Early intervention is required to carry out smooth discharge adjustment in the hospital dealing with patients with acute stage disease. In the present study, we investigated the characteristics of the patients who were unable to return to their original residences on discharge. Subjects were 657 patients (mean age 71.2 years) discharged from our hospital between June 1 to June 30, 2018. Approximately 10% of the patients were unable to return to their original residences. Most of them (N=53) lived in their own home or a nursing home before admission. They were generally old (mean age 81.2 years) and the top reasons of hospital admission were aspiration pneumonia, followed by bone fracture and neurological diseases such as intracranial hematoma or stroke. For the patients with these diseases, the disorder of the activity of daily living (ADL) made it difficult to return to their original residences and they were in need for finding medical facilities for recovery or recuperation on discharge. Thus, early intervention is crucial for the medical staffs including medical social workers, to promote smooth collaboration with regional medical facilities, especially when the elderly patients with above mentioned diseases are hospitalized.

The aim of this study is to determine the factor that significantly impacts the home discharge of disuse syndrome patients. This study included 425 patients with disuse syndrome, who had followed by rehabilitation. Excluding cases of bedridden before hospital admission；rehabilitation period less than 1 week；death discharge；the degree of independent living is C2, 1-week discontinued rehabilitation.

We retrospectively evaluated the factors available from the medical records. The factors included age, sex, primary disease, length of stay, period until the start of rehabilitation, rehabilitation period, functional independence measure (motor, cognitive, total), total units of rehabilitation provided, the average number of units of rehabilitation, life space, degree of independent living, discharge destination. For the statistical analysis, we used multiple regression analysis.

Logistic regression analysis was conducted on a) toilet transfer, b) urination management, c) lower body changing, which showed significant difference between the groups. We think that short-term intensive involvement in self-care (lower body change / excretion) and transfer is important for home discharge of elderly patients for acute rehabilitation.

To clarify the efficacy of the oral care, a standardized oral care procedure was performed in our medical and care facility. According to the development of oral care, the oral environment index (OEI) improved significantly. The incidence of fevering over 38℃ between the clean group and others, the clean group showed less incidence of fevering.

It was suggested that the intensive oral care prevents pneumonia of patients in the medical and care facility.

The Kanagawa Prefectural Keiyukai Keiyu Hospital performs 4,850 operations a year as an acute hospital with 410 beds. In 2015, an additional operating room was planned to accommodate the increasing number of emergency operations. As a result, the reduction of the clean supply room was forced, and efforts were made to reduce and maintain medical materials, surgical instrument sets, and small steel items used in surgery in order to save space. First, the numbers of surgical instrument sets and small steel items used in the field were surveyed and counted. The type and number of small steel items used for each procedure were extracted, and the data was used to reexamine the contents of the surgical instrument set, and a new instrument set was created without waste for each procedure. The basic set is a set of instruments commonly used in several operations, and steel accessories frequently used separately for each procedure were attached as separate operative sets apart from the basic set. Conventionally, surgical nurses had prepared different sets at the time of instrument preparation, but differences occur depending on the ability of nurses. This mostly experience-based instrument preparation was a psychological burden for younger, inexperienced nurses. By setting a small set of steel items ordered according to the operation method, it was possible to shorten the time for instrument preparation and deployment, and the physical and mental burden was also reduced. With this approach, repeated sterilization of unused equipment, long storage of sterilized unused inventory, and safe-keeping storage prepared for a doctor or a nurse, had been eliminated. As a result, the number of small steel items was reduced by 48.8%, and space saving was achieved. In order to continue standardization in the future, periodical review is necessary.

CART (Cell-free and concentrated Ascites Reinfusion Therapy) has been reported to be practiced in various facilities in recent years as a treatment for refractory ascites, and the number of enforcement cases is increasing year by year. Nishijin hospital has been implementing CART since 1999. Before and after filtration concentration, TP measurement using a refractometer is carried out as a biochemical test of total protein (TP) and albumin, and as rapid measurement. The measurement principle is different between the biochemical test (Biuret method) and the refractometer, and measurement values can differ between the two tests. On examining the enforcement record of our hospital, we confirmed that the refractometer can be fully used as a confirmation method before action to the patient. From this fact, while refractometer needs close attention to use on ascites after collection, we consider it is useful as a quick measurement before action.