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6 Factors influencing consultation time and waiting time of ambulatory patients in a tertiary teaching hospital Jee In Hwang Original Articles Changes of Job Stress after the Adoption of a Computerized Order Communication System and Its Related Factors in Hospital Employees Sin Kam, Ki Soo Park, Seong Ah Kim, Jung Mi Kim, Chae Yong Lee, Sang Jae Jung, Jae Jin Jung Comparison of customer satisfaction with health examination programs provided by the Korea National Health Insurance and private healthcare organizations in Korea Youn-Soo Shin, Chong Yon Park, Sang Hyuk Jung, Hye Young Jung, Hye-Young Kang Quality of the pharmaceutical advertisement claims in five medical journals in Korea Song Vogue Ahn, Won Choi, Chul Joon Kim, Seong Choon Choe, Kang Hee Lee, Kyoungsoo Ha, Hyeon Chang Kim The evaluation of admission-discharge module system by OCS Jung Hup Song

7 The change of Employee Satisfaction in Radiology Department by Applying 6 Sigma Method Keun-Ohk Lee, Jai-Soung Park, Chung-Hwan Kang, Mi-Young Kim, Seung-Sick Kim An Intervention Study of Pain Reduction during IV Therapy in Hospitalized Children Myo-Jin Kim, Joung-Hae Bak, Won-Seok Seo, Mi-Young Kim, Sun-Kyoung Park, Jai-Soung Park Study of matching user operation name and operation classification code (ICD-9-CM) (Through OCS program use facilitation at operating room) Hyang-Ha Choi, Mi-Young Kim, Do-Jin Kim, Ji-Won Yu, Jung-Hwa Chang, Su-Jung Park, Jae-Sung Park Reduction of inappropriate revisits to the emergency department 72 hours after being discharged by 'Discharge explanation report' Ha Young Park, Min Seob Sim, Hyoung Gon Song, Keun Jeong Song, Articles of Association Information for Authors

8 Volume 12, Number 1, 6~16, Factors influencing consultation time and waiting time of ambulatory patients in a tertiary teaching hospital Jee-In Hwang College of Nursing Science, Kyung Hee University : Tel) , ) jihwang@khu.ac.kr 6

9 Abstract Objectives : The purpose of this study was to identify the characteristics influencing consultation and waiting time in ambulatory patients. Methods : This study was conducted in a tertiary teaching hospital. Subjects were a total of 10,383 ambulatory patients. Consultation time was measured by time spent for meeting with his/her physician per patient. Waiting time was defined as the time difference between each patient's reserved time and time to meet with his/her physician for ambulatory care. Multiple regression analyses were performed to determine the factors influencing consultation and waiting time. Results : Consultation time was different according to patient' age, previous experience of clinic visit, recent admission history, medical department, specialist care, type of reservation, and day of the week. Significant factors influencing waiting time were patient' age, residential area, previous experience of clinic visit, recent admission history, medical department, specialist care, time spent after ambulatory care begins, and day of the week. Conclusions : The medical department was the strongest factor affecting both consultation time and waiting time. The ambulatory reservation management systems should take into account patient characteristics as well as care-related features. Key Words: Ambulatory care; Consultations; Waiting Lists; Outpatient Clinics, Hospital 7

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11 Gender Female 5, NS NS Male 4, Age < < , , , Residential Seoul 5, <.0001 area Kyunggi 2, Others 1, Kangwon Chungchoung Kyungbuk Kyungnam Chula Jeju missing Number 0 5, < <.0001 of 1 2, admission* 2 2, Number 0 7, < <.0001 of recent 1 1, admission Visiting A < <.0001 experience B 9, C Total 10, * : Number of admission during the last year : A-New patients at the study hospital, B-Patients who had visited at the study hospital before C-New patients at the clinical department, but those who had visited at the study hospital before 9

12 Reserved No < care Yes 10, Reservation Routine 10, type Not routine Specialist care Yes 9, <.0001 No Time spent 0-1 3, <.0001 after clinic 1-2 3, begins 2-3 2, (hr) Reservation 9: < <.0001 time 9:30 1, :00 1, :30 1, :00 1, : : : : : : : : : : Day Monday 2, < <.0001 Tuesday 2, Wednesday 2, Thursday 1, Friday 1, Saturday Clinical Infection < <.0001 department Endoclinology 1, Gerontology Rheumatology Gastroenterology 1, Cardiology 1, Nephrology Allergy Oncology 1, Pulmonology Total 10,

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14 Constant <.0001 Age Residential area Other areas Seoul, Kyunggi Previous visiting experience Yes <.0001 No Number of recent admission <.0001 Specialist care <.0001 Reserved care <.0001 Day Friday Monday, Thursday, Saturday Tuesday, Wednesday Time spent after ambulatory care begins Clinical department Infection <.0001 Rheumatology <.0001 Pulmonology, oncology, allergy <.0001 Endoclinology, Gerontology, Gastroenterology, Cardiology, Nephrology R-Square 0.11 Adj R-Square 0.11 F value <

15 Constant Age < < Residential area Kyunggi, Other areas Seoul Previous visiting experience Yes <.0001 No Number of recent admission <.0001 Specialist care <.0001 Time spent after ambulatory care begins <.0001 Day Tuesday <.0001 Saturday <.0001 Monday, Wednesday, Thursday, Friday Clinical department Endoclinology Nephrology, gastroenterology, pulmonology, cardiology <.0001 Rheumatology, allergy, oncology <.0001 Infection <.0001 Gerontology R-Square 0.12 Adj R-Square 0.12 F value <

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20 Volume 12, Number 1, 18 ~ 39, Changes of Job Stress after the Adoption of a Computerized Order Communication System and Its Related Factors in Hospital Employees Sin Kam 1), Ki Soo Park 2), Seong Ah Kim 3), Jung Mi Kim 1), Chae Yong Lee 3), Sang Jae Jung 3), Jae Jin Jung 4) Graduate School of Public Health 1), Kyungpook National University, Department of Preventive Medicine 2), College of Medicine, Gyeongsang National University Department of Preventive Medicine 3), College of Medicine Pochon CHA University Department of Internal Medicine 4), College of Medicine Pochon CHA University : Tel) , ) parkks@gnu.ac.kr 18

21 Abstract Background : This study was carried out to examine the changes of job stress after adoption of order communication system(ocs) and its related factors. Methods : Two hundreds and twenty one employees in a university hospital were surveyed 4 months before and 1 year after the OCS had been adopted. Author used Korean version of Karasek s job content questionnaire(k-jcq) to evaluate job stress. The questionnaire developed by Doll s was used to assess the satisfaction for the OCS. Result : With the adoption of OCS, the scores of skill discretion increased significantly from 29.9 to 30.8 that meant job stress was decreased. In use of OCS, direct user group showed significant increase of skill discretion, whereas the indirect user group showed significant increase in psychological job demand, and it was statistically significant when compared to direct user group(p<0.05). Among the changes in job stress, skill discretion score change was significantly different by age(p<0.05). This study revealed that there was statistically significant relationship between the change of skill discretion score and time computer use, level of satisfaction for content of provided information(p<0.05). And psychological job demand score change was significantly different by time of computer use(p<0.05). Conclusion : Adoption of OCS into hospital may increase job stress, but when it is adopted wisely and appropriately, it may enhance skill discretion of each individual, and decision authority while reducing psychological job demand. Key Words: Job stress, Order communication system 19

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42 Volume 12, Number 1, 40~51, Comparison of customer satisfaction with health examination programs provided by the Korea National Health Insurance and private healthcare organizations in Korea Youn-Soo Shin, Chong Yon Park, Sang Hyuk Jung, Hye Young Jung, Hye-Young Kang Graduate School of Public Health Yonsei University, National Health Insurance Corporation National Health Insurance Corporation, Health Insurance Research Center* Department of Preventive Medicine, College of Medicine, Ewha Womens University** Graduate School of Public Health, Yonsei University*** : Tel) , ) hykang@yumc.yonsei.ac.kr 40

43 Abstract Backgrouds : This study was performed to compare the satisfaction levels for health examination programs provided by between the Korea National Health Insurance Corporation (KNHIC) and private healthcare organizations in Korea. We investigated factors associated with the satisfaction level for the KNHIC health examination. Also, factors explaining for the additional receipt of private healthcare organization's examination were identified. Methods : A self-administered questionnaire survey was conducted in June 2004 with 250 beneficiaries of the KNHIC industrial workers' program and 100 beneficiaries of the KNHIC selfemployed program. A total of 297 completed the questionnaire, including 213 (85.2%) and 84 (84.0%) for each insurance program. Ten questions measuring satisfaction levels for each examination program were rated on a scale ranging from 1 (strongly unsatisfied) to 5 (strongly satisfied). Results : Among the subjects receiving both examinations, the mean satisfaction level for the KNHIC examination (3.07) was significantly lower than that for the private healthcare organization's examination (3.50) (p<0.05). The KNHIC examination showed lower satisfaction for all of the 10 items than the counterpart. In particular, the KNHIC examination had the scores of lower than 3.0 for the items reflecting post-examination management services. According to the multiple regression analysis results, the satisfaction for the KNHIC examination was positively associated with the positive attitude toward health examination( =0.38, p<0.00). The logistic regression results showed that the likelihood of receiving the private healthcare organization's examination in addition to the KNHIC examination increases as the respondents were less healthier(or=0.29, 95% CI = ), the satisfaction level for the KNHIC examination decreased(or=0.46, ) or the attitude toward health examination was more positive (OR=2.56, ). Conclusion : The relatively low satisfaction level for both examination programs suggests that there's ample room for improvement of health examination services in Korea. The negative association between additional receipt of private healthcare organization's examination and satisfaction level for the KNHIC examination implies that the improvement of the satisfaction for the KNHIC examination would help to reduce the national expenditure spent on the additional examination. Key Words: Health Examination, Satisfaction, Questionnaire Survey 41

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54 Volume 12, Number 1, 52~61, Quality of the pharmaceutical advertisement claims in five medical journals in Korea Song Vogue Ahn 1), Won Choi 2), Chul Joon Kim 2), Seong Choon Choe 3), Kang Hee Lee 4), Kyoungsoo Ha 1), Hyeon Chang Kim 1) Department of Preventive Medicine, Yonsei University College of Medicine 1) Medical Department, MSD Korea 2) Medical Department, Sanofi-Synthelabo Korea 3) International Cooperation Team, Ministry of Health and Welfare, Korea 4) : 52

55 Abstract Background : The promotion and advertisement of pharmaceuticals should be based on evidence from clinical trials. We conducted this study to assess whether the pharmaceutical advertisement claims in Korean medical journals had relevant references, and whether the claims were supported by the references. Methods : We reviewed pharmaceutical advertisements in five Korean medical journals issued during the first half of 1999 and during the first half of Three investigators independently reviewed the advertisements to see whether the studies quoted to endorse the advertising messages supported the corresponding claims. Using multiple logistic regression analyses, we investigated which factors were associated with the quality of the advertisement claims. Results : From the 550 advertisements in the five journals, we identified 157 different advertisements and 475 different promotional claims. Only 149 claims had at least one reference, and 105 claims had references of published article. We could find supporting evidences in the 90 claims. The factors which were associated with the quality of advertisement claims were category of drugs, category of claims, and the manufacturer characteristics. Claims for cardiovascular and endocrine drugs, and claims on efficacy, and claims of multinational company were more evidence-based. Conclusion : Majority of the pharmaceutical advertisement claims in Korea did not have appropriate references. Drug category, claim category, and the manufacturer characteristics were associated with the quality of advertisement claims, and the manufacturer characteristics was the most important determinants. Key Words: Quality, Evidence, Pharmaceutical, 53

56 All advertisements Advertisements for specific drugs Different advertisements Different advertisements with 1 claim Claims Claims with 1 reference

57 Cardiovascular 19 (30.1%) 26 (27.7%) Gastrointestinal 10 (15.9%) 16 (17.0%) Category of Endocrine 10 (15.9%) 13 (13.8%) drugs Antimicrobial 9 (14.3%) 14 (14.9%) Others 13 (20.6%) 17 (18.1%) Not mentioned 2 (3.2%) 8 (8.5%) Manufacturer Domestic 30 (47.6%) 51 (54.3%) Multinational 33 (52.4%) 43 (45.7%) 0 3 (4.8%) 9 (9.6%) 1 14 (22.2%) 18 (19.1%) Number of 2 6 (9.5%) 9 (9.6%) claims 3 18 (28.6%) 16 (17.0%) 4 9 (14.3%) 22 (23.4%) 5 or more 13 (20.6%) 20 (21.3%) 55

58 Category of Efficacy 121 (63.4%) 184 (64.8%) claims Safety 39 (20.4%) 53 (18.7%) Convenience 13 (6.8%) 15 (5.3%) Others 18 (9.4%) 32 (11.3%) Number of 1 56 (29.3%) 78 (27.5%) references 2 4 (2.1%) 6 (2.1%) 3 or more 2 (1.1%) 3 (1.0%) No reference 129 (67.5%) 197 (69.4%) Publication Published article 38 (19.9%) 67 (23.6%) type Abstract 14 (7.3%) 9 (3.2%) Monograph 2 (1.1%) 3 (1.0%) Data on file 5 (2.6%) 6 (2.1%) Other 3 (1.6%) 2 (0.7%) No reference 129 (67.5%) 197 (69.4%) 56

59 Medline-listed Yes 30 (79.0%) 63 (94.0%) No 8 (21.0%) 4 (6.0%) RCT* 27 (71.1%) 44 (65.6%) Observational 1 (2.6%) 2 (3.0%) Meta-analysis - 3 (4.5%) Study design Animal study - 3 (4.5%) Others 3 (18.4%) 12 (17.9%) Uncertain 7 (18.4%) 3 (4.5%) Supporting Yes 29 (76.3%) 61 (91.0%) the claims No 1 (2.6%) 2 (3.0%) Uncertain 8 (21.0%) 4 (6.0%) * RCT = randomized controlled trial 57

60 Drug Respiratory category Cardiovascular 5.39 ( ) 4.94 ( ) ( ) ( ) Analgesics 2.01 ( ) 2.78 ( ) ( ) 4.76 ( ) Antimicrobials 1.27 ( ) 1.97 ( ) 3.78 ( ) 2.73 ( ) Endocrine 5.59 ( ) 4.11 ( ) ( ) 7.92 ( ) Gastroenteric 1.64 ( ) 0.45 ( ) 2.59 ( ) 1.15 ( ) Others 3.29 ( ) 1.71 ( ) ( ) 2.39 ( ) Claim Convenience, category cost, others Efficacy 3.47 ( ) 3.75 ( ) 3.23 ( ) 3.49 ( ) Safety 2.25 ( ) 2.30 ( ) 1.38 ( ) 3.25 ( ) Publication year ( ) 2.76 ( ) 1.66 ( ) 2.41 ( ) Manufacturer Domestic category Multinational ( ) ( ) 7.57 ( ) 9.92 ( ) * Adjusted for other variables in the table 58

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64 Volume 12, Number 1, 62~76, The evaluation of admission-discharge module system by OCS Jung Hup Song Department of Occupational Medicine, Kyungpook National University Hospital 62

65 Abstract Background : There were so many patients who are waiting for admission in Emergency room in spite of more than one hundred empty beds everyday. This study was conducted to evaluate admission-discharge module system by OCS which reduce empty beds. Methods : The data of bed utilization in general beds from 2004 were reviewed. For evaluation of performance at admission-discharge module system by OCS, the change of Occupancy of bed were calculated. Results : The percentage of Average Bed Emptiness was changed from 13.8% to 9.2%. The residents in surgery(100%) and in internal medicine(75.5%) approved this system. Conclusion : The personnel in hospital recognized that it was very important to manage bed. The management of beds by OCS was helpful to reduce empty beds and was important. 63

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80 Volume 12, Number 1, 78~90, The change of Employee Satisfaction in Radiology Department by Applying 6 Sigma Method Keun-Ohk Lee 1), Jai-Soung Park 2), Chung-Hwan Kang 1), Mi-Young Kim 3), Seung-Sick Kim 1) Dept. of Radiology, Soonchunhyang University Bucheon Hospital 1) Dept. of Radiology, School of Medicine, Soonchunhyang University 2) Dept. of Quality Improvement, Soonchunhyang University Bucheon Hospital 3) : 78

81 Abstract Background : The concept of 'service' in a hospital is based on the quality of medical staffs who serve as customer-satisfying media, and this is what distinguishes general hospitals from other business corporations in which customer satisfaction is achieved through commercial products. Thus, the internal employee satisfaction is essential in the improvement of the 'service' and subsequent 'competitiveness' of a hospital. The purpose of this study is to establish internal marketing strategies for a general hospital through regular surveys on employee satisfaction. Method : Surveys on employee satisfaction in radiology department were conducted regularly twice a year in a university hospital with 800 beds 2001 in The subjects of this study were 35 employees who work in radiology department. The authors developed the questionnaires and the surveys were conducted initially during the first 6 months of the year. After necessary improvements were made by applying 6 Sigma techniques, subsequent surveys were conducted during the latter 6 months of the year and the degree of employee satisfaction was compared. Results : Overall satisfaction increased with a constant rate and the authors were able to assess that the hospital is being gradually stabilized. The degree of satisfaction assessed by multiple choices showed only minor changes. However, as a result of focusing on the demands put forth by the employees through the open questions, the degree of satisfaction increased gradually year after year. Conclusions : It is important to heighten the internal employee satisfaction systematically and harmoniously through the assessment on the demands of the internal customers and feedback-based communications between the management officers and the staffs. Continuous surveys on the internal employee satisfaction will serve to be valuable materials in the establishment of internal marketing strategies for a general hospital. Key Words: Employee satisfaction, Satisfaction, Feedback. 79

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94 Volume 12, Number 1, 92~102, An Intervention Study of Pain Reduction during IV Therapy in Hospitalized Children Myo-Jin Kim 1), Joung-Hae Bak 1), Won-Seok Seo 2) Mi-Young Kim 3), Sun-Kyoung Park 3), Jai-Soung Park 3) Dept. of Nurse, Soonchunhyang University Bucheon Hospita 1) Dept. of Pediatric, School of Medicine, Soonchunhyang University 2) Dept. of Quality Improvement, Soonchunhyang University Bucheon Hospital 3) : 92

95 Abstract Background : Most hospitalized children will experience physical pain as well as psychological distress. Painful procedure can increase anxiety and fear of pediatric patients and their parents who do not have understanding logical of their disease and hospitalization. This study attempted to identify pain reduction in related to therapeutic intervention by age and environmental improvement. Methods : A total of 194 hospitalized children and their parents were investigated. Data collection period was 3 months from March to May Four instruments were used to collect the data : Faces Pain Rating Scale(FPRS), Heart rate, Oxygen saturation and Pain behavioral check list. The data were analyzed by a SPSS program and tested 2-test, t-test, ANCOVA. Results : 1. Age from 0 to 3, the Heart rate, FPRS, Oxygen saturation and Pain behavioral check list were significantly different in theraputic intervention group when compare to control group. 2. Age from 4 to 6, FPRS, Oxygen saturation and Pain behavioral check list were significantly different in theraputic intervention group when compare to control group. But the heart rate were not significantly different when compare to control group. 3. Age from 7 to 9, FPRS and Pain behavioral check list were significantly lower in therapeutic intervention group when compare to control group but Heart rate and Oxygen saturation were not significantly different when compare to control group. Conclusion : The results of this study concludes that most children experience acute pain during IV therapy and it can be reduced by age specific therapeutic intervention and by change of surrounding environment. 93

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106 Volume 12, Number 1, 104~112, Study of matching user operation name and operation classification code (ICD-9-CM) (Through OCS program use facilitation at operating room) Hyang-Ha Choi 1), Mi-Young Kim 2), Do-Jin Kim 3), Ji-Won Yu 1), Jung-Hwa Chang 1), Su-Jung Park 4), Jae-Sung Park 2) Dept. of Medical Record, Soonchunhyang University Bucheon Hospital 1) Dept of Quality Improvement, Soonchunhyang University Bucheon Hospital 2) Dept. of Pulmonary Medicine, Soonchunhyang University Bucheon Hospital 3) Dept. of Nurse, Soonchunhyang University Bucheon Hospital 4) : 104

107 Abstract Background : The necessity of unify and standardize codes used at hospital has been emphasized since OCS (Order Communicating System) was adopted. Therefore, the purpose of this study were to standardize operation code by continuous training of the ICD-9-CM code that is used as standard code in OCS program at operating room. Method : In 400 operation data, operation code entered in OCS program at operating room was compared to operation name recorded in medical record. In addition, a matching rate between input data of operation code by medical record department and computing input data of operation code in 3,710 cases was compared for each department. User operation name and operation code were matched and major diagnosis by operation department and operation name were also matched. Results : User operation name was reflected in operation classification code in detail, and operation code entered on user was registered. Input rate and matching rate of operation code were gradually improved after improvement activity. In particular, a matching rate was high at ophthalmology where operation name is segmented. Plastic surgery and orthopedics with a lot of emergency operation and comprehensive operation name show low input rates. Conclusions : As the medical field makes progress in computerlization, awareness of information exchange and sharing becomes higher. Among codes to classified medical institution, codes related to surgical operation are all different by user of hospital and department. Computerlization and standardization is essential. And when efforts of standardization continue in alliance with individual hospital and institution, initiative of preparing medical policy data at a national level will be accelerated. Key Words: operation classification code, rate of operation code 105

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116 Volume 12, Number 1, 114~123, Reduction of inappropriate revisits to the emergency department 72 hours after being discharged by 'Discharge explanation report' Ha Young Park, Min Seob Sim, Hyoung Gon Song, Keun Jeong Song, Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine : 114

117 Abstract Background : Patients who were discharged from the emergency department(ed) may revisit. These patients are divided into two groups; one is expected scheduled condition, the other is unexpected condition. These patients of inappropriate revisits to the ED would be unsatisfied, difficult to make rapport and take legal action as a result of additional medical charges. The purpose of this study was to reduce inappropriate revisits to the ED with a new method which was developed by analyzing inappropriate revisits in Methods : This study was conducted in a tertiary hospital consisting of 1,278 beds. The most common cause of inappropriate revisits was the medical team's lack of explanation about a disease. Thus we decided that the effective method was to offer full explanations to patients to understand the clinical pathway of a disease. We made four types of stickers to explain most common 4 diseases in An emergency physician completed 'discharge explanation report' and explained it to patients in Results : In 2002 inappropriate revisited patients were 164, patients with four diseases were 79. During the same period of 2003, inappropriate revisited patients were 56 (-65.9%), four disease patients were 6 (-92.4%) and in 2004 inappropriate revisited patients were 52, four disease patients were 19. Causes of revisits were lack of explanation about a disease in 35 patients (44.3%) in 2003, and 5 patients (83.3%) in 2003, and 16 patients (84.2%). Conclusions : Application of 'explanation stickers' at discharge reduced inappropriate revisits from 34.5% in 2002 to 15.9% in Application of 'Discharge explanation report' by emergency physician reduced inappropriate revisits from 15.9% in 2003 to 13.5% in Reduction of inappropriate revisits elevated the quality of medical treatment, and decreased patients' dissatisfaction in ED. Key Words: Revisit, Emergency department, Quality assurance 115

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119 Total visits 9,116 8,842 9,186 NS Revisits in 72 hrs <.01 Inappropriate visits <.01 Inappropriate visits of 4 most common diseases <

120 male : female (person) 36 : 43 3 : 3 12:7 NS Mean age (year) NS Childs<15 years (person,%) 28(35.4%) 3(50.0%) 5(26.3%) <.05 Mean duration (hours, min) 24hours 6mins 23hours 36min 20hours 18min NS Mean visit number of times NS Fever 35(44.3) 3(50.0) 6(31.6) NS Gastroenteritis 22(27.8) - 6(31.6) NS Ureter stone 13(16.5) 1(16.7) 6(31.6) NS Urticaria 9(11.4) 2(33.3) 1(5.2) NS ED discharge 59(74.7) 5(83.3) 13(68.4) NS General ward admission 18(22.8) 1(16.7) 5(26.3) NS Transfer out 2(2.5) - 1(5.3) NS 118

121 Lack of explanation Inappropriate or incomplete 35(44.3) 5(83.3) 16(84.2) NS treatment 29(36.7) 2(10.5) NS Misdiagnosis Discharged with indications 6(7.6) 1(16.7) - NS of admission 4(5.1) - - NS Lack of comprehension of patients 5(6.3) - 1(5.3) NS 119

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134 ,,,, : (02) FAX(02) (02) Volume 12 Number Publisher Jung Don Seo M.D., PhD Editor in Chief Jung Don Seo M.D., PhD Published by The Korean Society of Quality Assurance in Health Care Department. of Preventive Medicine College of Medicine, UI San University Seoul, Korean Designed by MEDICONSULT