Falls in hospitals are common events that cause considerable morbidity. Though studies for prediction of the risk of falls have been reported, criteria which worked well in an original research study may not work in a hospital with different patient populations.

We studied the efficacy of risk-assessment tools that contain 41 items of questionnaires proposed by the National Hospital Organization by case-control study. From January 2010 until April 2010, 82 patients were reported as fall accidents and were defined as the cases. Three controls were selected in the source population for each case and matched by gender, age, and the ward in the hospital. Finally, 234 controls were selected. The suitability of 41 items was compared, and odds ratios were calculated. In 16 items, the lower limit of 95% confidential interval of odds ratio was greater than 1.0, and the lower limit of 99% confidential interval of odds ratio was greater than 1.0 in 9 items. Using multiple logistic regression analysis, 5 items were selected by forward selection as significant(p<0.05). These were “Assistance required in dressing”, “History of fall during hospitalization”, “Restlessness and agitation”, “Using wheel-chair, cane, walker or handrail”, and “Using narcotics”. Case-control study is a convenient method to evaluate the efficacy of assessment items.

A hospital required by the local people is a hospital that is necessary to the area. It is a hospital where people could be looked at by doctors at all hours, where people could get better quickly, and the staffs are kind and considerate. To make this happen, it needs to be a “Double Winner” of medical quality and managerial quality. In March, 1987, Iwate Prefectural Central Hospital was newly constructed at the present site to provide advanced medical care to the people of Iwate. Our mission statement is to never reject emergency patients, for which we have established a system that every clinical department is to be on-call for emergencies. We dispatch clinicians to the desperately short-staffed rural public hospitals while providing training and educational programs to the medical workers and clinicians within the prefecture as a designated clinical training hospital.

We have struggled with running cost deficits. However, since 1998, with the collaborated efforts of all staffs engaging in both top-down and bottom-up communications, we have been able to turn the deficit around to profit at present.

We have 2 main objectives for the future. One, establishing a comprehensive areal medical care system, and two, transformation from hospital-ended medical care to residence-ended medical care. It is to establish a seamless medical care system with terminal care and home healthcare for the elderly in mind. Also, in 2018, the neighboring Iwate Medical University Hospital is scheduled to move to Yahaba District. A new emergency medical service system for the Morioka area including refurbishing of a year-around medical heliport must quickly be put in place.

We clarify the damages to the function and structure of the operating rooms after the earthquake by a questionnaire survey to Tohoku and north-east Kanto area. We sent questionnaires containing 33 questions to 415 acute care hospitals and collected from 213 hospitals (51%). Total of 474 patients were undergoing various kinds of operation during the earthquake and total of 222 operations were canceled after the earthquake. One hundred fifty three (71％) of the total hospitals were built in a quakeproof structure or quake-absorbing structure, and 48 (22%) hospitals were not built in quakeproof structure. Of the 213 responding hospitals, the emergency electric power source did not work in 12 hospitals. The reasons of difficulty to continue operation were shaking, the sense of fear of the OR staff, terror of patients and blackout. The supplies for surgical operation and general materials were lacking around the areas badly damaged by earthquake, such as Aomori, Akita, Yamagata, and Ibaraki prefectures. One hundred fifty four hospitals answered that it was difficult for surgery to be performed on the next day and later after the earthquake. All hospitals in Fukushima and Miyagi that had replied said they had difficulties for routine surgery from the day after the earthquake.

The management of the operating rooms within Tohoku and north-east Kanto area was difficult by the earthquake. In the hospital near epicenter, especially in areas where seismic intensity was more than 6, it was impossible to conduct usual operation because of infrastructural damage. Medical materials were in short supply around the areas badly damaged by the earthquake. It is necessary to review each hospital's storage supplies and system of distribution. When widespread disaster happens caused by the earthquake, building a network and cooperation with peripheral hospitals is necessary to the management of operation and operation room.

A review of the Cancer Control Basic Plan was carried out in June 2012. Promotion of oral care by the collaboration of the departments of Medicine and Dentistry and strengthening cooperation with dentists who specialize in oral management had been specified for the prevention and reduction of the side effects of the treatment of cancer. We have created a common oral management plan in order to ensure smooth cooperation between the departments. Before starting oral care, the dentist has to create an oral management plan based on a request from the medical doctor. The actual oral management is then performed by a regional dental clinic. We started our program in July 2012 to build the system. We had received a request for oral management for 323 cancer patients (252 preoperative patients and 68 chemotherapy patients) by July 2013, and have performed oral management programs for 283 patients. A total of 129 patients (94 preoperative patients and 35 chemotherapy patients) received oral management in our department, while 154 patients (139 preoperative patients and 15 chemotherapy patients) received care at the regional dental clinic. The contents of the oral management program were primarily periodontal disease control. There were no differences in the contents of oral management in the regional dental clinic and our department. However, tooth extractions and fixed teeth related to general anesthesia were more common in our department compared to the regional dental clinic.

We can share cancer patient information by creating a common oral management database. This means that collaboration between the regional dental clinic and general hospital for the oral management of cancer patients is possible.

The importance of hospital discharge support and coordination departments is increasing in recent years due to the shortening of hospital stay at acute care hospitals and other factors. As it is unclear to what extent the general public is aware of the presence of Medical Social Workers (MSW) and hospital discharge coordinating nurses that work in these departments to fulfill these duties, we conducted an Internet-based questionnaire survey. Respondents were 112 men and 188 women, of which 69% were in their 40s or 50s and 121 (40%) were the patient's son or daughter；the most common relationship to the patient. A total of 91% of patients had a hospital stay of two weeks or longer. The most common diseases were malignant tumor, stroke, and pneumonia. It was common among those with a hospital stay of 1-3 months and those with stroke or pneumonia to respond that their hospital stay was shorter than they hoped. In questions on concrete reasons for anxiety and issues, many had only a vague uncertainty. Relatively high anxiety issues were the course and prognosis of symptoms, self-management of daily life, post-discharge recovery, and the scheduled discharge date. The most reliable people to turn to for relieving anxiety or solving problems were the primary physician (30%), MSW (25%), or a family member (18%), and awareness of hospital discharge coordinating nurses tended to be lower than that of MSWs. Those who were highly satisfied with hospital discharge support and coordination also had a favorable impression of the hospital overall. In conclusion, the results of this survey suggest that awareness of hospital discharge coordinating nurses remains lower than that of MSW and that enhancing these services may lead to an increase in loyalty to the hospital.

In a system referred to as PRE-AVOID, pharmacists are requested to send reports to the Japanese Society of Hospital Pharmacists (JSHP) about all the cases in which side effects due to pharmacotherapy, drug interactions, and lack of therapeutic effect have been prevented or alleviated while practicing pharmaceutical care in consideration of patients' clinical conditions. Since 2008, Ageo Central General Hospital (our hospital) has had resident pharmacists in all the wards, and our hospital has constructed the PRE-AVOID system. In this study, we examined trends in the number of PRE-AVOID reports in our hospital between fiscal year 2004 and 2011；the number of PRE-AVOID reports according to the task conducted at the time of the reported event；and the comparison between PRE-AVOID reports of our hospital and those of all over Japan. The average number of PRE-AVOID reports was 19.5 per year until fiscal year 2008, the average after the fiscal year 2009 was 469.3 per year. In most reports, the task conducted at the time of the event consisted of hospital ward duties and guidance regarding medication management. Of the reported 18,208 reviews from all medical institutions in Japan, 566 reports were of our hospital (3.11%). The marked increase in the number of PRE-AVOID reports is likely attributed to the fact that the placement of resident pharmacists in hospital wards has allowed for detailed observation and examination of the status of medication usage, and that the acquisition of information from nurses has allowed for the detection of a larger number of cases eligible for PRE-AVOID reports. Another possible reason is the facilitation of prescription-related suggestions provided by drug-dispensing pharmacists owing to resident pharmacists in hospital wards. Our study showed that resident pharmacists in hospital wards play an important role in safety of medical treatment.

Two cases with excess medical expense under the comprehensive health-care payment system in spite of ethical consideration were reported.

Case 1 was a 70 year-old male who was admitted due to severe acute alcoholic pancreatitis. Respiratory support and continuous hemofiltration were applied. Although remission was obtained, his condition worsened again. Then, ethical analysis with Jonsen's method was performed, and the decision of therapeutic continuity was made. However, he could not recover again and died of multi-organ failure. Consequently, excess medical expense (difference between real reimbursement by DPC/PDPS and theoretical reimbursement assuming fee for service payment system) of 490 thousand yen had occurred without any financial aid.

Case 2 was a 53 year-old male. He was admitted for terminal state of osteosarcoma. Massive dose of narcotics was necessary to heal his pain which derived from multiple bone metastasis. He died at 95 days after admission. Although the excess expense estimated about 5.25 million yen, we could not find any appropriate method to reduce it under comprehensive payment system.

In order to achieve appropriate therapy under ethical consideration, some public financial support for excess expense is necessary in comprehensive health-care payment system.

The purpose of this study is to reveal the design of cost accounting system for university hospitals in Japan. Interviews were conducted with 10 university hospitals in 2012.

According to this study, university hospitals generally construct cost accounting system which can calculate departmental cost. Cost accounting data inconsistencies attributed to variations of accessible data units possibly fail to satisfy administrator's objectives. The results also suggest that additional cooperation with related systems and reforming complex operation are important.

This study shows that cost accounting in university hospitals reasonably maintain overall accuracies；on the other hand, system needs to be improved in terms of information and operation system design.

Recently, medical service providers have to offer smoother bed management because of social factors associated with the healthcare reform. However, various issues have occurred owing to social backgrounds such as advanced medical technologies and an increase of older inpatients, thus resulting in difficulties in bed management. In order to secure beds for emergency patients, Houetsu Hospital, a secondary emergency hospital with 65 beds, had to shorten the length of stay and closely cooperate with local organizations that support life after discharge. The in-hospital regional medicine cooperation room, which was composed of various professions in charge of different tasks, introduced a meeting to share information about inpatients every day. The staff in this hospital also visited neighboring hospitals and institutions to share information and found a lot of requests for community-wide information sharing. Thus, a community-based cooperative meeting was held. This led to closer cooperation with local institutions and smoother support, which facilitated the discharge of inpatients. In future, it will be important to strengthen a community-based support system that allows residents to live peacefully in a town where they have lived for many years.