신생아집중치료센터의 기능평가 및 효율적인 운영 방안
Functional Analysis of Neonatal Intensive Care Centers and Effective Operation Plan
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미숙아 환자 수의 증가와 함께 신생아중환자실의 기능이 중요시되고 있는 요즈음 2012년 3월까지 전국에서 총 13개소에서 정부지원 지역거점 신생아집중센터가 개소되었다. 단순한 병상 수의 증가 뿐만 아니라 신생아중환자실이 얼마나기능하고 있는지 평가하고 효율적인 지원을 하는 것이 필요하다. 이를 위해 신생아중환자실 기능 평가를 위한 도구로2011년도의 연간 출생 재태주수 32주 미만의 입원 환자수를 활동성의 지표로 삼아 국내 신생아중환자실의 기능을 등급화하여 분석하였다. 병상 수의 규모가 클수록 활동성이 증가되나, 병상 수 외에도 장비, 신생아중환자실 인력, 산과 인력 등의 요인이 독립적으로 활동성에 영향을 주었다. 활동성 지표로 등급화 된 병상 규모별로 시설 ∙ 장비 ∙ 인력의 기준을 제시할 수 있으며 역으로 기준에 맞췄을 때 활동성을 예측하여 신생아중환자실 기능의 평가 도구로 사용할 수 있을것이다. 한편, 개소 후 최소 6개월 이상의 자료를 확보할 수 있었던 지역거점 신생아집중치료센터 13곳의 개소 전 ∙ 후를 비교한 결과 모든 센터에서 활동성 지표가 증가되었고 지역화에 일부 기여하였다. 개소 후 두드러지게 활동성 지표가 증가되었던 3곳의 센터는 그 외의 센터와 비교 시 크기와 장비의 차이는 없었으나 전공의 ∙ 전문의 ∙ 간호사 ∙ 전문간호사를 포함한 신생아중환자실 인력과 산과 인력의 보충에 차이를 보였다. 정부의 거점병원 지원에 있어서 지역간 등급별 신생아중환자실 분포 현황 및 권역 별 유출 환자 수에 따라 다각적인 전략이 필요하다.
Abstract
Regional hub neonatal intensive care centers are opening supported by Ministry of Health and Welfare, with the need for more neonatal intensive care unit (NICU) beds response to increasing number of prematurity. Besides beds expansion, functional role of NICU is important and the evaluation tool of functional analysis of NICU is necessary. In this review, admission of preterm infant born before 32 gestational weeks was considered as a functional component and the annual number of those babies was used as an activity marker. The activity of NICU was higher with increased bed number, but also increased equipment, NICU personnel, obstetric personnel were independent factors for the higher NICU activity. Levels of NICU can be defined according to the activity, and reference bed size, equipment, personnel can be defined according to each level. In reverse, functional analysis of NICU can be performed with known bed size or equipment predicting activity level. Meanwhile, the evaluation of 13 regional hub NICU revealed that they partially contributed to the regionalization of NICU, and the activity was increased in all regional hub NICUs. Three regional hub NICUs showed markedly increased activity after opening, and those centers showed increased NICU personnel and obstetric personnel compared to other centers. In terms of regional hub government support, multilateral plan should be operated, besides simple bed size, considering distribution of different functional level of regional NICUs and leaking patient in the region.
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