BACKGROUND AND OBJECTIVES

Inpatient physical therapy (PT) care entails careful provision of service for individuals across a spectrum of disorders needing evidence-based physical rehabilitation during their hospital admission. The main difficulty is identifying adequate time allocation for safe patient service within an eight-hour working time frame. At a selected tertiary teaching government-run hospital, an arbitrary personnel-population ratio method is used for human resource allocation which may lead to issues in service delivery and healthcare workforce wellness. Apart from patient care, physical therapists also assume non-clinical roles revolving on administration, clinical education, and research. This highlights the importance of identifying the duration of tasks to assess work efficiency and manage time constraints posed by the limitations of the work shift. Practice guidelines may help improve staff workload scheduling, however, there is a lack of available guidelines regarding physical therapy practice in the hospital or acute care setting for developing countries. The purpose of this study was to determine the duration of care for inpatients with musculoskeletal and neurological conditions and administrative tasks, and to determine the relationship of duration of care with months of experience.

A continuous observation time motion study of a typical workday of all physical therapists in an in-patient setting of a tertiary teaching hospital was conducted. An external observer will time the tasks done by the PT. The external observer kept distance from the direct patient encounter to minimize interference that may affect timing. Patients with conditions of different etiologies and functional levels were included.

Nineteen physical therapists with a mean experience of 54.63 months were observed. There were no adverse events during the implementation of this study. The total mean time in minutes of management of neurological patients is 37:32, and musculoskeletal patients is 28:30. Time for administrative tasks took an average of 20:33 minutes. There was also a low positive correlation on months of experience and treatment duration for patients with neurologic conditions (p=0.0471). Results showed that the allocated treatment duration is determined to be sufficient for performing PT activities. The optimal number of patients to be decked can also be appropriately determined to optimize resource allocation.

Our pilot study attempted to quantify the duration of PT care in an inpatient setting that caters to patients with different diagnosis and varying needs for PT management. Although descriptive statistics and a weak to insignificant correlation was seen in most of the variables, there may be some benefit in gathering more duration data across different acute care settings within the country. Our pilot time and motion study can contribute to the limited evidence of duration of inpatient care that may inform human resource allocation, deliverables prioritization, and employee wellness and development. Figures have been presented which could be the basis for future policy research for management science and resource allocation studies.

A study on the implementation of hospital information system and degree of job satisfaction is available but not widely deployed. The purposes of this study are to analyze level of hospital information system in selected secondary, tertiary hospital and to compare convenience, degree of information applicability, willingness of participation, degree of job satisfaction after implementation of hospital information system by each department and to consider factors influencing degree of job satisfaction. Two secondary hospitals and four tertiary hospitals are participated and two sets of questionnaires are used for this study. Convenience and degree of information applicability are significant by each department. Convenience, degree of information applicability, willingness of participation are major factors in improving degree of job satisfaction after implementation of hospital information system.
Hospital Information Systems* ; Job Satisfaction* ; Surveys and Questionnaires ; Tertiary Care Centers

This study was to evaluate hospital characteristics as composition of manpower and facilities to the death rate of patient; and to earmark the factors affecting the overall hospital mortality rates. The data utilized were derived from survey material conducted by the Korean Hospital Association on 32 tertiary referral hospitals in Korea between 1986 and 1994. The findings are: 1. Those hospitals having the most capacity per bed had little difference to the mortality rates than the others. 2. Those hospitals having the most daily patients per specialist had significantly higher mortality rates than the others, but the number of daily patients per nurse had little effect on the mortality rates. 3. Those hospitals which had a relatively sufficient number of quality assurance activities revealed a lower mortality, and particularly in case where such effort was directed to the clinicians, the outcome was remarkable. we concluded that the major factor affecting the hospital mortality rates seems to be the number of specialists per number of beds, the degree of quality assurance assessment of the clinicians, the quality assurance activities of each hospital as a whole, and the number of daily patient per specialist. According to the findings of this study, the composition and quality of specialist and adequate quality assurance activities seemed to be the essential for the improvement of hospital care. Therefore, in this regard the proper implementation of policy and support is highly recommended. Due to lack of available research material, the personal characteristics of specialists haven't been considered in this study However, this longitudinal observation of 32 tertiary referral hospitals over a nine year period has significant merit alone.
Hospital Mortality* ; Humans ; Korea* ; Mortality ; Specialization ; Tertiary Care Centers*

BACKGROUND: The medical service delivery system in Korea works inefficiently and patients tend to visit tertiary hospitals by means of the emergency department (ED). Overcrowding of the ED threatens the health and life of emergency patients as a result of the inability to effectively distribute emergency medical resources in the community. To solve this problem, improvement in the medical delivery system and dispersion of patients by strengthening primary care may be helpful. In order to make policy decisions for this, it is necessary to estimate the scale of patients who can be distributed to primary care.METHODS: From January 1 to December 31, 2016, we analyzed the National Emergency Department Information System (NEDIS) data of patients who visited a tertiary ED to examine the proportion of patients eligible for primary medical care. The inclusion and exclusion criteria for primary care were made through the consensus of three physicians.RESULTS: A total of 65,061 NEDIS records were analyzed. Among them, by inclusion criteria, 29,818 cases were Korean Triage and Acuity Scale level 4 and 5, and 11,791 patients visited the ED during the day. After considering the exclusion criteria, there were 6,468 cases who may be suitable for primary medical care.CONCLUSION: Of the patients who visited the ED of tertiary hospitals, approximately 10% of them may be suitable for primary care. There should be a discussion and social consensus to reduce overcrowding in EDs and deliver better medical services.
Consensus ; Emergencies ; Emergency Service, Hospital ; Humans ; Information Systems ; Korea ; Primary Health Care ; Tertiary Care Centers ; Tertiary Healthcare ; Triage

OBJECTIVES: There is a need for effective processes in healthcare clinics, especially in tertiary hospitals, that consist of a set of complex steps for outpatient care, in order to provide high quality care and reduce the time cost. This study aimed to discover the potential of a process mining technique to determine an outpatient care process that can be utilized for further improvements. METHODS: The outpatient event log was defined, and the log data for a month was extracted from the hospital information system of a tertiary university hospital. That data was used in process mining to discover an outpatient care process model, and then the machine-driven model was compared with a domain expert-driven process model in terms of the accuracy of the matching rate. RESULTS: From a total of 698,158 event logs, the most frequent pattern was found to be "Consultation registration > Consultation > Consultation scheduling > Payment > Outside-hospital prescription printing" (11.05% from a total cases). The matching rate between the expert-driven process model and the machine-driven model was found to be approximately 89.01%, and most of the processes occurred with relative accuracy in accordance with the expert-driven process model. CONCLUSIONS: Knowledge regarding the process that occurs most frequently in the pattern is expected to be useful for hospital resource assignments. Through this research, we confirmed that process mining techniques can be applied in the healthcare area, and through detailed and customized analysis in the future, it can be expected to be used to improve actual outpatient care processes.
Ambulatory Care ; Delivery of Health Care ; Hospital Information Systems ; Humans ; Mining ; Outpatients ; Prescriptions ; Tertiary Care Centers

BACKGROUND: The purpose of this study was to analyze the endotracheal intubation cases performed in the emergency department. METHODS: We investigated retrospectively 326 cases of endotracheal intubation performed in the emergency department of a tertiary care center from April 1, 1998 to March 31, 1999. We focused on operators, medications used, its success rate and immediate complications, and the relationship between its success rate and medications. RESULTS: Of 326 consecutive intubations, 193 patients(59.2%) were done by emergency medicine residents or attending physician. While 320 patients(98.2%) were successfully intubated, 6 patients could not be intubated and 2 patients underwent tracheostomy. Of 50 cases of intubations(15.3%) attempted with paralyzing agents, 48 cases were done with succinylcholine and 46 cases underwent by emergency physicians. Intubations with neuromuscular paralysis resulted in high success rates at the first attempt. Of 55 immediate adverse events were encountered in 47 patients(desaturation=17, bronchial intubation=15, hypotension=8, bradycardia=4, cardiac arrest=2, others=5). CONCLUSION: At this institution, paralyzing agents were used infrequently, but almost all of them were used by emergency physicians.
Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Humans ; Intubation ; Intubation, Intratracheal* ; Paralysis ; Retrospective Studies ; Succinylcholine ; Tertiary Care Centers* ; Tertiary Healthcare* ; Tracheostomy

PURPOSE: In this research, a definition of overcrowding in emergency department (ED) was proposed, and the actual state of overcrowding in ED was measured by surveys and extensive statistical analysis of data using objective variables. METHODS: The emergency physicians (EP) of 10 arbitrarily selected hospitals were questioned about the definition and cause of overcrowding in ED. The hospitals were divided into two groups (high-feeling and low-feeling) in accordance with the survey results. Admission/discharge records of the patients including arrival/departure date and time, were also collected for the duration of 4 weeks with consideration of seasonal variations, from March 2002 to March 2003. Four parameters, the bed ratio (BR), the provider ratio (PR), the acuity ratio (AR), and the demand value (DV), which were used for the evaluation of overcrowding, were calculated for each hospital. A statistical analysis was carried out to see whether any difference existed in the BR, the PR, the AR and the DV between weekends and weekdays. Also, a similar statistical method was used to analyze the differences between the high-feeling group and the low feeling group. RESULTS: In the survey, 83 physicians were asked to answer the questions. The most preferred answers (>70%) for the definition of overcrowding were "saturation of the beds in the ED for more than 6 hours a day."For the cause of overcrowding, the popular answers were "delay in the consultation and the disposition decision" (74.7%), "use of the ED by non-urgent patients"(74.7%), and "lack of inhospital beds"(65.1%). Among the 10 hospitals, 5 hospitals were categorized the high-feeling group, and the rest fell into the low-feeling group. The average BR and AR were higher in high-feeling group than those of low-feeling group (p<0.01, p<0.01). However, average PR of low-feeling group was higher than that of high-feeling group (p<0.01). Average DV did not exhibit any difference between the two groups (p=0.31). CONCLUSION: The definition of overcrowding in the ED should include not only the lack of beds in the ED but also patient's acuity and the lack of providers. Certain aspects of overcrowding are clearly different between the high-feeling and the low-feeling groups.
Crowding ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Humans ; Seasons ; Tertiary Care Centers*

PURPOSE: The purpose of this study was to examine the effects of emotional labor and organizational justice on organizational socialization of emergency room nurses. METHODS: This study was done over a 4 month period, with 185 emergency room nurses from general and tertiary hospitals in 2 regions of Korea. The nurses completed self-report questionnaires from August 20 to September 30, 2015. The data from the self-report questionnaires were analyzed using descriptive statistics, independent t-test, one way ANOVA, Pearson correlation coefficients, and Hierachial multiple regression analysis with the IBM SPSS 21.0 program. RESULTS: The significant predictors of organizational socialization for the emergency room nurses were procedural justice (β=.38), emotional labor (β=.−23) and distributive justice (β=.19). These variables explained 54% of the variance in organizational socialization of emergency room nurses. CONCLUSION: The results indicate that it is necessary to formulate a plan for enhancing procedural justice and distributive justice, and for decreasing emotional labor.
Emergencies* ; Emergency Service, Hospital* ; Korea ; Social Justice* ; Socialization* ; Tertiary Care Centers

PURPOSE: Until recently, three variants of benign paroxysmal positional vertigo (BPPV) have been recognized: the first is posterior-canal canalolithiasis, the second is horizontal-canal canalolithiasis, and the last is horizontal-canal cupulolithiasis. However, the last two types of BPPV have not been introduced into the textbook of Emergency Medicine yet. The otolith repositioning maneuvers are effective treatments for BPPV, but in emergency medicine, there has been little interest in and research on them. Our goals were to determine the efficacies of these treatments and to examine the clinical features of each types of BPPV. METHODS: We performed a 6-month prospective study on forty-one patients (47 cases) who presented with a history and physical examination consistent with active BPPV to the emergency departments of a secondary hospital and a tertiary hospital (Dec. 2001-May. 2002). The patients were treated with a modified Epley canalith repositioning maneuver for posterior-canal BPPV, a modified Barbecue rotation for horizontal-canal canalolithiasis, and the maneuver of Jo et al. for horizontal-canal cupulolithiasis. RESULTS: A resolution attributable to the first intervention was obtained in 71.4% of the posterior-canal BPPV cases by using the modified Epley maneuver and in 73.1% of the horizontal-canal BPPV cases by using a modified Barbecue rotation and the maneuver of Jo et al. CONCLUSION: The otolith repositioning maneuvers result in a resolution of vertigo in the majority of patients (84.8% of the cases) immediately after treatment. They are safe and require no special equipment or investigations. They should be established as the treatments of choice for BPPV in emergency department.
Emergency Medicine ; Emergency Service, Hospital ; Humans ; Otolithic Membrane* ; Physical Examination ; Prospective Studies ; Tertiary Care Centers ; Vertigo*

BACKGROUND: Massive transfusion is defined as an 8- to 10-unit transfusion of red blood cells (RBC) within 24 hours in an adult or a 4- to 5-unit transfusion of RBC within 1 hour. Massive transfusion plays an important role in saving the lives of trauma patients. We investigated changes in blood volume and blood product ratios used in massive transfusion in trauma patients at emergency room (ER) and traumatic center emergency room (TER) and evaluated prognostic factors of patients based on mortality. METHODS: We compared massive transfusion requirements for trauma patients between the ER and TER such as amount of transfusion, mortality, and ratio of products. The patients selected were over 18 years old. The patients who were transfused with more than 10 units of RBC within 24 hours were defined as massive transfusion patients. RESULTS: There were a total of 189 people who received massive transfusions at the ER over 4 years, and 67 patients were transfused at the TER over 1 year. There was no significant difference in the ratio of blood products between the two groups, but the mortality rate of the ER (63.1%) was significantly higher than the TER (41.8%). CONCLUSION: The ratio of blood products was not related to patient mortality, but the mortality rate of the TER was lower than that of the ER.
Adult ; Blood Volume ; Emergencies* ; Emergency Service, Hospital* ; Erythrocytes ; Humans ; Mortality ; Tertiary Care Centers*