Kagawa seamless care study society was established in the central and western part of Kagawa Prefecture in November, 2005, and the cerebral apoplexy inter-regional association critical path created with the Excel base has been employed. The system which enables employment of the Internet using Kagawa Medical Internet eXchange (K-MIX) was started from January, 2009, and the data total and analysis of evaluation criteria by the use of digital information were attained.

In this study, the multiple regression analysis of the factor relevant to a home return and principal component analysis were conducted using 271 home-return cases from convalescent rehabilitation hospital.

Functional Independence Measure (FIM), Barthel Index (BI) and modified Rankin Scale (mRS) had high relation against a home return. Age, sex, the household family number, evaluation of daily life function, and the level of care needed had low relation. Age was suggested as related factor in evaluation of daily life function or the level of care needed. In the item of FIM, there is a significant difference by movement items, specifically related to self-care items, such as having a meal and clothing themselves.

According to the accreted fractionation of medical system and shortening hospital stay, it will be more important to organize multidisciplinary interventions. However, many of the medical staff in the acute care hospitals treating would not be familiar with the life style of patients after discharge.

In order to promote the relationships among our hospital nurses, local doctors and the other types of medical staff, we have held meetings twice in 2009. These meetings have made the staffs involved to know the patient life style in hospital and after discharge. We suggest that it is important to hold meetings with participations by multidisciplinary medical staffs.

Complications and accidents related to the artificial respiratory apparatus can be lethal at times. Therefore, mastering its knowledge and technique for safe use is crucial.

The disability care ward at the National Hospital Organization Asahikawa Medical Center has 40 beds. About 10 NPPV (Noninvasive Positive Pressure Ventilation) apparatus are constantly operating on neuromuscular disease patients of this ward. For the safe use of the NPPV apparatus, we have created an apparatus manual incorporating the incidents on medical treatment in the past. With this manual, we gave the ME (Medical Equipment) education to all nurses of the ward.

Fourteen incidents on medical treatment regarding the NPPV apparatus occurred in 2 years before the ME education. However, it decreased to 1 occurrence in 2 years after the ME education. For the confirmation of knowledge and technique, we evaluated the nurses in both written and practical tests. The tests revealed that there were nurses who were only able to answer correctly by 50% or less. The tests also revealed that the answer rate of the problem regarding the circuit of the NPPV apparatus was less than 50%. Many nurses had only insufficient technique regarding the connection of the circuit.

These results suggest that even if the incident on medical treatment has not occurred outwardly, there is an underlying possibility of an accident to occur. We conclude that, for the safe use of the NPPV apparatus, a periodical evaluation of knowledge and technique along with the training course and the ME education is necessary.

In this paper we aimed to assess how we should support and care for medical staffs who are involved in medical accident. We asked medical staffs who were involved in medical accident higher than 3d influence level accident, and had collected replies from 45 people of 43 hospitals. We qualitatively analyzed the answers of the questionnaires in terms of how they felt from the response of the others in their work place following the accident.

As a result, we extracted from answers 9 categories as follows；“sense of relief of getting over the incident by on-the-spot operational coordination”, “feeling better after talking to someone”, “feeling comforted by being told that you were not the only responsible party' ”, “regaining positive outlook through shared reflection with their coworkers”, “burden of repetitive fact confirmation”, “regret arising by reviewing fact”, “annoyance of single-handed accountability and responsibility”, “anxiety of not being informed of the situation”, and “discomfort felt by secondary discordance among staffs in charge”. These findings suggest that it is important to make clear the direction of response to the accident, to establish a support system of staffs in charge and their surroundings, to improve communication within work place, and to make cooperative work climate.

We reviewed induction and maintenance costs of our hospital information system. We introduced an ‘e-medical record’ made by Software Service Inc. as a basic system of a hospital information system in April 2006. The ‘e-medical record’ consisted of an electronic chart system, a medical business accounts system, a laboratory examination system, a transfusion system, a hospital meal system and an operation anesthesia system as section systems. As other section systems made by other companies, we introduced PACS, radiologic imaging section RIS, radiotherapy section RIS and laboratory information system for pathology. For these systems, we reviewed induction costs, additional costs in five years and maintenance costs. The system induction costs and additional costs were 699,100,000 yen (total cost), which was calculated to be 139,800,000 yen per year. The total sum of maintenance expenses was 41,900,000 yen per year. Therefore, the total of the induction and maintenance expenses was calculated to be 181,700,000 yen per year. It was equivalent to 2.2% of the annual medical profession gross earnings in our hospital, at 533,000 yen per bed. This expense is lower than that obtained from literature review. As the main reasons for the lower cost, we list (a) choosing a package-type electronic chart system, (b) choosing-as much as possible-a section systems made by the same maker for electronic chart system, and (c) choosing low-end terminal PCs.

Patient information from bedside monitors (monitor), such as electrocardiogram, blood pressure and the oxygen saturation in blood, has been sent to telemetry central monitor (receiver) in the nurse station by radio. When number of monitors are short due to an increase in the patient number requiring monitor, central dispatching is desired to manage the monitors. However, in case monitors are moved between wards, radio frequency (channel) must be changed to avoid interference because monitors are used on wireless base. Therefore, we devised a new system in term of monitor management. This is an ideal system that avoids interference even without changing channels between wards. This method also saves operation time and cost. We report newly-devised method and its benefit.

The purpose of this study was to elucidate the current status of role-sharing in the outpatient service. Questionnaires were sent to 94 hospitals that filed health insurance office to organize office assistants. Of the 37 hospitals that responded, 24 (64.8%) had less than 400 beds. The ratio of nurses to office clerks in the outpatients department was 4.46：1.

We surveyed the roles played by different categories of staff in each of the 24 hospital outpatient services. “Writing or input prescription” was the sole duty of physicians at these hospitals, and duties such as “directions to laboratory” were not performed by physicians at these hospitals. Other services were shared among physicians, nurses, and office clerks.

Although some of the outpatient services could be transferred to office clerks on governmental notice, the survey results showed that these services were mainly performed by the physicians and/or nurses. For example, “booking the next appointment” was performed by physicians at 25 (67.6%) of the 37 respondents；by nurses at 22 hospitals (59.5%)；and by office clerks at 21 hospitals (56.8%). A similar distribution was observed for the “preparing medical records”.

At hospitals with relatively few office clerks, nurses undertook clerical roles. To improve role sharing, hospitals are suggested to increase the number of office clerks in the outpatient department.

We conducted a survey of 48 doctors working at the Nittazuka Medical Welfare Center on the consciousness and the actual condition of committee operations. Of them, there are 31 doctors belonging to 87 committees. The survey was answered by a total of 81 people, including 30 chairpersons and 51 committee members. 42% of doctors answered that committee operations were considered a burden, and chairpersons in particular indicated a higher percentage. Of those who answered, 24.7% of doctors contrived ways to relieve the burden of committee operations, and chairpersons in particular indicated a higher percentage. Of the respondents, 61.8% answered they wished to resign from the committee. Annually, a total of 29.5 hours was spent on committee operations and 61.4 hours for chairpersons. It revealed a correlation between the hours of committee operations and the burden of committee operations, although no correlation was seen on resignations from committees. While doctors working in a hospital understood the necessity of committees, the committee activities were a major contributor to the burden of daily operations and they felt that they would like to resign from the committees more than they found it a burden. However, although a higher percentage of chairpersons answered that it was a burden, their attendance rate was higher and half of them wished to resign from committees. This indicated that they had a mission towards committee operations, in addition to the fact that those committees were directly linked to medical care services. In an effort to decrease the burden involved in committee operations, it is necessary to effectively utilize doctors’medical clerks and make an adjustment with other committees and departments. Additionally, one way to reduce the exhaustion of doctors is to provide them with some sort of an incentive.

Under Economic Partnership Agreement, selected nurses from Indonesia and the Philippines are trained at host facilities in Japan. The purpose of this study is to investigate the host facilities’ reason for their acceptance, support system for education for the national examination, situation of the facilities, and future considerations for a support system for foreign nurses.

A self-administered questionnaire was distributed to 152 host facilities. The response rate was 65.8% (100/152). Cooperation for international exchange and national policy were most often cited reasons for acceptance, and only a few cited nurse shortage. The disadvantages recognized by host facilities were burden of training and lack of external support. On the other hand, revitalization of facility was most often cited as an advantage for host facilities. Most facilities replied that the ability of Japanese language could be the barrier against the national examination. The result of this study suggested that whereas most foreign nurses could communicate in basic Japanese, they felt difficulty in offering nursing services in Japanese.

It would be important to develop educational methods and tools that clarify the roles of host facilities and external agencies, and to share knowledge and experience of facilities with good performance.

A critical pathway must be developed with ease. In addition, there must first be a critical pathway of the process on the whole before that pathway can be computerized. For the purpose to simplify this process, we have designed a tool using Excel. It begins by making an Excel sheet with the terms of standard achievement aim necessary for making critical pathway and then allocating a link account to each term. With a simple ‘copy and paste’ function, a critical pathway can be created easily by using this devise.