Abstract
In2000, the national healthcare policy of Japan was changed to push for a function-specific reorganization of hospitals, such as acute phase-specific or chronic phase-specific, and to promote at-home-care in order to control healthcare budgets and manpower more efficiently and economically. Among others acute phase hospitals have been required to shorten the average length of stay (LOS). In April2005the National Hospital Organization Okayama Medical Center (OMC), an acute phase general hospital with580beds, expanded its Division of Management for the Regional Medical Liaison (DMRML) by stationing a discharge arranging nurse (DAN), a newly created position, and two medical social workers (MSW) as full-time staff members, whose duties include arrangement and preparation of patients' hospital discharge. A risk-screening checklist (RSC) was developed by the DMRML and applied to adult patients, to be filled out by the nurses in charge at the time of the patient's admission. The team of DAN and MSWs visited every ward (WR) once a week to survey the RSC. They also attended the doctor-nurse conference of each ward to collect information about patients. After a half-year trial, the RSC was revised to evaluate risks more quantitatively and to collect indispensable information for discharge arrangements (DA) completely at admission. In addition, the position of a key-nurse (KN) was established, who is a staff nurse of each ward and in charge of the DA. Since then general meetings of KNs, DAN, and MSWs have been held monthly to discuss any problem at each ward. Through this revised DA system, the fill-out rate of RSC has improved and the average LOS has decreased remarkably. These results suggest that our DA system gives outstanding satisfaction not only to the patients but also to the medical home care staff after discharge.
