The progress of clinical inspection techniques, particularly in terms of information technology, has been very fast. The number of new clinical inspection items is large and is increasing even at present. Currently, doctors and nurses are too busy to provide good medical treatment, and they cannot adequately respond to the results of laboratory tests, which evolve every day. There are numerous requests for medical technology specialists to perform additional roles. The Ministry of Health, Labour and Welfare is familiar with the background of this situation. From 2007, information sharing of the allotment of roles added to each hospital has been promoted. Medical means of assistance has been harmonized in Japan. A notice dated April 30, 2010 regarding the allotment of roles was proposed. The Japanese Association of Medical Technologists has been working in the Central Laboratory of Clinical Investigation of hospitals where patients visit. I would like to present the direction of the roles of medical technicians in this report.

A laboratory test is divided into 3 phases, namely, the checking of a previous process, the testing process, and the postprocess checking. For the promotion of business expansion, JAMT is consistent in including the time of checking and in indicating the work done. “Ward business promotion and information communication between facilities by medical technicians” are the main subject of this investigation. The implementation situation was determined by a questionnaire survey using the groupware system and by directly contacting registered facilities. Medical technicians indeed encountered problems in business expansion. “Delayed cancellation of business expansion caused by human factors”, “business expansion in relation to medical safety and contribution to treatment and patient needs”, and “establishment of an organization offering medical services added to site needs” were identified as problems encountered in business expansion. I am thinking that the form can be changed to knowledge which corresponds to these and the job category as “medical technician” which can’t do to chip for a patient from “check engineer” by learning a skill.

Medical technologists monitor and check patients’ clinical condition and treatment. They should cooperate with doctors, nurses and other medical staff members and show their ability to patients. The effect of assigning a medical technologist in a ward was studied, for which cooperation with a hospital was requested by the Japanese Association of Medical Technologists (JAMT). I obtained agreement with a hospital proprietor. Regarding the management of a hospital ward with the cooperation of medical technicians, this study showed the importance of a medical treatment team and also the lack of doctors and nurses. After selecting a ward and setting the objectives and contents of this study, we conducted a preliminary training and surveyed the actual work conditions of a medical technician in a ward with a questionnaire. Patient information management took an average of 91.3 minutes for a medical technician to perform in the ward. Electrocardiography took an average of 74.8 minutes in terms of business content for a medical technician in the ward. Taken together, a technician spent a total of 6 hours and 24.1 minutes to carry out the duties in the ward. Regarding the questionnaire responses, “Activities related to a laboratory test seem to decrease” as a result of holding conferences with a medical technician, a sense of expectation of a team, participation in classes and committee meetings before and after actual inspection by a doctor and a nurse. The evaluation showed a significant improvements when a medical technician was included in the team. Analysis of the responses of the patients to the questionnaire also suggested a significant contributions of medical technicians to their clinical condition. Medical technicians have specialized skills and may contribute to meeting medical needs in a hospital.

Medical technology procedures are performed for monitoring a patient’s clinical condition as well as treatment. A medical technologist should cooperate with doctors, nurses and other staff members and show their ability to a patient. From a given background, we determine the effect of a medical technologist’s presence in a ward in cooperation with the Japanese Association of Medical Technologists (JAMT). After obtaining the consent an inspection department, we explained medical technologist’s presence to the facility’s chief, nurses’ chief director and purser together with JAMT and obtained an agreement regarding field verification. After selecting the ward and defining the objectives, and contents of this study, a preliminary training and a questionnaire survey of the actual business conditions were carried out. “Patient’s information management” took an average of 68.0 minutes for a medical technician to complete as a task in a ward. “Extraction of a sample” took an average of 54.2 minutes as a business content of a medical technician in a ward. For all businesses, the total time was 5 hours and 11.9 minutes. The questionnaire results indicated that the burdened feeling of nurse is eliminated. The tasks that I would like to leave to a medical technician are electrocardiography and blood testing. The others are the explanation of results to patients and blood sugar measurement for each check. It was indicated that an explanation for each check should be given to patients.

In the promotion of a medical team including medical technologists, stationing medical technologists at a ward and business expansion there involve a variety of issues. To promote business expansion in a small laboratory, coordination with other departments is important. However, it is a problem when other departments have unfavorable impressions of the laboratory. It is assumed that for the business expansion of a laboratory, first, the impression that the laboratory is difficult to work with should be changed. Incorporating businesses require the following changes. Communication between departments should be actively promoted. The laboratory should not refuse requests from other departments. With the accumulation of small efforts such as attentive care and ingenuity, the unfavorable impression of the laboratory gradually improved and the laboratory was able to gradually earn the trust of the nursing department, form better connection with doctors, and gain the trust of executives, resulting in the business expansion of the laboratory.

Following the change in the roles of medical technicians implemented in early April 2015, medical technicians have begun sample extraction from the nasal cavity and pharynx, with the aim of playing an active role in the care of outpatients. Dissemination of information by a hospital committee, training for the acquisition of qualifications, and acquisition of technological training were performed beforehand. A target of the whole inspection department became clear by the inclusion of the above as hospital business targets, and 45 members acquired qualification in the first year of implementation. An “Infection Lounge” was established by the department of facilities with the infection task force. I prepared a leaflet of “extraction point” and planned for improvement. It was the ideal chance and the hospital staff recognized the achievements of medical technicians following the change in the roles of medical technicians.

Medical technologists who took classes designated by the Ministry of Health, Labor and Welfare and received certificates of completion were designated to collect some specimens. In conjunction with this, we hoped to expand the work of collecting specimens and conducting a rapid test for influenza during the influenza epidemic period, and explaining the points of caution about living for patients suffering from influenza. In addition, questionnaires were administered to doctors, nurses and clinical assistant clerks, and their responses were evaluated. As a result, 97% answered that this business expansion was good and highly evaluated. We improved the operation of outpatient clinics, which was complicated so far and established a new form of medical treatment by expanding our business. Our business expansion led to the shortening of the outpatient clinical waiting time and the establishment of good communication and trust with patients. Medical technologists collected specimens and made it possible to provide high-quality medical treatment.

The Order for Enforcement of the Act on Medical Technologists, and other relevant laws and regulations were revised, and the revision of clinical specimen sampling has been in effect since April 1, 2015. Since the introduction of the influenza antigen rapid test kit in 2001, we have evaluated the parameters and conditions that may affect the results of clinical examinations such as fever duration at the time of sampling, vaccinations, and sample type (e.g., throat swab, nasal swab, or nasal aspirate). We communicated with our staff members closely to share our findings on how to obtain and store clinical specimens correctly, and how to protect against infections to ensure correct and appropriate clinical examinations in a proactive manner. Our members have also been trained to understand how the patients feel during specimen sampling and to treat them appropriately to ensure that the procedure causes as little burden as possible. As medical technologists grasp the condition of the patients during specimen sampling and the importance of sharing the test results with the attending physician, the results of urgent tests can be provided rapidly, which contributes to reducing the burden on physicians and nurses. Working as a single team in our clinical laboratory, we can obtain and test high-quality clinical specimens and report the test results promptly to help physicians provide high-quality care. Our initiative also helps other healthcare professionals change their mindset on how to respond to patients’ needs.

Part of the law on the duties and responsibilities of medical technologists was revised in June 2014. Thereafter, medical technologists were allowed to collect specimens from patients. In our hospital, medical technologists collect specimens in cooperation with nurses. In this paper, we report the present status of feces collection from the rectum for examination of norovirus infection as an example of specimen collection. We suggest that specimen collection by medical technologists has many advantages to themselves and can lead to high-quality medical service to patients. It also has many advantages to other staff members, for example, medical technologists can work in the ward or in the outpatient department apart from the laboratory. In addition, it is important especially in a hospital with only a small number of medical technologists that the technologists work in cooperation with other staff members.

First of all, the collaboration of the Blood Transfusion Section and the Clinical Team of a hospital is important in order to ensure safety and proper blood transfusion. In our hospital, the following operational system has been implemented from June 2005. (1) A Blood Transfusion Check Medical Technician conveys a blood product for blood transfusion. (2) A confirmation is obtained at the time a blood transfusion request is received by a nurse. (3) Patient confirmation and bedside services are electronically authenticated, and the patient is observed for 5 minutes at the bedside after blood transfusion. Bedside service authentication is a good opportunity for a Blood Transfusion Check Medical Technician to check the entire work flow of the blood transfusion method of treatment. As a result of knowing the problems of the whole-blood transfusion method of treatment as well as a blood transfusion check, we are able to revise the maintenance manual of our hospital and operation, and to set up a safe and proper blood transfusion therapy system. When performing blood transfusion medical treatment in a hospital, a Blood Transfusion Check Medical Technician should be present at the bedside, and it is necessary for the benefit of the patient that a doctor and a nurse consult with each other concerning the blood transfusion.

A clinical laboratory technician's explanation and consultation work at a blood purification center is useful for reducing the amount of work and improving the efficiency of hospital staff members. Laboratory technicians are also considered helpful for improving self-management awareness by reviewing the conditions of the patients themselves. However, it was found that knowledge related to patients, such as patient psychology and pathology required in team medical care, information sharing such as description of medical records, and acquisition of communication skills with patients and other staff members, are required for the technicians.

For the purpose of improving ward work, we tried to review the various tasks currently being performed in a ward. Questionnaires were administered to medical staff members including those in the nursing and laboratory departments to inquire about the demand and necessity of ward work, and all the resident doctors agreed to the ward work of a laboratory technician. In carrying out ward duties, the demonstration of expertise leads to understanding and staff motivation, and we decided to take the initiative and implement them. We newly started blood vessel ultrasonography in the dialysis ward. We report not only inspection work but also VA management standards, flow chart preparation, review of reporting style, and staff education to achieve smooth operation as members of a team; thus, we obtained good evaluation results.

The summary analyses of the incident accident (IA) reports of the Medical Safety Management Committee, the efforts to improve work from the fiscal year safety target of the laboratory technical department, and the positive reports are introduced. We compiled and analyzed IA reports for three years at the Department of Laboratory Technology, and IA reports for two years of work related to inspection in the ward/outpatient/dialysis section. We were able to share the problems from information of the IA reports in our department, which led to work improvement. An inspection technician assigned to another department work in preparation of blood collection tubes, collection of inspection materials, description of inspection, and so forth. We can prevent IA of other departments by doing routine work as an expert technician. The objectives of the annual safety analysis are to self-evaluate the degree of achievement of business improvement and identify problems for the next fiscal year. The positive report seems to be a good system that leads to improvements in the IA reports and collaboration with other departments involved in safety. To continue and develop medical safety, we will create an environment that makes it easy to prepare IA reports, cooperate in sharing information and improving situations, and analyze reports comprehensively regardless of the department. It is important that we will lead to routine work from the task of IA report improvement in collaboration with other departments.

These days, many types of jobs in the medical care system involve the team approach as well as correspondence with both outpatients and hospitalized patients. In each workplace, it is becoming harder to obtain the required number of people owing to the introduction of new businesses, maternity leaves, and retirements. The shortage of nurses has become a problem in our hospital. For this reason, how to support a workplace with insufficient personnel was considered. Consequently, support from medical technologists was requested. We examined what kind of support we could provide in our test division. Various problems actually emerged when considering hospital duty support. By solving these problems, we will be able to develop a better hospital business system.

At present, the Japanese Association of Medical Technologists (JAMT) is actively promoting team medicine, which includes ward medical technologists. Medical technologists currently participate in a pulmonary embolism prevention project as members of a medical team tasked to revise manuals from the professional viewpoint. We (1) developed an examination system, (2) established an in-hospital practice standard for the echo examination of veins of lower extremities (for each hospital department), (3) established an in-hospital venous thromboembolism (VTE) risk assessment list (common to all hospital departments), and (4) cooperated with the rehabilitation department (prevention of delayed getting out of bed), as well as completed the practice standard for veins of lower extremities, added a VTE risk assessment list, and revised the perioperative pulmonary embolus prevention manual in January 2016. The cooperation of each department is essential for the prevention of pulmonary embolus, and we conducted perioperative pulmonary embolus prevention using a common practice standard. This work involved the entire hospital and played an important role by contributing to medical quality improvement, including team building and improvement of medical safety.

As a business activity of a specific clinical technologist to be implemented in a ward, in recent years, the shift from crude physical examination, blood sampling, explanation of each inspection, taking part in ICT·NST activities, and so on to client-centered team medical care has begun. This shift is the trend in the wards, and the clinical technologists in the laboratory test department of this hospital are actively implementing this new system when drawing blood specifically. They take charge of various functions from the inspection instruction collection, to the reading of the reports of the results with the clinical technologist going to the nurse stations of all the wards and collection of all results for the rapid determination of the clinical condition of the patient, diagnosis and treatment, which are all connected with the improvement of the quality of treatment.

Our hospital is designated as a medical center that provides medical support in remote areas including the dispatch of doctors to a remote area without a doctor. Therefore, we have a shortage of doctors and nurses. Moreover, many of our patients are elderly with dementia and in need of high-level care. This is not only our challenge but also the biggest challenge the Japanese medical care system is facing. To provide the best medical care for patients, we need to support doctors and nurses by working together as a team and by eliminating the wall of sectionalism and making the best use of limited resources. For this purpose, we established a ‘Working Group of Nursing Section of Clinical Laboratory Department’ to expand our medical support as WMT ward medical technologists.

Medical technologists have been contributing to team medicine recently. Medical technologists in Kindai University Hospital also take part in medical practices in ICT (Infection Control Team) and NST (Nutrition Support Team). At the Center of Transfusion Medicine and Cellular Therapy, medical technologists specializing in blood transfusion started to be stationed at the clinical laboratory in an operation department in July 2011. They managed blood products, performed blood plasma fraction preparation for use during operation, kept a record of a refrigerator for the exclusive use of blood products, and intervened in case of massive bleeding during blood transfusions at the time of operation. Since August 2013, we started to explain to patients the significance of the finding of clinically important antibody irregularities. A doctor in charge expects that a medical technologist specializing in blood transfusion explains to a patient regarding the procedure and directly hands over to the patient “the attention card in blood transfusion”. Additionally, we started to be stationed at a hospital ward for hematological diseases in April 2015 with the aim of lessening the work burden of doctors and nurses and expanding medical services as medical technologists.