Since 2008, we have carried out the ward rounds with regional liaison staffs (doctor, nurse, medical social worker) in the NHO Himeji Medical Center. We analyzed statistically the data concerning with regional medical cooperation between 2007 and 2015 and examined the effects of ward rounds. As a result, it was suggested that the rounds have 4 effects. First effect is the practice of interdisciplinary teamwork. Second is the improvement of communication among medical staffs. Third is the rise of ward nurses' knowledge and recognition concerning discharge supports. Forth is the contribution to hospital profits. Rise in ward nurses' knowledge and recognition through ward rounds may increase the rates of discharge adjustments starting within 10days after hospitalization. The ward rounds are remarkably useful methods to achieve discharge supports starting early.

Japan Ministry of Health, Labour and Welfare newly introduced medical fee for supporting consultation system for the purpose of communication improvement between patients and medical staff in revision of medical payment system in 2012. As a result, Kyushu University Hospital established Advisory Office for Patients where medical social workers as dedicated staff accept complaints and consultations from patients.

We investigated the methods and importance of in-hospital colabolating system to handle complicated and wide-range complaints from patients need cooperation among various departments to settle smoothly.

We reviewed the details of consultation cases accepted from May to October in 2015 at the Consultation & Support Center. Consultation which require exclusive knowledge of medical issues such as symptoms or medical treatment was the largest part and complaints was followed；however, this was also difficult for only medical social workers to deal. This shows that it is necessary for medical social workers to ask for cooperation to various in-hospital network. Many of complaints arised from mis communication between patients and medical staff. Therefore, corresponding to each case politely and kindly leads to the improvement of patient's satisfaction and the decrease of medical litigation. We are continuously trying to blush up skills of medical social worker to correspond consultation more quickly and appropriately.

To advance the quality of medical care during the nighttime in the Department of Internal Medicine, Kitasato University Hospital, doctors on night work are divided into those who provide medical care for hospital patients and those who provide medical care for ambulatory patients. The doctors performing the medical care for ambulatory patients have revealed that some patients who repeatedly come to hospital during the nighttime do not receive disease-specific treatment because of individual and/or familial and/or social backgrounds. To construct a support system for such patients, we have set up a specialist team composed of a doctor and a nurse for ambulatory patients during the nighttime, a nurse for outpatients during the daytime, and a medical mediator, social worker, and psychiatrist. Alongside a consulting psychiatrist, the specialist team objectively interprets the medical condition and treatment for the patient, and then discuss and develop a specific strategy for how the patient will receive disease-specific treatment in regular outpatient visits during the daytime. The team then facilitates strategy of sharing and interaction between healthcare providers. Even though issues may arise between the patient and the healthcare provider following implementation of the strategy, the team will continue to support the patient and the healthcare provider until the issue is resolved. This integrated solution through a specialist team resulted in less stress for the healthcare provider and lead a more pleasant experience for the patient and the healthcare provider during the patient's recovery. Due to a shift in demographics and disease structure, a specialist team including a doctor, a nurse, a medical mediator, a social worker and a psychiatrist, as described here, is critical for personal support of patients.

Reducing the length of postoperative stays in acute care hospitals is very important. We assessed prolonged hospital stays in relation to therapy for gastrointestinal cancer. We surgically treated 136 patients with gastric cancer (GC) and 266 with colon cancer (CC) at our hospital between January 2015 and December 2016. The average hospital stay after surgery for GC and CC was 20.0 and 18.0 days, respectively, and 57 (42%) and 105 (39%) patients, respectively, remained for prolonged diagnosis procedure combination (DPC) hospitalization period II. The main reason for prolonged hospital stays among 79% and 92% of patients with GC and CC, respectively, was patient factors associated with postoperative complications. However, preventing complications and promoting close ties with transfer hospitals helped to reduce postoperative stays beyond DPC hospitalization period II between 2015 and 2016 from 35 (50%) to 22 (33%) patients with GC, and from 68 (51%) to 37 (22%) of those with CC. More patients with various comorbidities or advanced gastrointestinal cancer are undergoing these procedures. Complications need to be avoided, and primary and transfer hospital collaboration should be optimized to further reduce the length of hospital stays.

The number of patients transported to hospitals by ambulances and of those without referrals including patients with mild conditions started increasing after the East Japan earthquake disaster of March, 2011, making it difficult to focus medical resources on patients with severe conditions. Since October 2015, a levy of 2700 yen (including consumption tax of 200 yen) was introduced in the form of selective off-hours medical expenses. Here we report our findings of the impacts of this levy.

We compared the number of emergency patients from October 2015 to September 2016, i.e. after the introduction of off-hours medical expenses with the number of those from October 2014 to September 2015, i.e. before the introduction of these expenses.

The overall number of off-hours emergency patients decreased by 15.1％ (from 26,629 to 22,597) and that of off-hours direct access patients decreased by 18.2％ (from 22,155 to 18,118). Although the number of off-hours emergency patients transported by ambulances remained mostly unchanged (4,474 before the introduction vs. 4,477 after the introduction), that of off-hours inpatients reduced by 2.4％ (from 3,449 to 3,365).

In addition, the number of patients with acute upper respiratory inflammation decreased by approximately 21.9％ (from 3,116 to 2,435), and that of patients with acute gastroenteritis decreased by approximately 26.4％ (from 1,649 to 1,214). None of the patients refused to pay the expenses.

With the introduction of selective off-hours medical expenses the number of off-hours emergency patients which mainly included patients with mild conditions reduced by approximately 15％ whereas that of off-hours inpatients remained unchanged.

There are regional disparities in the healthcare providing system in Japan, including differences in the average length of stay in hospitals across the country and in the number of deaths at home. Some regional areas experience shortages of social resources, and it is inferred that there may be problems with home care support provided by nurses in these areas. This case study therefore examines home care support provided by nurses working on integrated community care wards across several regional areas.

We conducted interviews with three nurses providing home care support at three hospitals in three prefectures. Nine categories emerged from the results, “Intervene at an early stage to enable future home care”, “Promote activities of daily living for patients and instruct caregivers on nursing care methods”, “Evaluate patient progress across different activities by multiple occupation”, “Provide information to enable cooperation”, “Supervise patients and their families to support home care”, “Help families accept patients' current state”, “Support of patients continue to live at home”, “Improving practical skills in home care support”, and “Think about future home care support”.

Integrated community care wards exist because there are large numbers of older patients with decreased ability to carry out activities of daily living, which in turn make it difficult to provide home care support. Elderly patients staying on integrated community care wards need time to prepare for discharge, but this must be balanced against the adverse effects of prolonged hospitalization. Home care support provided by nurses must therefore be in collaboration with other healthcare professionals in hospitals and community care teams. We therefore suggest that cooperation across healthcare professions is important.

In recent years, the cooperative relationships between medical and dental fields are increasingly important for the super-graying society. By review of the Basic Plans to Promote Anti-Cancer Measures due to the prevention and reduction of a side effect from the cancer treatment and improvement of the further living quality of the patient, the promotion of oral care by the cooperation between dentistry and oral surgery was included. However, there are still many problems with the cooperative relationships between medical and dental fields in the hospital where no department of dentistry and oral cavity surgery exists. Therefore, we worked on introducing the cooperation of dentistry and oral cavity department, and oral cavity management system of all hospitalized patients by a multidisciplinary member activity. The system developed around the role of coordinator who has the specialized knowledge of dentistry. In addition, this system was conducted based on collaborating with the local dental clinics, the perioperative oral cavity management, overall oral care (including education), cooperation with dentistry, and dental hygienist activity support. The system developed were put into effect from April 1, 2015 to July 31, 2016. It resulted in 197 cases of dental clinics cooperation, 139 cases of perioperative oral care, and 312 case referrals during this period. In addition, we are trying to facilitate the progress to strengthen the collaboration between medical and dental, and improve the knowledge and techniques, and also strengthen partnership with local dental clinics and dentistry.