Colon cancer (ICD10：C18-C20) is one of the leading causes of deaths in Japan, and the morbidity and mortality rates have been increasing. The objectives of this study were to estimate and project the social cost of colon cancer using a cost of illness (COI) method. We calculated COI of 1996, 2002, 2008, 2014 and 2020 by using government office statistics and the COI method.

COI was estimated to be in upward trend from 871.6 billion yen in 1996 to 1,160.3 billion yen in 2008. As for the future projection using the mixed model, which was considered to be the most credible, COI was predicted to decrease (1,057.5 billion yen in 2014 and 941.1 billion yen in 2020). Among major contributing factors of COI change were aging of the population, changes in the medical system, and improvements and developments in medical technology, and especially the decrease of the human capital value by aging of the population was considered to be the most contributing factor. The results of this study would be used for health policy-making such as anti-cancer strategies.

Appropriately analyzing the content of incident cases, putting the measures into action, and preventing recurrence are essential to medical safety management. Our previous analyzing methods took time because of their complexity and did not infiltrate to the workplace. Therefore we have designed a RCA-sheet incorporating the PDCA cycle that can be used easily. We have been educating the safety promotion staff in the workplace using this sheet from January, 2012. We have conducted practical exercise sessions in 47 out of 56 departments, 81 times in total. Exercise sessions were given within business hours but allowed a minimal exception. The number of corrections was 45 in 2011, 46 in 2012, and 81 in 2013, showing we had succeeded in doubling the number of cases. The results of the study suggested that this PDCA-cycle-incorporated RCA-sheet was useful both in vitalizing the KAIZEN activities from incidents and safety education in the workplace.

An incident report (IR) should be clear in description of the event which requires prompt responses. However, many IRs are written in a way difficult to understand the content of events, and necessary responses are frequently delayed. To address this problem, quality control methods were applied to improve the IR procedure. IR should include an initial summary of the event, be simple in description, display all events in a chronological order, and be objective. An example including these four items was given to staff, and some revisions were recommended to past inappropriate IRs. Consequently, IR including these four items proved to be more effective, and revisions of IRs have decreased. It was suggested that the IR which involves the initial summary of the event, with simple, chronological and objective description is useful.

Since January 2012 our hospital has been uploading most medical information by IP-VPN connection to a public data center to prepare for eventual transition to filmless data storage and to reduce the risk of losing medical information through natural disasters. To contribute to health care throughout our district we have scheduled and performed radiological examinations at the request of physicians at nearby medical institutions since 1990.

To enhance regional medical cooperation we constructed an ICT-based system (called Himawari Net) using the data center in February 2012. Authorized physicians can use the system to book radiological examinations and view diagnostic reports and images of those examinations easily and safely by Internet VPN (SSL) connection without any charge. This network system has contributed to a great increase in CT and MRI examinations from affiliated clinics and hospitals over the previous fiscal year and improved the relationship between those medical institutions and our hospital.

Using the network system has enabled us to utilize the diagnostic abilities of radiologists to contribute to community medicine. It also indicated that the system needs to be changed to improve its convenience, versatility and scalability for promotion of region-based total medical care.

A proportion of patients with cancer who could receive medical treatment at home among the inpatients were estimated by the following method. Referring to the previous works, three conditions are assumed as follows：1) “woman as a main caregiver who also lives with the patient”, 2) “there is a period longer than two months to the death after cancer was diagnosed”, and 3) “pain control is good”. Hypothesis and the estimated values were evaluated.

Among 349 cases, the conditions 1) and 2) were met in 157 cases (45.0%) and 281 cases (80.5%), respectively. 131 cases (37.5%) met both conditions, in which, more than half of the cases also had good control of the pain counting 72 cases. All three conditions were satisfied in 72 cases (20.6%) among all 349 cases.

This value was estimated slightly high from the following reason；the above three conditions were assumed only from “patients treatment status” and “a patient's family environment” without considering social support system or hospital's backup system. In the estimation of a pain control, “the period of pain control” and “the level of consciousness of the patient” were not considered.

As a result, the possibility of a medical care at home is judged to be lower than 20%.

The present study was conducted to understand policies on nursing administration implemented by nursing administrators working in health care facilities in which a large proportion of nurses were satisfied with work, and to examine common nursing administration factors identified in these nursing administrators. The subjects were five nursing administrators working at hospitals in Prefecture A in which the job satisfaction level among nurses was high. Semi-structured interviews with nursing administrators were conducted to investigate their nursing administration policies, and the results were analyzed qualitatively and inductively. Common administrative policies implemented by those administrators included：[strategies to assure the quality of nursing care], [a variety of information sources and the importance of listening], [fulfilling educational systems], [empowerment and support systems], and [work environments with an emphasis on work-life balance]. In addition to these, [the organization of the hospital based on good relationships and mutual understanding with the Department of Nursing] was extracted as a foundation for nursing administrators to implement their administrative policies. As common backgrounds, nursing administrators had at least 30 years of experience as nurses and were certified nursing administrators. Based on their policies as top managers, nursing administrators exercised their leadership to revise routines performed in the Department of Nursing and the current systems to develop “a hospital more attractive to nurses.” They played a pioneering role as leaders to continuously discuss nursing care that responds to social needs and execute improvement.

The study aims to clarify the functions of nurses in acute care hospitals on the basis of the nursing practice of proficient nurses. Semi-structural interview survey was administered to 5 senior nursing officers and 24 proficient nurses working in an acute care hospital. In the senior nursing officer's interview, the nursing practices of the mid-level nurses considered as roll-models were clarified. Based on the summary of records of raw data, similar data were compiled into categories for analyses. The proficient nurse's nursing practice was classified into 14 roles. Three functions out of 14 roles for nurses in acute care hospitals are as follows：1. to aid in accurate diagnosis and maintain accurate treatment plan, 2. to promote staff development, and 3. to promote the overall medical treatment as a team.

The use of electronic medical records is predominant in large-scale hospitals. However, criticism is high from the nursing staff in that it increases workloads, and that it robs time away from patient care. To investigate this claim, we looked at most common and standard nursing procedures at hospital admission and divided these into 29 duty types to carry out a time and motion study. As a result, the average time spent on admission duties was long at 222.5±84.67 with large standard deviations. Records keeping explained for majority of the time spent on duties. With electronic medical systems becoming popular in acute care hospitals, reassessment and restructuring of nurse duty procedures seems crucial.

The medical service continuously offered in a remote tsunami disaster-stricken area has been revalued. After the 2011 tsunami disaster destroyed the sole community hospital in Yamada town, emergency patients had to be transported to the distant center hospital. The logistics of such transport had been extremely challenging. Amongst 4,749 cases of the emergency ambulance dispatched in the past six years, 131 cases were treated by cardiopulmonary resuscitation under control of the regional first-aid station. Whereas 66 out of 77 cases (86%) were received by the community hospital nearby and three patients survived before the disaster (survival rate, 4%), in the post-tsunami emergency transport, 46 out of 54 cases (85%) were transferred to the center hospital located 25 km away from the town but no patient survived. Because 81% of the first-aid cases treated by cardiopulmonary resuscitation were the elderly over 70 years old, the need for home emergency service for the bedridden elderly grew in the town. In contrast to the facility-based medical service, the door-to-door medical delivery service could be supplied from the early stage of the disaster, and the numbers of the elderly who received the home visits by a doctor and nurses increased by 1.5 fold after the disaster in the town. The average annual mortality rate of the elderly who received the home visits was 34%, and the palliative care for dying individuals at home was in need. As a result of the continuous visit service after the disaster, 85% of these infirm with age are currently able to stay at home in the town at the end of their lives. Community hospital staffs are encouraged to participate in the management of health care and it is necessary to correspond to the transformation of society which we are now facing.

There are a significant number of patients with mild symptoms who visit emergency room. Our hospital started to charge out-of-pocket medical cost when patients with mild symptoms visited emergency room after office hours in 2001. This study aims to assess emergency patients after charging out-of pocket medical cost. Outpatient visits per month for emergency room decreased from 2,005 patients to 1,785 patients after charging out-of pocket medical cost while number of inpatients per month for emergency room increased from 220 patients to 240 patients. This indicated that the hospital had shifted to medical treatment for the more serious patients. The result of this study suggested that the hospital was able to be prompted a role of acute clinical setting. However, 7 patients who refused to consult the hospital due to being charged out-of pocket medical cost were hospitalized on the following day. Careful explanation about out-of pocket medical cost seems to be necessary when medical staff provide emergency medical triage system.