Impact of delirium on prolonged intensive care unit stay in critically ill older patients.

Objectives: Central Line-Associated Bloodstream Infections (CLABSIs) are associated with prolonged hospitalization, increased healthcare costs. It is important to reduce CLABSI rates through interventions. This study investigated the current status of CLABSI rates among hospitalized patients to gather foundational data for implementing CLABSI intervention measures. Methods: During a month from June 1st to 30th, 2023, a retrospective investigation of CLABSI rates was conducted among patients hospitalized at a tertiary hospital in South Korea. Psychiatric and obstetric, hospice, emergency, neonatal wards, and delivery rooms were excluded from the study. CLABSI was defined according to NHSN and Korean National Healthcare-associated Infections Surveillance System. Results: A total of 48 CLABSIs were identified, with mucosal barrier injury laboratory-comfirmed bloodstream infection (MBI-LCBI) accounting for 29 (60.4%) and non-MBI-LCBI for 19 (39.6%). Among MBI-LCBI, 28 (96.6%) occurred in hematology wards, while among non-MBI-LCBI cases, 9 (47.4%) occurred in general wards, 9 (47.4%) in hematology wards, and 1 (5.3%) in the intensive care units (ICUs). Overall CLABSI rates was 2.75 per 1,000 catheter days, with 1.66 for MBI-LCBI and 1.09 for non-MBI-LCBI. By department, the CLABSI rates per 1,000 catheter days were 6.11 in hematology wards, 1.02 in general wards, and 0.63 in the ICUs. A total of 58 organisms were isolated, with gram- negative bacteria (78.8%) predominating in MBI-LCBI and gram-positive bacteria (56.0%) in non- MBI-LCBI. Among MBI-LCBI, Klebsiella pneumoniae (30.3%), Escherichia coli (27.3%) were the most frequently isolated organisms, whereas among non-MBI-LCBI, coagulase-negative staphylococci (16.0%) and E. coli (16.0%) were the most frequently isolated organisms. Conclusions: The CLABSI rates among hospitalized patients at a tertiary hospital in South Korea was higher for MBI-LCBI than non-MBI-LCBI, with the majority occurring in hematology wards. Since the departments and causative organisms are different depending on MBI-LCBI and non-MBI-LCBI, it is necessary to individualize the CLABSI surveillance policy based on this.

Background/AimsThe incidence rate of nontuberculous mycobacterial pulmonary disease (NTM-PD) is increasing worldwide. However, data regarding the age- and sex-specific epidemiology of NTM-PD are limited. This study aimed to investigate the long-term epidemiologic trends of NTM-PD within the recent 11-year period in a tertiary referral hospital in Korea.MethodsWe retrospectively reviewed the medical records of the patients diagnosed with NTM-PD between January 2006 and December 2016 at Severance Hospital, South Korea.ResultsThere were 1,017 incident cases with NTM-PD during the study period. The mean age was 62.7 years, and 41.2% were men. Women were younger than men (59.9 years vs. 66.7 years, p < 0.001) and a higher proportion of women had bronchiectasis (88.6% vs. 77.1%, p < 0.001). The incidence rates of NTM-PD annually increased by 14% (95% confidence interval, 10% to 19%) from 1.2 in 2006 to 4.8 in 2016 (per 100,000 patients-year). The peak incidence rate was in the 50s for women and in the 70s for men, except for those aged ≥ 80 years. Mycobacterium avium complex was the most common causative species of NTM-PD (63.6%).ConclusionsThe incidence rate of NTM-PD in a tertiary referral hospital in South Korea continued to increase from 2006 to 2016. Furthermore, there were age- and sex-related differences in the clinical characteristics, which might contribute to understanding the nature of the disease and inherited and acquired host factors.

Physicians and nurses working in acute care settings, such as tertiary hospitals, are involved in various stages of critical and terminal care, ranging from diagnosis of life-threatening diseases to care for the dying. It is well known that critical and terminal care causes moral distress to healthcare professionals. This study aimed to explore moral distress in critical and terminal care in acute hospital settings by analyzing the experiences of physicians and nurses from various departments. Semi-structured in-depth interviews were conducted in two tertiary hospitals in South Korea. The collected data were analyzed using grounded theory. A total of 22 physicians and nurses who had experienced moral difficulties regarding critical and terminal care were recruited via purposive maximum variation sampling, and 21 reported moral distress. The following points were what participants believed to be right for the patients: minimizing meaningless interventions during the terminal stage, letting patients know of their poor prognosis, saving lives, offering palliative care, and providing care with compassion. However, family dominance, hierarchy, the clinical culture of avoiding the discussion of death, lack of support for the surviving patients, and intensive workload challenged what the participants were pursuing and frustrated them. As a result, the participants experienced stress, lack of enthusiasm, guilt, depression, and skepticism. This study revealed that healthcare professionals working in tertiary hospitals in South Korea experienced moral distress when taking care of critically and terminally ill patients, in similar ways to the medical staff working in other settings. On the other hand, the present study uniquely identified that the aspects of saving lives and the necessity of palliative care were reported as those valued by healthcare professionals. This study contributes to the literature by adding data collected from two tertiary hospitals in South Korea.

Physicians and nurses working in acute care settings, such as tertiary hospitals, are involved in various stages of critical and terminal care, ranging from diagnosis of life-threatening diseases to care for the dying. It is well known that critical and terminal care causes moral distress to healthcare professionals. This study aimed to explore moral distress in critical and terminal care in acute hospital settings by analyzing the experiences of physicians and nurses from various departments. Semi-structured in-depth interviews were conducted in two tertiary hospitals in South Korea. The collected data were analyzed using grounded theory. A total of 22 physicians and nurses who had experienced moral difficulties regarding critical and terminal care were recruited via purposive maximum variation sampling, and 21 reported moral distress. The following points were what participants believed to be right for the patients: minimizing meaningless interventions during the terminal stage, letting patients know of their poor prognosis, saving lives, offering palliative care, and providing care with compassion. However, family dominance, hierarchy, the clinical culture of avoiding the discussion of death, lack of support for the surviving patients, and intensive workload challenged what the participants were pursuing and frustrated them. As a result, the participants experienced stress, lack of enthusiasm, guilt, depression, and skepticism. This study revealed that healthcare professionals working in tertiary hospitals in South Korea experienced moral distress when taking care of critically and terminally ill patients, in similar ways to the medical staff working in other settings. On the other hand, the present study uniquely identified that the aspects of saving lives and the necessity of palliative care were reported as those valued by healthcare professionals. This study contributes to the literature by adding data collected from two tertiary hospitals in South Korea.

To evaluate the prevalence of oculoplastic surgeries performed in a tertiary hospital in South Korea and to highlight the proper choice of surgery according to disease. Retrospective chart review was conducted over a 12-month period (March 2013 to February 2014) on all of the patients who underwent oculoplastic and reconstructive surgery by a single oculoplastic specialist with 15 years' experience. A total of 656 patients were enrolled in the current study. Of them, 355 patients (54.1%) had eyelid surgery, 151 patients (23.0%) had orbital surgery, and 150 patients (22.8%) had lacrimal surgery. Orbital surgery was more commonly performed in men (122 male patients versus 29 female patients, P = 0.00 by Pearson chi-squared test) and was also more common in younger patients than in other surgery groups (56.3 years in eyelid surgery versus 39.3 years in orbital surgery versus 46.9 years in lacrimal surgery, P = 0.001 by Pearson chi-squared test). Blepharoplasty was the most common eyelid surgery, contributing 24.2% of total eyelid surgeries, followed by lid mass excision (68 patients, 19.1%), Hotz operation (59 patients, 16.6%), and levator advancement (47 patients, 13.2%). Among orbital surgeries, reconstruction of orbital wall fractures was the most common, and was performed in 89 patients (58.9%) of total orbital surgeries, followed by orbital tumor debulking surgery (25 patients, 16.5%) and orbital decompression for dysthyroid optic neuropathy (19 patients, 12.5%). Endoscopic endonasal dacryocystorhinostomy (DCR) was the most common lacrimal surgery (84 patients), occurring in 56% of total lacrimal surgeries, followed by Monoka tube intubation (16 patients, 10.6%) for congenital nasolacrimal duct obstruction and conjunctivo-DCR using Jones tube (12 patients, 8%). Eyelid-related conditions, especially cosmetic blepharoplasty, were among the most commonly encountered surgeries in the Oculoplastics Department of a tertiary care hospital in South Korea. Blowout fracture repair and endoscopic DCR were the most common in orbital and lacrimal surgery. The authors hope that the current survey will contribute to the surgical training of ophthalmology residents and, on a larger scale, health care policies.

BackgroundThe transition from student to professional nurse is fraught with challenges, often resulting in reality shock, which can significantly impact new nurses’ ability to adapt to clinical practice. Practical adaptation training programs are critical in mitigating these challenges by providing structured support during this transitional period. This study investigates the transitional experiences of novice nurses participating in a practical adaptation training program at a tertiary general hospital in South Korea, with the objective of generating foundational data to guide the development of more targeted and effective educational interventions.MethodsThis study utilized a qualitative research design to explore the experiences of 27 newly employed nurses who participated in a practical adaptation training program, led by clinical nurse educators, between April and August 2023. Participants were divided into four focus groups, and thematic analysis was performed using NVivo 12 software to facilitate coding and the development of themes.ResultsData analysis revealed four primary themes and ten sub-themes related to the experiences and needs of the new nurses within the training program. These themes were: “gradually growing for a better me,” “becoming a channel of communication,” “aiding in enhancing work performance ability,” and “educational needs for better operation of the practical adaptation training program.”ConclusionsThe findings underscore the critical role of practical adaptation training programs in facilitating the successful transition of new nurses into their professional roles. The themes highlight the personal and professional development enabled by the program, the essential function of communication channels, and the program’s impact on improving work performance. Moreover, the study emphasizes the need for ongoing assessment and improvement of such training programs to ensure their ongoing effectiveness and relevance.Clinical trial numberNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12912-025-04205-3.

BackgroundThis study was performed to evaluate the changing pattern of antibiotics usage among hospitalized patients of tertiary hospital in South Korea.MethodsTotal antibiotics prescription record of hospitalized patients from 2004 to 2013 were collected at a tertiary university hospitals. The antibiotics is defined as class J01 from anatomical therapeutic chemical classification system (ATC). The consumption of each class of antibiotic was converted to defined daily dose (DDD)/1,000 patient-days by using ATC of World Health Organization.ResultsOver the 10-year study period, the annual consumption of systemic antibiotics ranged from 815.10 to 1047.96. The proportion of broad-spectrum antibiotics and non-broad-spectrum antibiotics use are as follows: 45.4% (417.55/920.69) vs.. 54.6% (503.15/920.69), respectively. A 16.9% of decrease in total antibiotics consumption was observed in 2013 compared with 2004 (1000.69 in 2004 vs.. 831.46 in 2013). The decrease rate of non-broad spectrum antibiotics usage was 39.3% during the study period (607.21 in 2004 vs. 368.88 in 2013). In contrast, a stepwise increase in consumption of broad-spectrum antibiotics was observed (14.9% of increase; 393.48 in 2004 vs. 462.58 in 2013). Among broad-spectrum antibiotics, a significant decrease trend was observed for third-generation cephaloporins (P < 0.001). In contrast, a significant increase trend was observed for β-lactam/lactamase (P < 0.001). The monthly overall consumption trend of fluoroquinolones and glycopeptides remained stable (P = 0.061; P = 0.107, respectively). In addition, there were significant decrease trends for consumption of non-broad-spectrum antibiotics, including first generation cephalosporins (P = 0.019) and aminoglycosides (P = 0.004). However, the consumption of second generation cephalosporins, imidazole and penicillins showed a stable trend (P = 0.175; P = 320; P = 0.234, respectively).ConclusionA total antibiotics consumption showed significantly decrease trend from 2004 to 2013. In contrast, a stepwise increase in consumption of broad-spectrum antibiotics was observed in the tertiary hospital in South Korea.DisclosuresAll authors: No reported disclosures.

Comparison of early warning scores for predicting outcomes in adult and older patients in emergency department: Multicenter study.

BackgroundThe risk of tuberculosis (TB) infection among health care workers (HCWs) is higher than as noted among workers in the general population. The prevalence and risk factors of TB infection among HCWs were assessed in a tertiary hospital in South Korea, resulting in a conclusion of an intermediate TB burden within the country.MethodsThis cross-sectional study enrolled HCWs who underwent a QuantiFERON-TB Gold In-Tube (QFT-GIT) test to detect the presence of a latent TB infection (LTBI), in patients admitted to a tertiary hospital in South Korea in 2017. The departments of the hospital were divided into TB-related and TB-unrelated departments, which were based on the risk of exposure to TB patients. In this sense, the risk factors for LTBI, including current working in the TB-related departments, were analyzed.ResultsIn this case, a total of 499 HCWs (54 doctors, 365 nurses and 80 paramedical personnel) were enrolled in this study. The median age of the subjects was 31 years (range, 20–67 years), 428 (85.8%) were female, and 208 (41.7%) were working in the TB-related departments. The prevalence of LTBI was 15.8% based on the QFT-GIT. Additionally, the prevalence of experience of exposure to pre-treatment TB patents was higher among HCWs working in the TB-related departments, than among HCWs working in the TB-unrelated departments (78.8% vs. 61.9%, p<0.001). However, there was no significant difference in the prevalence of LTBI between the two groups (17.3% vs. 14.8%, p=0.458). On a review of the multivariate analysis, only the factor of age was independently associated with an increased risk of LTBI (p=0.006).ConclusionBroadly speaking, the factor of age was associated with an increased risk of LTBI among the HCWs in South Korea. However, those workers current working in the TB-related departments was not associated with an increased risk of LTBI.

This study aimed to identify the characteristics of home health care (HHC) patients, main diagnoses, service type, home visit patterns, and primary caregiver type from a major tertiary hospital in South Korea to provide basic data for tailored nursing care. We used Electronic Health Records (EHRs) data of 1776 patients, from 2011 to 2020, from a premier tertiary hospital in South Korea and conducted secondary data analysis using descriptive statistics, a chi-squared test, and an independent samples t-test. Patients’ mean age (i.e., 50.9% men and 49.1% women) was 74.50 ± 15.48 years. Further, admission to HHC via the outpatient and inpatient department comprised 1047 (59.0%) and 729 patients (41.0%), respectively. Based on the Korean Standard Classification of Diseases, neoplasms (49.9%) were identified as the most common main diagnosis, followed by diseases of the nervous system (10.3%) and musculoskeletal system and connective tissue disease (6.2%). An average of 2.2 homecare nursing services were provided per visit, with lab sampling (43.9%), other intravenous injections (31.0%), and ventilator care (23.0%) being the most frequent services. The total HHC service period for patients via the outpatient department was 76.88 days longer (292.24 vs 215.36 days) than those from the inpatient department. Younger patients were cared for by parents and siblings and older patients by spouses, offspring, and formal caregivers. It is pivotal to identify general characteristics of HHC patients through long-term monitoring and retrospective analysis to provide high-quality and tailored interventions to them.

This study aimed to determine the factors influencing patients’ choice of physician at the first visit through database analysis of a tertiary hospital in South Korea. We collected data on the first treatments performed by physicians who had treated patients for at least 3 consecutive years over 10 years (from 2003 to 2012) from the database of Seoul National University’s affiliated tertiary hospital. Ultimately, we obtained data on 524,012 first treatments of 319,004 patients performed by 115 physicians. Variables including physicians’ age and medical school and patients’ age were evaluated as influencing factors for the number of first treatments performed by each physician in each year using a Poisson regression through generalized estimating equations with a log link. The number of first treatments decreased over the study period. Notably, the relative risk for first treatments was lower among older physicians than among younger physicians (relative risk 0.96; 95% confidence interval 0.95 to 0.98). Physicians graduating from Seoul National University (SNU) also had a higher risk for performing first treatments than did those not from SNU (relative risk 1.58; 95% confidence interval 1.18 to 2.10). Finally, relative risk was also higher among older patients than among younger patients (relative risk 1.03; 95% confidence interval 1.01 to 1.04). This study systematically demonstrated that physicians’ age, whether the physician graduated from the highest-quality university, and patients’ age all related to patients’ choice of physician at the first visit in a tertiary university hospital. These findings might be due to Korean cultural factors.

Experience of Violence from the Clients and Coping Methods Among Intensive Care Unit Nurses Working in a Hospital in South Korea

Incidence, Cause, and Preventability of Postdischarge Medication-Related Emergency Visits in Older Patients Without Cancer: A Single Tertiary Hospital Study in South Korea.

Older patients have a higher risk of aspiration pneumonia and mortality if they are hospitalized. We aimed to assess the effectiveness of an aspiration prevention quality improvement (QI) program that utilizes the Gugging Swallowing Screen (GUSS) in older patients. This retrospective cohort study was conducted in an acute medical care unit of a tertiary hospital in South Korea. The study used one-to-one propensity matching and included 96 patients who received the QI program and 96 who did not. All patients were aged 65 years or older and had risk factors for aspiration, including neurological and non-neurological disorders, neuromuscular disorders, impaired airway defenses, and dysphagia due to esophageal or gastrointestinal disorders. The primary outcomes included the duration of the fasting period during hospitalization, changes in nutritional status before admission and at discharge, in-hospital mortality, and readmission due to pneumonia within 90 days. Fasting period, changes in weight and albumin levels upon discharge after hospitalization, and length of stay did not differ significantly between patients in the GUSS and non-GUSS groups. However, the risk of readmission within 90 days was significantly lower in patients who underwent the GUSS than in those who did not (hazard ratio, 0.085; 95% confidence interval, 0.025-0.290; p = 0.001). The GUSS aspiration prevention program effectively prevented readmission due to pneumonia within 90 days in older patients with acute illnesses. This implies that the adoption of efficient aspiration prevention methods in older patients with acute illnesses could play a pivotal role by enhancing patient outcomes and potentially mitigating the healthcare costs linked to readmissions.

Preventing Delirium in Critically Ill Children