For a patient to live out his/her lifetime in his/her hometown, support system comprised of community-based integrated care system by interprofessional collaboration；physician care, nursing and welfare, is essential. Such interprofessional team must operate under a common goal and mutual respect and understanding of their members' expertise. As one of the indicators of a well-functioning support system, strengthened cooperation of the interprofessional team in patient discharge path contributes to the community-based integrated care system.

The conference on critical pathway (CP) is defined as the opportunity of presentation and discussion with respect to CP and medical care quality by all professions inside and outside of the hospital. We investigated the effectiveness of the pathway committee activity with a focus on in-hospital conference on CP with questionnaire surveys in this hospital. We introduced CP in 2002. The pathway committee started in April 2006. The in-hospital conference on CP was held 70 times from June 2008 to December 2016 to widely encourage CP. We took a questionnaire survey after each conference. Furthermore, consciousness investigations for CP to all staff in this hospital were carried out two times in 2008 and 2016. As compared the 1st conference with the 70th conference, the number of approved CP and CP application rate have increased from 55 to 271 and from 26.2% to 55.5%, respectively. Questionnaire also unveiled that the clinical departments with low number and application rate of CP and which had less interests in CP existed. Satisfaction and comprehension of the conference doubled in 8 years in the attendees survey. The positive answers to advantage of the CP rose in the surveys in all staff in this hospital. But, the less effort in self-learning slightly increased, to our regret. The comprehension to CP and CP numbers and application rate increased by conference. CP seems to have widely penetrated in all staff. The pathway committee activity is essential for promotion and spread of CP. The education by conference is effective. Conventional conference has limitations toward decrease of staff motivation, toward self-study, and departments which had less interests in CP. New measures to improve this outcome must be considered.

The objective of this study was to elucidate the discharge destination of patients admitted to community comprehensive care wards and related factors as part of measures in such wards to support return to residential care. Subjects were 485 patients who were admitted to and discharged from community comprehensive care wards at hospitals A and B in the Kyushu region. The patients' age, sex, place of residence before admission, purpose and length of admission, level of need for nursing care at admission and discharge (items A and B), and discharge destination were investigated, and the factors related to discharge destination were identified. Patients whose discharge destination was their home or a residential care facility were classified as group I, and those whose discharge destination was a facility other than those indicated for group I were classified as group II. Patients who died during hospitalization were classified as group III. Patients in the community comprehensive care ward of hospital A (“a-ward patients” below) were classified to groups I to III, and patients in the community comprehensive care ward of hospital B (“b-ward patients” below) were classified to groups I and II. Among a-ward patients, the oldest was in group III, and the length of hospitalization was longest in group II. Scores for item A, the level of need for nursing care, were highest in group III at both admission and discharge. Scores for item B, the level of need for nursing care, were also highest in group III at both admission and discharge. Among b-ward patients, the length of hospitalization was longer in group II than in group I. The level of need for nursing care was also higher in group II than in group I at both admission and discharge. Relationships were observed between discharge destination and patient age, length of hospitalization, and level of need for nursing care, suggesting that these may be factors that influence whether a patient is discharged to residential care.

Since 2012, to promote the medical-dentistry cooperation programs in the cancer treatment, many cooperative cancer dentists were registered in Japan. But practical oral management before the cancer treatment was confined to in-hospital dentists, and cooperation between local dental clinics and oncologists was not common. Therefore, we started developing a medical cooperation model which preceded the cancer treatment in that the oral management is done at a patient's local dental clinic by request from the hospital oncologists.

At the beginning, we performed the first stage cooperation trial for twelve patients before operation. Subsequently, we performed the second stage cooperation trial for twenty-five patients before the dosage of bone modifying agents or anti-cancer agents. In the second stage trial, to obtain understanding of the need of the dentistry consultation, dental hygienists performed orientation.

To evaluate this system, we performed questionnaire survey for the medical doctor, the dentists who received patients, and the patients. This survey revealed high patient satisfaction and stability of our system.

In conclusion, we succeeded to construct the stable medical-dentistry cooperation system throughout two terms of trial.

This study aimed to develop a brochure for outpatients, to help them understand the nursing support offered for home care by the outpatient department. The brochure made it easy for outpatients to demand support when it was necessary. The study sample comprised 95 nurses from the outpatient department in X hospital, and we asked them about the usability of the brochure.

More than 80% of the nurses provided positive answers on the three questions pertaining to the usability of the brochure. For example, one of questions was “Do you think the brochure is an effective method to help a person grasp his/her need for home care support?” Regarding points for improvement of the brochure, the nurses clarified that it needed simplification. Other improvement points pertaining to practical utility were nurses' lack of knowledge regarding home care, uncertainty of roles related to home care support among medical service personnel in the hospital.

The prevention of trips is extremely important. However, the risks associated with the use of heelless footwear including slippers are not fully recognized by patients and healthcare professionals. At TOYOTA Memorial Hospital, a team called “Triangle no Kai,” comprised of members from various professions, led intra-hospital efforts to prevent medical accidents. They worked on the prevention of trips, with a focus on footwear. The team created “Best Shot,” a guide to standardize a safe care environment in terms of walking around, and then made a round of inspection. They created an informational leaflet on footwear for patient enlightenment. They promoted awareness among all the staff by presenting the risk of trips associated with wearing slippers via the hospital's intranet. No significant decrease was noted in the reported number of trips. However, there were no more serious accidents leading to severe physical injuries. Our experience suggests that preventive activities to eliminate the risk of footwear-related trips are effective.

The additional adjunct for doctor assistant, DA, was introduced in the revision of medical treatment reward for the first time in 2008. However, with the concern that this additional adjunct alone could not meet the required personnel expenses, there were hospitals which opted out of the introduction of DA out of fear that it may reduce the profit of the hospital. On April, 2014, our hospital have employed 33 DAs. The annual expenses required for the DA employment is calculated based on the annual salary and the annual expenses of employment insurance is 643,830,000 yen. On the other hand, the income by the additional adjunct of the DA placement of 15：1 was 73,047,000 yen. This resulted in 8,664,000 yen as an annual profit. In addition, the DA introduction resulted in not only decreasing the office work of physicians but also increasing inpatient and operation volumes. In conclusion, the introduction of DA contributes to increase in hospital profits.

There are many difficulties to establish emergency medical services in rural area. For keeping good motivation in the medical staff, we need some ideas for efficiency. In April 1, 2016, Minami-Nara General Medical Center was established in wider southern rural area of Nara prefecture where there was no emergency medical services. In preparation for some foreseeable problems in starting a new emergency department in a rural medical center, we created a new program much like ‘on-the-job-training’ where less-skilled doctors were buddied up with a versed doctor, and built a consulting system using ICT (information and communication technology). Every staff at our hospital can consult the other medical specialist who is out of hospital at any time. We accepted 22,369 patients including 6,929(31.0%) ambulances and 272(1.2%) doctor helicopters between April 1, 2016 and December 31, 2017. We were able to accept twice as many patients than we used to.

From our experience, we can say it is possible to manage emergent medical services in rural area by making enough preparations for risk hedge.