Medical chart review using the standardized form is a useful method to identify adverse events, but it is labor intensive and review experience is essential to get reliable results. A simplified format version was therefore developed that is easy to use even for inexperienced staff. This study aims a) to verify whether the simplified version can actually identify adverse events correctly and b) to investigate the feasibility using other information sources to alleviate efforts of chart review.
Over a period of two months after admission the medical charts of patients in six different wards at three acute hospitals were investigated by doctors and nurses of the respective wards with a simple survey sheet. Thereafter experienced chart reviewers reviewed and identified adverse events at those wards retrospectively. The result of the retrospective survey was regarded as a standard for the adverse events to which the first prospective survey was compared. Data of the in-house reporting system and the infection control team as well as length of hospital stay were also examined as to whether they could also be reliable indicators of adverse events.The retrospective survey identified adverse events in 8.7% of the cases. The sensitivity, specificity and positive predictive value of the prospective survey were 87.5%, 80.5% and 29.2%, respectively. The sensitivity of the in-house reporting system was 3.0%; that of the reported nosocomial infection cases 20.0%. Patients, whose length of stay was long, were likely to experience adverse events (sensitivity=71.0%).
These results demonstrated that even inexperienced staff is able to identify adverse events using our simplified format version, suggesting effectiveness of this simplified version. In regard to the other information resources, further studies are necessary to proof their effectiveness in identifying adverse events and a possible contribution in alleviating the workloads of medical chart reviewers.

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The purpose of the present study is to develop indicators to estimate nursing staffing needs based on patients' care needs.
Data on the degrees of nursing needs and patients' classification was collected by a cross-sectional survey in October 2006, including 3,827 in-patients of 25 nursing units in 6 teaching hospitals. The patients' age was 66.8±16.9 years and the length of hospital stay was 17.3±7.8 days. In regard to the degree of nursing necessities, patients were classified under a nursing quantitative adjustment indicator, A-I=1.5, B-I=1.4, C-I=1.3, A-II=1.3, B-II=1.2, C-II=1.1, A-III=1.1, A-IV=1.1, B-III=1.0, C-III=1.0, B-IV=1.0, and C-IV=1.0. The number of patients with high care needs (A-I) were 1.5 times higher than those with low care needs (B-III, C-III, B-IV, C-IV).

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　Recently, the physician shortage problems in Japan have been center of attention. The shortage in pediatrics, obstetrics/gynecology and anesthesiology is said to be especially severe. But there are few empirical studies about such shortage problems. The target of this paper is to clarify the structure of the shortage problems of 3 clinical departments.
　Several indexes were identified as proxies of supply and demand of physicians for each clinical department. The trend of supply and demand of 3 clinical departments' doctors was estimated using these proxies. Coefficient of variation and Hirschman=Herfindahl Index was calculated to measure geographic distribution and agglomeration of doctors.
　This study demonstrated that the main cause of the shortage in obstetrics/gynecology was supply-side problem, but the main cause of the shortage in pediatrics and anesthesiology was demand-side problem.
　The situations of‘physician shortage' are quite different among different clinical departments. Policies based on each clinical department's situation are also required.

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We have surveyed the present situation and challenges of a newly introduced Prefectural Healthcare Expenditure Control Plan. This survey was based on a literature survey and a questionnaire survey by mail targeting all 47 prefectures.
Responses were received from 39 prefectures (response rate: 83.0%) and the results show that the organization structure and data used for planning is similar among prefectures. In less than half of the prefectures do hospital associations' representatives attend regional planning committees. In order to assure a cost-effective improvement of the regional healthcare, which is one of the major goals of this plan, participation of representatives of hospital associations in the regional committees is important in the future.
Often-cited data, which seemed necessary but difficult to obtain, was healthcare claim data by prefecture, gender and age as well as individual data of national surveys such as the national patient's survey. Rules of accessing and using national government-owned data including claim data by prefectural governments should be considered to make the planning process more effective.
Japanese government is expected to set targets as to a healthcare increase rate and to establish and demonstrate a predictive model for healthcare expenditure which would reflect the prevention of lifestyle-related diseases. Prefectures need to organize committees, which should reflect the perspectives of stakeholders, and establish a data analyzing system.Keywords‥healthcare expenditure control plan, health plan, questionnaire survey

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The TOYOTA-KAI Medical Corporation KARIYA TOYOTA General Hospital introduced the Order Entry System in 2003. A test tube preparation system, to manage blood collection tubes, was also established in the same year. The new system has enabled hospital staff to manage orders for lab tests systematically during working hours, but not during other times of the day. Appropriate measures should be taken to correct this.
Approximately two incidents per month have been reported, including failure to perform ordered tests and failure to cancel unnecessary tests because of poor communication regarding changes in orders. In addition, approximately one incident of patient misidentification has been reported per year, which could have resulted in a fatal outcome.In order to address these problems, the hospital has started a project to introduce a patient identification system for blood sample collection. This project is mainly being carried out by the Safety Management Team (SMT) and the SMT Working Unit, which is an SMT's subordinate unit including nurses, co-medical staff, and clerical staff. Unit members are addressing medical safety issues through a cross-functional approach.
When the Order Entry System was established, the hospital also sought the opinions of nurses, co-medical staff and clerical staff for a more multilateral perspective. On the basis of those opinions and a shell-model analysis, problems were identified and system goals clarified. Through these efforts, a system has been established that takes into account medical safety and efficient job performance. Moreover, as a side benefit the accidents' incidences have decreased and the blood-collection process is now managed more effectively.

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Formerly bedside fall accidents were analyzed based on the patient's assessments and the medical report analysis results, but the interrelation of various factors is indefinite and the former measure was therefore not necessarily fundamental. The purpose of this study is to clarify the fundamental causes of bedside fall accidents and their structure. The HAZOP, a technique investigating primary risk factors and currently used in industrial fields, was introduced for this study. A causal relationship is described between each risk factor and its influence based on hypothetical propositions.
About 270 causal relationships were extracted by HAZOP and cause-structural figures of bedside fall accidents were created in the light of the 4M technique. As a result causal relationships were arranged for every factor such as 1.human-factor, 2.apparatus-factor, 3.environment and information-factor, 4.organization and managerial-factor, and four cause-structural figures of a bedside fall accident were drawn up.

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As demonstrated by the recent increase of civil and criminal suit in medical fields, society has come to have negative perceptions about medical treatments. Defendants (doctors/hospitals) in medical suits are often required to submit records including images of processes during surgeries. It is therefore essential to keep images as medical case history in endoscopic surgery based on the charge couple device (CCD). The present study examines an objective storage method for endoscopic surgical records. The image synchronous documentation system developed by KS Olympus (Tokyo, Japan) was used to document the images of a surgery itself as well as an external view in synchronization with biological information including blood pressure, ECG and oxygen saturation under anesthesia. The documented data was then stored on a removable HDD as randomly accessible data. Different storage conditions were comparatively examined in regard to image resolution and cost. It was found that MPEG1 1.5Mbyte/h is currently the best cost-performance storage condition. It was also confirmed that the system could objectively document surgical data. The present system is useful for documenting the information from various types of surgery including endoscopic surgery.

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