We tried to establish a predictive hospitalization model in patients with chronic kidney disease.
We conducted an ordered logistic regression analysis with hospitalization period classification as an explanatory variable and patient contents as dependent variable. In the constructed probability calculation model, we identified combination among dietary intake, age, I63・I69：cerebral infarction (including sequelae), N08：diabetic nephropathy，and I50：heart failure.
The hospitalization period can be predicted by inputting the evaluation value for five items, which are patient conditions at the time of admission. Predicting the hospitalization period at the initial stage may provide valuable information for the subsequent need and organize collaboration, and suggests the possibility of a more effective bed management.

The aim of this research was to clarify the relationship between sense of coherence (SOC) and personality traits in novice nurses. Subjects were 1,280 novice nurses from across the country who participated in a questionnaire survey by mail. The survey included the subject's SOC, SOC constructs (comprehensibility, manageability, and meaningfulness), and personality traits. Measurements were conducted using the 13-item SOC scale and the TIPI-J. Analyses were performed using correlation analysis and multiple regression analysis. The collection rate was 23.5% with 301 valid responses. Regarding the relationship between SOC and personality traits, a correlation was confirmed with all personality traits (p＜0.01). In multiple regression analysis, neuroticism exhibited the strongest influence on SOC (β＝-0.364). Regarding the influence on SOC constructs, conscientiousness exhibited the strongest influence on meaningfulness (β＝0.288). Further, agreeableness and extraversion exhibited significant effects on all SOC constructs. Regarding the relationship between SOC and personality traits, it was suggested that the lower the neuroticism, the higher were the SOC, conscientiousness, and the SOC construct of meaningfulness. Further, it was suggested that the higher the extraversion and agreeableness, the higher were the SOC and all SOC constructs.

The number of patients who are transported by ambulance nationwide is increasing year by year, especially for elderly and minor cases. The number of patients urgently transported to Kyushu Hospital, an independent administrative corporation, Regional Medical Function Promotion Organization, is increasing. Among them, there are an increasing number of patients who are not suitable for hospital admission and who are unable to return home due to physical and social reasons. Such patients are transferred directly from the emergency room to nearby medical facilities, and the number of such transfers is increasing year by year. Since the work associated with the transfer in the emergency room has become complicated, we analyzed the problems at the time of transfer adjustment and examined the countermeasures. By creating a transfer manual, work efficiency and standardization were improved, leading to a reduction in the time required for the patient to be transferred to the emergency room. In addition, the use of information sheets describing the patient's life history, social background, etc. facilitated collaboration with the hospital and transfer destinations.

Nagano Prefectural Hospital Organization, which became a local independent administrative institution in 2010, comprises five hospitals. Following this change in management entity, several important issues related to organization management (such as staff motivation and management awareness) have been observed. Accordingly, we have developed a project aimed at improving organizational culture through activities by multi-disciplinary and cross-sectional project teams, which were concurrently implemented in the five hospitals. Ten to thirty staff members at each hospital participated in this project and conducted SWOT analyses to identify and resolve the issues of hospital management. The strengths, weaknesses, opportunities, and threats of each hospital's internal and external environments were extracted through the analyses, and various countermeasures were proposed. In addition, project reports that described a series of activities, attractiveness, and vision of the hospital organization were made and shared by all project members. As a result, we believe the project provided opportunities for hospital staff to focus on hospital organization management on the whole, to share issues, and to exchange opinions. At the same time, it enabled the five hospitals to improve their workplace environment and organizational culture, and to increase their attractiveness to both the local communities and hospital staff.

Nurses should assess the states of patients and prioritize their responses for patients having high medical dependence in diversification of medical needs, while they are securing the safety and the comfort of the patients and providing services appropriately. However, they have little opportunity to looking back on their behavior objectively. Therefore, at Kagawa university hospital, we have introduced the simulated educational program based on “multi-tasking” situation for evaluating practical skill at nine months after finding employment, because we wanted to clarify the problems of newcomer nurses by looking back on their behavior from their responses to multi-tasking situation. The purpose of this study is to examine the practical skill evaluation and the training effect by this situation-based simulation educational program.
Sixty-four nurses who were employed in April 2017 were tasked to respond to multi-tasking situation during ten minutes in the prepared setting scenes, after which they performed self- and observer-evaluation using the checklist consisted of 11 items. In addition, subjects performed a debriefing session with their instructors while watching the video of their response to multi-tasking situation. At the evaluation of the checklist, all subjects were able to prioritize their responses.
This result might show that nurses had acquired the practical skill by OJT and the experiences in daily nursing scenes during their nine-months work. Furthermore, more than 90% of the subjects showed willingness to use this simulation again to learn about their own problems for practice. From the results of this study, the multi-tasking situation-based simulation educational program might be one of the effective educational programs for nurses in evaluating their practical skills and gain feedback to individual's problems.

This study aimed to conduct practical group training on “anticipating sudden changes and nursing” to enable independent learning in novice nurses. Hospital A faces the challenge involved in shifting from conventional lecture-based learning and practicum work to the learning of actual nursing practices.
Therefore, to allow novice nurses to apply their previous learning and experience, we changed the order of tasks in orientation training to the following：practicum, lecture, practicum. In group practicums, the participants were asked to assume that the condition of the patients discussed in the “Physical Assessment I” class that they previously attended had underwent changes in condition. They subsequently selected five required observation items among those listed on a previously prepared observation card and presented the results of those observations. The participants then considered these data, assessed the patient's disease course and determined further required actions. The top three priority items were selected from an “action card.” Thereafter, lectures that provided hints regarding the solutions to these problems were conducted, and the same practicum tasks were again presented to the participants to provide them an opportunity to improve their thought processes.
As a result, comparing the cards selected before and after the lecture, the number of groups that selected items necessary for primary evaluation such as breathing and circulation increased after the lecture, and the group difference decreased. The participants indicated that cards allowed them to easily discuss and review the cases and to carefully think about the reasons used to identify the high-priority items.
Training in non-technical skills is useful in determining priorities as a group via a process of explaining ideas in an understandable manner. Simple-to-use cards were utilized in this study. Thus, the results can be generalized to other departments or facilities of any size.

We have adopted balanced scorecard (BSC) to improve the quality of medical treatment and conduct efficient and cost-effective hospital management since 2015. We set an offer of comfortable care and working environment for hospitalized patients and ward staffs, respectively, as one of annual targets in obstetrical and gynecological ward. In consequence, patient satisfaction level ameliorated, and ward staffs received patients' compliments. Ward staffs were motivated by freely giving their ideas to improve patient's care environment and by putting those into practice. Introduction of BSC makes it possible for ward staffs to systematically and accurately notice ward targets and action plans. It is suggested that a comfortable care environment can be offered to the hospitalized patients when ward staffs value enjoyment to obtain successful results in their job.

Financial performance of surgical operations constitutes one of the key components in proper hospital administration. At Miyagi Cancer Center (MCC) we have been able to make one-to-one correspondence between the cost and the patient on the in-house computer system, which was introduced in 2016, operating for the electric medical records the material ledger. Based on these accumulated data for 2 years, we analyzed the financial performance of each surgical operation case and demonstrated the results in visual formatting, i.g. tables and graphs, which helps the managing staff in charge to easily grasp the points of data. The items of analysis were categorized into：(1) cost versus revenue ratio (CRR) for each surgical division, (2) CRR for each surgical procedure, (3) the cost of medical supplies and equipment, and (4) anesthetic drug costs. It was revealed that the costs of implants in plastic and orthopedic surgeries are on the increase and CRR of endoscopic surgeries stays high. Also disclosed was that supply costs of auto-suture and energy devices amount approximately 40% of the total expenditure for supplies and equipment cost. We believe that continuous financial analysis of this kind and visual presentation will greatly contribute to focusing on the targets of reducing the cost on medical supplies and equipment.