Conceptualized framework for levels of obstetric care

It has been demonstrated that risk-appropriate perinatal and obstetric care can improve perinatal morbidity and mortality. Recently, various studies focus on the importance of evaluation for maternal conditions and allocation of high risk pregnant women to highly qualified facilities. Therefore, it is necessary to develop the conceptualized framework for levels of obstetric care and establish the guidelines for the situations that should be cared in each level of facility. In this review article, we reviewed several classifications of obstetric care in eastern and western countries, and conditions in which transfer should be recommended depending on the risk and capacity of centers.

Clinical Analysis of Characteristics of Patients Who Visit Otorhinolaryngology Clinic in Secondary General Hospital / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Common cold is an upper airway viral infection and can be managed by conservative treatment. According to the hospital referral system, mild diseases like common cold should be treated first at a primary physician clinic. However, now in Korea, visiting high-level hospitals for mild diseases is not impossible officially and even the rate of visiting high-level general hospital has increased in spite of the current hospital referral system. This study aimed to provide data of characteristics of patients who choose high-level hospitals for mild diseases like common cold. SUBJECTS AND METHOD: We conducted a survey targeting those who visit general hospitals for common cold. The questionnaire comprised of asking first choice of contact hospital, sex, age, awareness and use of antibiotics when visiting primary physician, medical examinations and duration of treatment, and reasons for thinking that general hospitals are superior to primary hospitals. Subjects were categorized according to their choice of first contact hospital with common cold, primary physician or general hospital. For each group, independent sample t-test and chi-square test were applied to variables. RESULTS: Among the variables for the two groups, statistical significances were found in age, duration of treatment and whether medical examinations were performed or not. CONCLUSION: Underestimation for primary physician and vague faith in medical examinations were most influential factors that lead patients with mild diseases to visit general hospitals. This study finds that programs for educating the public are necessary to make them understand that primary physician clinics are enough to treat common cold and that an institutional framework will be needed to support the hospital referral system.

The Utility of Routine Serial Brain Computed Tomography for Referred Traumatic Brain Injury Patients According to the Severity of Traumatic Brain Injury

PURPOSE: Patients with traumatic brain injury (TBI) were referred from other hospitals for further management. In addition, patients routinely underwent computed tomography examinations of the head (HCT) in the referral hospitals. The purpose of this study was to evaluate retrospectively the utility of routine HCT scans according to the severity of TBI. METHODS: Patients with TBI referred to our hospital between December 2005 and July 2008 were included in this study. We investigated HCT findings, indications for repeat HCT examinations (routine versus a neurological change), and neurosurgical interventions. The head injury severity was divided into three categories according to the Glasgow Coma Scale (GCS) score, including mild, moderate, and severe TBI. The use of neurosurgical interventions between patients who underwent routine HCT scans and patients who underwent HCT scans for a neurological change were compared according to the severity of TBI. RESULTS: A total of 81 patients met the entry criteria for this study. Among these patients, 67%(n=54) of the patients underwent HCT scans on a routine basis, whereas 33%(n=27) of the patients underwent HCT scans for a neurological change. A total of 21 patients showed signs of a worsening condition on the HCT scans. Neurosurgical intervention was required for 23(28.4%) patients. For patients who underwent routine HCT examinations, no patient with mild TBI underwent a neurosurgical intervention. However, one patient with moderate TBI and three(13%) patients with severe TBI underwent neurosurgical interventions. The kappa index, the level of agreement for HCT indications of intervention and referral reasons for intervention, was 0.65 for high hierarchy hospitals and 0.06 for low hierarchy hospitals. CONCLUSION: Routine serial HCT examinations in the referred hospitals would be useful for patients with severe head injury and for patients from low hierarchy hospitals where no emergency physicians or neurosurgeons are available.

Stroke Patients in the Convalescent Rehabilitation Ward of an Acute Stroke Center : A Regional Inter-hospital Referral Model Compared with an Intra-hospital Referral Model / The Japanese Journal of Rehabilitation Medicine

The purpose of this study is to investigate stroke patients in a convalescent rehabilitation ward of an acute stroke center. We collected data on 314 stroke patients discharged from the convalescent rehabilitation ward between January 2004 and December 2005. In total, 108 patients were classified as our regional inter-hospital referral model group. Alternately, 206 patients were classified as our intra-hospital referral model group. The regional inter-hospital referral model group took a longer time for transferring and discharging as compared with the intra-hospital referral model group. There was a significant difference in the days between onset of stroke and transfer, and the days between onset of stroke and discharge returned home. In conclusion, we should have a better opinion of the intra-hospital referral model in order to improve the quality of rehabilitation medicine.