Problems of Trauma Care and Rate of Preventable Trauma Death in Jeju, South Korea

PURPOSE: This study was undertaken to investigate preventable trauma death and trauma care errors contributing to death on Jeju Island. METHODS: A retrospective study was conducted on all trauma deaths between January 2008 and May 2010 at five emergency departments (ED) in Jeju. Of the 165 deaths, 101 patients included for study after excluding death within one hour or after one week. Injury severity was scored according to the Injury Severity Score (ISS) and survival probability (Ps) was calculated. Trauma care errors were coded to six categories: pre-hospital, ED, operating room, intensive care unit, general ward, and inter-hospital transfer. In addition, system inadequacy, problems in treatment, diagnosis, and procedures were analyzed. Patient records were reviewed independently and preventability was determined by agreement. RESULTS: The preventable death rate was 35.6%, and the mean ISS was 25.25+/-10.78. Of all 149 inappropriate cares, 66.4% contributed to death. Of the 121 treatment-related problems, 88 problems occurred in the ED. Of the 18 system-related problems, 12 were in the pre-hospital phase. Seventy of the 96 problems associated with deaths occurred in the ED, and 12 of 29 problems in the pre-hospital phase. CONCLUSION: The preventable death rate was high. Inappropriate care rendered in the treatment process in the ED and system-related errors in the pre-hospital phase were major contributors to preventable trauma deaths. To reduce preventable deaths, more efforts are required on organizing trauma team management and improving care errors during the pre-hospital and inter-hospital transfer.

Effect of the New Emergency Fee Schedule on the Pattern of Emergency Patients

PURPOSE: This study was conducted to solve the problems due to overcrowding of emergency medical centers (EMC) and to help EMCs to improve their financial status. Korean government has implemented a new emergency fee schedule into National Health Insurance (NHI). This policy is aimed at reducing non-emergent visits to EMCs. METHOD: This study was conducted to analyze the impact of the new policy by using a before-after comparison of the patterns of patients' visit to an EMC, Asan Medical Center (AMC). Data electronically recorded at the EMC of AMC were reviewed retrospectively. RESULT: The new emergency fee schedule reduced the rate of increase of non-emergent visit to EMC. CONCLUSION: However, this policy could not succeed in limiting total number of EMC visits. It means that this pricing policy made a partial success in solving the problem of overcrowding of EMCs.

Comparison of Asan Medical Center Criteria and National Health Insurance Criteria Among Emergent Patients

PURPOSE: To solve the problems of overcrowding in the emergency department (ED), the Korean government adopted the new emergency fee schedule into National Health Institute (NHI) as of April 2000. The purpose of this system was to determine non-emergent patients from visiting the ED. However, there have been no studies regarding the decision criteria for what constitute an 'emergency'. For that reason, we compared the concordance between the criteria used at the Asan Medical Center since 1998 to designate an emergency with those used by the government to improve the system. METHODS: We performed a retrospective study by collecting the data from 107,097 patients who visited Asan Medical Center from January 1st, 2001, to December 21st, 2002. The criteria on emergency in NHI consist of 36 items, while the criteria at Asan Medical Center are decided by emergency physician and nurse when the patient arrived at the ED. Based on laboratory and radiologic data, a secondary decision is made when the patient is moved from triage to the adult resuscitation room or transferred to an other medical center or discharged. RESULTS: The number of patients who were classified as emergent by both criteria was 22,452 (21%), the number of patients who were classified as non-emergent by both criteria was 39,657 (37%), and the number of patients who were classified in the same way by both criteria was 62,109 (58%). The number of patients for whom the two sets of criteria gave different classification was 44,988 (42%). The Kappa value was 0.138 (p < 0.005). CONCILUSION: There was high discordance between the criteria used by Asan Medical Center and NHI. Further studies and improvements are required.