, Newborn ; Infant, Premature ; Intensive Care Units, Neonatal/organization & administration*

This study was aimed to provide data on the use of medical resources by preterm infants following discharge from the neonatal intensive care unit (NICU). The cohort included preterm infants (n=2,351) born at 22-32 weeks' gestation who were discharged from the NICUs of 44 Korean hospitals between April 2009 to March 2010. Mean duration of post-discharge follow-up was 425+/-237 days. After discharge from the NICU, 94.5% of total infants visited a pediatric outpatient clinic (11.5+/-9.8 mean visits), 42.9% visited a pediatric clinic for respiratory problems irregularly (4.9+/-6.6 mean visits), and 31.1% utilized emergency center at least once. Among all visits to the emergency center, 24.7% resulted in readmission and 50.8% of those visits were due to respiratory problems. At least one episode of readmission was required by 33.6% (788/2,346) of total infants, and 18.4% (431/2,346) of total infants were readmitted with respiratory problems at least once. Among all infants readmitted for respiratory problems, 16.2% (70/341) were diagnosed with respiratory syncytial virus infection which accounted for 30.3% of viral etiologies confirmed by laboratory testing. Infants born at <30 weeks' gestation had more frequent total readmission and respiratory readmission than those > or =30 weeks' gestation (2+/-1.7 vs. 1.7+/-1.2, P=0.009, 1.8+/-1.2 vs. 1.5+/-1.1, 0.027, respectively). Overall, use of medical resources is common, and respiratory problems are the leading cause of use of medical resources. Total readmissions and respiratory readmissions are more frequent in more immature infants.
Cohort Studies ; Databases, Factual ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/*pathology ; Intensive Care Units, Neonatal ; Male ; Patient Readmission ; Republic of Korea ; Respiratory Distress Syndrome, Newborn/*pathology ; Retrospective Studies

BACKGROUND: Preterm infants have difficulty maintaining body temperature after birth. However, clinical guidelines advocate that neonatal body temperature should be maintained at 36.5°C–37.5°C. PURPOSE: We aimed to investigate the incidence of admission hypothermia in very low birth weight (VLBW) infants and to determine the association of admission temperature with in-hospital mortality and morbidities. METHODS: A cohort study using prospectively collected data involving 70 neonatal intensive care units (NICUs) that participate in the Korean Neonatal Network. From registered infants born between January 2013 and December 2015, 5,343 VLBW infants born at less than 33 weeks of gestation were reviewed. RESULTS: The mean admission temperature was 36.1°C±0.6°C, with a range of 31.9°C to 38.4°C. Approximately 74.1% of infants had an admission hypothermia of <36.5°C. Lower birth weight, intubation in the delivery room and Apgar score <7 at 5 minutes were significantly related to admission hypothermia. The mortality was the lowest at 36.5°C–37.5°C and adjusted odd ratios for all deaths increased to 1.38 (95% confidence interval [CI], 1.04–1.83), 1.44 (95% CI, 1.05–1.97) and 1.86 (95% CI, 1.22–2.82) for infants with admission temperatures of 36.0°C–36.4°C, 35.0°C–35.9°C, and <35.0°C, respectively. Admission hypothermia was also associated with high likelihoods of bronchopulmonary dysplasia, pulmonary hypertension, proven sepsis, pulmonary hemorrhage, air-leak, seizure, grade 3 or higher intraventricular hemorrhage and advanced retinopathy of prematurity requiring laser therapy. CONCLUSION: A large portion of preterm infants in Korea had hypothermia at NICU admission, which was associated with high mortality and several important morbidities. More aggressive interventions aimed at reducing hypothermia are required in this high-risk population.
Apgar Score ; Birth Weight ; Body Temperature ; Bronchopulmonary Dysplasia ; Cohort Studies ; Delivery Rooms ; Hemorrhage ; Hospital Mortality ; Humans ; Hypertension, Pulmonary ; Hypothermia ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care Units ; Intensive Care Units, Neonatal ; Intubation ; Korea ; Laser Therapy ; Mortality ; Parturition ; Pregnancy ; Prospective Studies ; Retinopathy of Prematurity ; Seizures ; Sepsis

PURPOSE: This study was conducted to assess the appropriateness of emergency department-based triage for determining whether to transfer of burn patients to a burn care specialty center. METHODS: Eligible subjects were enrolled from the EDbased injury surveillance registry from April 2006 to March 2007 in a regional emergency center, which logs more than 42,000 patients annually. To assess the appropriateness of emergency department-based triage for determining whether to transfer patients to a burn center, we used the transfer guidelines recommended by the American Burn Association as the gold standard. Under-triage (defined as non-transfer of a victim who should have been transferred) and the over-triage (defined as transfer of a victim who should not have been transferred) rates were calculated. RESULTS: The total number of burn injury victims was 144 and the male-female ratio was 1:1.15. The mean age was 25.5+/-20.9 years. The numbers of flame, electrical, chemical, inhalation, and other burn injuries were 133 (92.4%), 2 (1.4%), 6 (4.1%), 1 (0.7%), and 2 (1.4%), respectively. Of these 144 patients, 25 (17.4%) were transferred to the ED of a burn center after triage and primary management. The others were discharged and followed up at local clinics. The numbers of major and moderate burns that were indicated for transfer to the burn center were 33 (22.9%) and 3 (2.1%), respectively. The rates of under- and over-triage were 14.6% and 6.9%. CONCLUSION: The proportion of inappropriate disposition of burn injury in a regional emergency center was high (21.5%). Recommended guidelines for triage of burn injuries should be applied more strictly.
Burn Units ; Burns* ; Emergencies* ; Emergency Service, Hospital ; Humans ; Inhalation ; Triage*

The occurrence of postoperative pulmonary complications is strongly associated with increased hospital mortality and prolonged postoperative hospital stays. Although protective lung ventilation is commonly used in the intensive care unit, low tidal volume ventilation in the operating room is not a routine strategy. Low tidal volume ventilation, moderate positive end-expiratory pressure, and repeated recruitment maneuvers, particularly for high-risk patients undergoing major abdominal surgery, can reduce postoperative pulmonary complications. Facilitating perioperative bundle care by combining prophylactic and postoperative positive-pressure ventilation with intraoperative lung-protective ventilation may be helpful to reduce postoperative pulmonary complications.
Hospital Mortality ; Humans ; Intensive Care Units ; Length of Stay ; Lung ; Operating Rooms ; Positive-Pressure Respiration ; Respiration, Artificial ; Tidal Volume ; Ventilation*