- Outcomes for Employment of a Trauma Clinical Nurse Specialist in the Treatment of Trauma Patients
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Yooun Joong Jung, Young Hwan Kim, Tae Hyun Kim, Min Ae Keum, Dae Sung Ma, Kyu Hyouck Kyoung, Jung Jae Kim, Suk Kyung Hong
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J Trauma Inj. 2012;25(4):254-260.
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 Abstract
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- PURPOSE
Ongoing treatment and care, as well as initial stabilization, are required for trauma patients. With increasing number of sickest trauma patients and shortage of surgeons, the need for advanced practice nurse to provide and coordinate trauma care has been greater. The purpose of this study is to analyze the effect of hiring a trauma clinical nurse specialist and its influence on the treatment of trauma patients.
METHODS
Based on the employment of the clinical nurse specialist in December 2010, the patients were divided into two groups: patients admitted from January 1, 2010 to November 30, 2010 and patients admitted from December 1, 2010 to December 31, 2011. Retrospectively, data were collected using electronic medical records. The general characteristics, clinical courses, and ICU re-admission rates, collaboration (transfers to other departments and collaborative surgery) were compared.
RESULTS
To have a clinical nurse specialist on the trauma team resulted in a statistically significant reductions in the length of general ward hospital stay (p<0.05), the ICU re-admission rate, (p<0.03), the lead-time before transfer to other departments (p<0.05).
CONCLUSION
The clinical nurse specialist, as a professional practitioner, improved the quality of treatment through early detection and management of problems. In addition, as a coordinator, the clinical nurse specialist maintained a cooperative relationship with multi-disciplinary medical personnel. The trauma clinical nurse specialist contributed to the treatment of trauma patients positively through a decrease in ICU re-admission rate and length of hospital stay.
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Summary
- Medical Expenses for Trauma According to the Type of Medical Insurance
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Heeseung Park, Yooun Joong Jung, Young Hwan Kim, Tae Hyun Kim, Min Ae Km, Kyu Hyouck Kyoung, Jung Jae Kim, Suk Kyung Hong
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J Trauma Inj. 2012;25(4):178-187.
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Abstract
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- PURPOSE
In Korea, the nation's medical expenses were 12 billion won in 2010. The medical costs for individuals can also be overwhelming. If a patient has sustained severe trauma, his/her insurance company responsible may pay only part of the medical bills. In Korean, there are diverse types of medical insurance, such as health insurance, automobile insurance, and industrial accident compensation insurance. And each insurance system has a different type of payment system. Our study will be essential for establishing the optimal medical expense payment system.
METHODS
From January to December 2011, we retrospectively reviewed the medical charts of 161 patients who were admitted to our hospital's emergency room after having undergone severe trauma. Of those 161 patients, 125 were retrospectively reviewed. Written permission was obtained from all of the patients. We analysed the demographic characteristics, clinical outcomes, data of the trauma, type of the patient's insurance, and the entire bill when the patient was discharged.
RESULTS
Seventy-one patients had health insurance, 48 automobile insurance, and six industrial accident compensation insurance. High-deductible insurance included health insurance and industrial accident compensation insurance, with the deductibles up to 20.6% and 19.1%, respectively. We attempted to analyze the cause of the high deductible rate. In patients with health insurance, medicines, primarily sedatives, pain killers, antibiotics, and fluids. comprised a large proportion. On the other hand, industrial accident compensation insurance deducted for a high-grade hospital room charge.
CONCLUSION
We found that medical expenses were diverse according to the type of insurance. In particular, health insurance forced patients to pay too much of the medical expenses. Therefore, in Korea we should try to identify the insurance problems and improve the wage system.
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Summary
- The Importance of the Trauma Surgeon: A Reflection on the Management of Hemodynamically Unstable Pelvic Trauma Patients
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Sung Shin, Kyu Hyuk Kyung, Ji Wan Kim, Jung Jae Kim, Suk Kyung Hong
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J Korean Soc Traumatol. 2009;22(2):254-259.
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Abstract
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- PURPOSE
Pelvic trauma is a serious skeletal injury with high mortality. Especially in cases of severe injury trauma, treatment outcomes depend on early diagnosis and intervention. We expect trauma surgeon to play an important role in the management of severe multiple trauma patients.
METHODS
A retrospective study was performed on pelvic trauma patients with hemodynamic instability between March 2005 and September 2009. We divided the time period into period I (March 2005~Feburary 2009) and period II (March 2009~September 2009). The trauma surgeon and team started to work from period II. Data were collected regarding demographic characteristics, mechanism of injury, type of pelvic fracture, ISS (injury severity score), treatment modality, transfusion requirement, time to definitive treatment, and mortality.
RESULTS
During period I, among 7 hemodynamically unstable patients, 4(57.1%) patients died. However during Period II, only one of 6(16.6%) patients died. The demographic data and injury scores showed no differences between the two time periods, but the time to definitive treatment was very short with trauma team intervention( 14.4 hrs vs. 3.9 hrs). Also, the amount of transfusion was less(41.1 U vs. 13.9 U). With arterial embolization, early pelvic external fixation led to less transfusion and made patients more stable.
CONCLUSION
This study demonstrated the importance of the trauma surgeon and the trauma team in cases of hemodynamically unstable pelvic trauma. Even with the same facility and resources, an active trauma team approach can increase the survival of severely injured multiple trauma patients.
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