In Japan, “doctor's office work assistant” has been introduced in 2008, to reduce the burden on medical doctors working in hospitals. Under the direction of doctors, the office work assistants could prepare medical documents such as medical records, discharge summaries, medical certificates and written opinions. Training of the assistants has been promoted nationwide in medical institutions and vocational schools. First, lack of the absolute number of doctors is cited in the cause of the increased workload. Furthermore, doctors gaining seniority are expected to attend various meetings in line of hospital management and writing up complicated medical documents also causes burden. Administrative workload except the clinical practice has been increased markedly in hospitals. However, it is thought that there is a fundamental problem of medical record writing and management. The recording and the management of the medical documents have been slighted for many years in our country. Creation of medical records that is “worthy of disclosure” is demanded. From the viewpoint of quality of medical documents, the assistants are expected to play an important role in recording the medical documents. After the introduction, in the various questionnaire surveys about the reduction of the burden, high degree of satisfaction has been shown among the doctors. In addition, a growing number of reports which evaluated an effect of the introduction quantitatively, such as the shortening of overtime work and the reduction effect of overtime expense, have been published recently. To become independent as an expert of medical documents, the development of lifelong education program is desirable. For further skill improvement and better social recognition, the authorized system of the information exchange and the advanced qualification will be necessary. I hope that “doctor's office work assistant”, as an expert of writers of medical documents, contributes to team medical care and the improvement of healthcare quality in our country.

Cost of Illness (COI) study is a simple and easy method that measures burden of disease as monetary value. This method has been coming under criticism because it covers only the cost without considering outcome, and it is unclear who is to pay the cost. But COI study is simple to calculate compared with other methods for economic evaluation, and it has been used for political decision making in countries such as U.S.A. and New Zealand. COI study has established its position in spite of many criticisms by securing its credibility, repeatability and comparability rather than modifying its theoretical framework.

Cases of bone fractures accompanying falls that were experienced at our hospital from 2004 to 2009 were investigated.

Among 2,241 cases of incidents reported regarding falls, there were 25 cases (1.1%) of bone fractures. The cases involved 10 men and 15 women and occurred at nighttime (between 21：00 to 6：00) in 11 of 25 cases. Regarding the fracture site, femoral neck fractures were the most common at 11 cases, followed by 5 cases of upper extremity bones, 3 cases of lumbar spine, etc. The age of the 11 cases of femoral neck fracture was 72 ± 15 years old, which was high compared to the 14 other fractures cases. Moreover, the period from fracture occurrence to leaving the hospital was 64 ± 56 days for the 11 cases of femoral neck fracture, which was significantly longer compared to the 14 other fracture cases.

Classifying the 25 fractured cases according to the Kawamura classification, which was proposed from the standpoint of preventing falls, there were 3 cases of Group 1, 3 cases of Group 2, 9 cases of Group 3 (with ability of decision making/other than excretory activities), 10 cases of Group 4 (impairment of decision making). The 9 cases in Group 3 were peculiar in that there were many fractures of the lower extremities (7 cases), while the 10 cases in Group 4 were peculiar in that there were many fractures of the body trunk and lower extremities (8 cases), and there were 4 cases whose latest assessment scores were less than 10.

In conclusion, to prevent fractures, it is important to engage in the prevention of falls of Groups 3 and 4 of the Kawamura classification and carry out risk evaluation on the fractures for each patient.

Incident reports involving medical tools such as infusion or syringe pumps ranked third in frequency among incident reports of the Postal Services Agency Hospital in 2009. We analyzed the reports involving infusion pump or syringe pump in terms of frequency and risk. Thereafter, we implemented practical training based on the analysis for the purpose of preventing incidents.

The incidence of “operation or set method error” was the highest in both frequency and risk, followed by “speed setting error” and “line management error.” After training, the number of incident reports involving infusion or syringe pump decreased by 54%, from 96 to 44 cases. The incidence of infusion or syringe pump in the non-participants (40/128, 31.3%) was significantly higher than that in the participants (4/115, 3.5%) of the training.

The results of questionnaires gathered from the participants indicated lack of knowledge about the pump was the chief cause of these incidents. Our findings suggest that practical training in consideration of the frequency and risk is effective for the purpose of preventing incidents.

In surgical hand disinfection, the waterless method (a procedure to use alcohol-based hand rub) is becoming widely used replacing conventional two methods-the scrub method (a procedure to use antiseptics containing cleaning agent) and the two-stage method (a procedure to use alcohol-based hand rub after scrub method). We compared the waterless method with other 2 methods (scrub method and two-stage method) in terms of disinfection effect and cost so that we could evaluate the usefulness of the waterless method using the alcohol-based hand rub (STERICLON HAND LOTION 0.5%) containing 0.5w/v% chlorhexidine gluconate. We obtained a result that the reduction rate (%) of viable count by the waterless method reached 94.8% (p<0.05), which showed that the waterless method significantly effective for the surgical hand disinfection compared with the scrub method or with the two-stage method. Moreover, the waterless method showed persistent effect. In addition, the waterless method made it possible to reduce cost by more than 150 yen per one surgical hand disinfection compared with the scrub method or with the two-stage method. Based on the above result, the waterless method to use the alcohol-based hand rub containing 0.5w/v% chlorhexidine gluconate proved to have both excellent disinfection and cost-reducing effect compared with the scrub method or with the two-stage method.

An analysis was conducted using a new in-memory BI data analysis software program so that the present situation can be understood and efficiently managed regarding the analysis of electronic medical record surgical systems, even for amateurs who are not software engineers (SE).

The number of surgeries from approximately 10,005 DWH (Data warehouse) cases, hospital ward, department, degree of demand such as emergency plans, usage of the operation room, practitioner, number of surgeries, surgery time and situation of labor at anesthesiologist were extracted. The BI data analysis software program allowed for the simple visualization of the conditions of use for the operation room, with which all staff members involved in surgery were able to easily determine “the availability of the operation room”. Moreover, it was possible to show the displayed items in detail by drilling down. Next, when the evaluation axis was “sliced and diced,” and classified by operation room, the total surgery time could thus be determined by room and the intersection of the number of surgical cases and surgery time was thus found to be relatively constant, and the operation room was therefore found to be used efficiently.

This new software program made it possible to effectively respond to requests of the surgical site, thus making it helpful for the management of operation rooms by improving the system analysis quality.

In the ward of hematology department in Kurume University Hospital, more than 70% of patients receive chemotherapies, and more than half of the patients were of ages over 60-years-old. Chemotherapies for the treatment of hematologic malignancies cause many adverse events and limitation of patients' daily activities often leading to disuse atrophy and prolonged hospitalization. To prevent this disuse atrophy and to promote an early come back to normal life, we have organized systematized rehabilitation programs in the early phase of hospitalization. In cooperation with the department of rehabilitation, early rehabilitation intervention has been promoted. In addition, this organization led to the better collaboration of the specialists belonging to various sections for practice of patient-oriented medical care. The best medical care has been established by mutual understanding of specialties resulting in the improvement of the medical quality.

We surveyed consultation records of the Intractable Disease Support Centers across Japan to examine the contents of the consultation sessions and the support measures given. Of the 5,145 consultation sessions that were classified according to diseases, 3,314 sessions were for disease designated as intractable diseases (64.4%) by the Ministry of Health, Labour and Welfare；i.e., neuromuscular diseases, 1,365 sessions (26.5%)；immune system disease, 491 (9.5%)；and digestive system disease, 417 (8.1%). The consultation issues broadly covered the areas of not only healthcare (28.9%) and nursing care (23.9%) but also the welfare system (12.9%) and employment (14.7%).

A total of 5,914 support measures were given. The breakdown of measures given by counselors was as follows：2,898 measures (49.0%) for giving explanations of systems or advice according to diseases, 1,141 (19.3%) for“active listening”, and 1,023 (17.3%) for“introducing other counseling services”. Our investigation revealed that the consultations involved diverse issues on a wide range of diseases, a situation that was difficult to be dealt with by using only the knowledge and experience of individual counselors. It was considered preferable to further take measures to improve the quality of counselors and to modify the framework to support them.

In-hospital sterile instruments stored in the central sterile supply room were managed under the Supply, Processing, & Distribution (SPD) system. The system was reviewed to reduce dead stock (defined as in-hospital sterile instruments that had been stored for over 180 days-the period of validity) in hospital wards and in outpatient departments to increase work efficiency. For an analysis of the current situation, a survey was conducted on the names of in-hospital sterile instruments, numbers of supplies allocated to each department, numbers of instruments used in one month, types of appliances included in instrument sets, and time schedule of SPD. As the results of the survey, the numbers of allocated supplies were higher than the mean or even maximum numbers of sterile instruments actually used per day, and the same instruments were included in different sets. In the hospital wards, emergency treatments after 5:00 p.m. during night shift and ward rounds in the morning immediately before the start of the day shift were conducted. Then, the numbers of allocated supplies and time schedule of the SPD were changed and the appliance sets were reviewed. These improvements reduced dead stock in outpatient departments and in hospital wards by approximately 20 to 40% respectively, and increased work efficiency. The hospital decided to continue to exert efforts on a regular basis to implement appropriate inventory management based on the SPD system.