Healthcare worker's work-style reforms may contribute to not only the improvement of healthcare worker's well-being but also the improvement of clinical outcomes relating to patient safety. This study aimed to determine the relationship between physician's workloads and patient safety outcomes.
A systematic review was conducted on the literatures published from January 1964 to August 2018 in Ichushi Web and those published from August 2008 to August 2018 in PubMed.
As a result, 34 literatures relating to physician's workloads were obtained. There were many literatures regarding working time restrictions for residents in the US, but few studies with high-quality research design. There was no clear evidence that physician's workloads negatively affect patient's mortality and complication rates. On the other hand, it was suggested that physicians' increased workload could increase the number of particular types of errors.
To clarify the relationship between physician's workload and outcome relating to patient safety, studies with high-quality research design are needed.

Reperfusion of the coronary artery within a few hours from the onset of acute myocardial infarction (AMI) is important for patients' care. This study investigated the effect of family physician intervention on the promptness of acute coronary syndrome treatment.
From a total of 403 patients who underwent percutaneous coronary intervention at our acute care hospital for the diagnosis of AMI between April 2014 and March 2019, 187 consecutive patients who visited during the daytime on business days were included in this study. Patients were divided into two groups：with and without referral from other medical facilities (clinics and hospitals)；i.e., a home-D group and a direct group, respectively. The time from arrival at our hospital to reperfusion (door-to-balloon-time：DTBT), time from chest pain onset to reperfusion, and peak value of creatine kinase (peak CK) were compared between the two groups. DTBT was significantly shorter in the home-D group (93 ± 51 minutes, direct 128 ± 81 minutes：P = 0.010). However, the time from onset to reperfusion was significantly shorter in the direct group (519 ± 402 minutes, direct 370 ± 337 minutes：P = 0.017), although there was no significant difference in the peak CK value. This study indicated that this system also contributed to the reduction in DTBT. However, further improvement of the cooperation system is required to reduce the onset to reperfusion time.

In Japan, aging of population is accelerating. The majority of the population hopes to be treated at home at the end of life. However, when receiving home medical care, there is concern that you may not be able to go to hospital immediately when symptoms change suddenly. Therefore, it is important to reduce this concern. It is also important to consider the impact on management at hospitals that accept many of these patients. Therefore, it is important to have an overview of these patient characteristics.
The aim of this study is to clarify the difference between the characteristics of hospitalized patients and the proportion of hospitalization by ambulance of patients with home medical care before hospitalization. Using large-scale DPC data, we examined differences in patient attributes, hospitalization status, and discharge status according to the presence or absence of home medical care. As a result, patients with home medical care, the proportion of co-morbidities such as dementia and cancer, the proportion of patients with malnutrition and low ADL, and the proportion of people transferred to nursing homes were high, and the number of hospitalization days was long. In addition, the proportion of hospitalization by ambulance was high in many diseases. From this result, the hospital in charge of hospitalization treatment for patients who receive home medical care needs to pay attention to the influence on management due to prolonged hospital stay days. Therefore, it was thought that it was important to work on the optimization of admission and discharge management such as the improvement of the logistical cooperation and to work on hospital management without any adverse effect.

In recent years, our hospital has been urgently required to secure the number of new inpatients due to the shortening of hospital stays with the introduction of DPC (Diagnosis Procedure Combination) reimbursement system and the shift to a regional medical support hospital. Against this background, the aim of acquiring new inpatients has been to increase the ambulance acceptance rate since June 2017 as a hospital-wide effort. In this time, we examined whether the establishment of an emergency medical system that does not refuse calls will contribute to hospital profits. We have set an average ambulance acceptance rate of at least 75% per month. Then, they were divided into a reinforced group and a non-reinforced group and compared on a monthly average. As a result, the number of ambulances accepted, the acceptance rate, and the number of ambulance hospitalizations increased significantly in the reinforced group. Furthermore, in the reinforced group, the bed utilization rate, the number of new hospitalized patients increased, and the hospitalization income also increased significantly. This finding suggested that strengthening the hospital's emergency system could further increase the number of new inpatients in the entire hospital and increase hospitalization revenue.

Our Nutrition Support Team （NST） started medical and dental collaboration after the Great East Japan Earthquake. Perioperative oral management was newly introduced by revision of medical fees in 2012, so we planned to expand medical and dental collaboration by perioperative oral management. We started from esophageal cancer patient's preoperative oral management, gradually expanded to prevent osteonecrosis of the jaw, radiotherapy and chemotherapy patients. The target patients gradually increased, and many patients were referred to regional dental clinics. We think the medical and dental collaboration is expanding our region, but questionnaire for members of dental association revealed lesser and insufficient information sharing. Tackling this discrepancy will be our next task.

Nowadays, workstyle reforms have been promoted and there is an issue in medical community that hospital physicians are working too long because of night shift. Hospital physicians usually work at night consecutively even after daytime work, and there are concerns regarding the decrease in their concentration which possibly contribute to medical errors. In this study, we investigated how much concentration would be decreased after night work for pediatricians and which factors would affect decrease in concentration. Psychomotor Vigilance Task (PVT) was carried out to investigate the decrease in concentrations of pediatricians in our hospital after night work from December 2018 to January 2019. We conducted a questionnaire with items that included frequency of call, how time was spent during night work, and subjects are residents or supervisors. PVT was also carried out on different day for control. PVT time was significantly delayed compared to control after night work in all seven subjects. The factors which affected PVT time were frequency of call and sleep time. Residents had more delayed PVT time, which supposedly could cause decrease in concentration. In this study, we showed quantitative decrease in concentration after night work. Especially, residents are susceptive to mental and physical task due to their immaturity, as they spend more time to see patients and less time to sleep. Hospital pediatricians should consider how to do shift work for their health and medical safety.

As previously reported, the administration of fat emulsions causes catheter-related bloodstream infections, which lead to a tendency to avoid administering fat emulsions under total parenteral nutrition control. One-hundred patients under total parenteral nutrition involving 15 patients with catheter-related blood stream infections were examined for whether the administration of fat emulsions can be a risk factor of infection or not, along with other factors.
Catheter-related bloodstream infections were more likely to be confirmed in patients who had been administered fat emulsions (group with infection：66.7%, group without infection：37.6%, p=0.036), along with significant differences in the value of serum albumin prior to starting total parenteral nutrition (group with infection：central value 1.9 mg/dl, group without infection：central value 2.5 mg/dl, p=0.001) and the presence of diabetes (group with infection：53.3%, group without infection：23.5%, p=0.018). On the other hand, there were no significant differences in terms of the placing position of the catheter, number of lumens, and duration of the catheter placement.
These results suggested that catheter infections increased not only with administering fat emulsions but also with hypoalbuminemia and diabetes. The nutritional management in the previous stage is required for preventing catheter-related blood stream infections.

An antimicrobial stewardship program (ASP) is regarded as an effective countermeasure to Antimicrobial resistance, and it is widely adopted in large hospitals. However, in community-based integrated care systems, small to medium-sized hospitals should work towards implementing an ASP as well. The difficulty for them has been the lack of skilled staff, and the effects are unclear. We started an ASP in our small hospital in April 2018 and validated the effects of our ASP in this study. Our ASP is comprised of 2 parts：① notification of specific antibiotic prescriptions and ② post-prescription audits and weekly reviews. The median (interquartile range) of the number of culture specimens 6 months before 77.5 (70.3〜84.0) and 15 months after 127.0 (117.0〜142.0) starting the ASP increased significantly ( p ＜0.001). The median (interquartile range) of the antimicrobial use density of meropenem in both periods was 31.7 (28.8〜33.7) and 24.1 (19.1〜30.1), respectively. This decrease was not statistically significant ( p ＝0.173). The median (interquartile range) of the detection rate of carbapenem-resistant Pseudomonas aeruginosa in both periods increased from 0.0% (0.0〜0.0%) to 3.6% (1.4〜7.0%), significantly ( p ＝0.007), although it decreased gradually after starting the ASP. In this study, an ASP was effective in a small hospital despite the limited availability of skilled staff.

At Nagasaki university hospital, ward pharmacists check the brought-in medicines and the situation of preoperative discontinuation drugs for all hospitalized patients through the interview on the hospitalization day. Ward pharmacists then input the drug information of patients to electronic medical records for uniform management. Patients undergoing operation on Mondays had been hospitalized on Fridays (three days before operation), but since April 2017, they were hospitalized on Sundays (a day before operation) for shortening hospital stay.
There had been concerns about safety problems because ward pharmacists were not able to interview patients hospitalized on Sundays, and we began a pharmacist outpatient care to check brought-in medicine (POCBM) for patients who scheduled for hospitalization from May 2017. POCBM enabled medical professionals to refer the drug information of patients by using electronic medical records even when pharmacists are absence. Also, if the patients scheduled for operation were taking preoperative discontinuation drugs incorrectly, ward pharmacists would conduct the cessation of preoperative discontinuation drugs as needed after the referral to attending doctors. These approaches enable pharmacists to confirm the preoperative discontinuation drugs which doctors are unaware of and are effective to avoid postponement or cancellation of the operation.
POCBM began with patients whom doctors requested for patients hospitalized on Sunday. In medical fee revision FY 2018, medical service fees related to checking brought-in medicine for patients scheduled for hospitalization was introduced. The importance of checking brought-in medicine for patients scheduled for hospitalization was recognized. “A pharmacist outpatient care to check brought-in medicine for patients scheduled for hospitalization” is expected to be implemented on more patients who are scheduled for hospitalization. Thus, we are planning to expand the target patients.

We investigated how the directors of the nursing division feel and care about nurses not using the child-raising and care support system. The subjects are 142 nurse administrators from hospitals adopting a shift-work system. The method is a postal questionnaire survey. Survey contents are；basic attributes, the status regarding the promotion of work-life balance (WLB), and factors that may increase the work burden of nurses as well as measures to reduce their burden. Descriptive statistics were performed using SPSS ver.23. In addition, one-way analysis of variance was conducted to evaluate the relationship between the presence or absence of the staff's work burden perceived by the nurse administrators and the number of hospital beds；and that of nurses, the presence or absence of groups promoting WLB, and approaches to WLB.
This study was conducted with the approval of the ethics committee of Okayama Nursing Association. A total of 116 responses were obtained with a response rate of 82%. The nurse administrators considered that “frequent night-shift work, overtime work, working on holidays, sudden shift change, and an increased workload” might increase the work burden on nurses. They also considered that a “sudden shift change” and “participation in a committee” increased the staff's work burden in hospitals with low number of beds and nurses, respectively. We must deal with issues, such as the “reform of the committee”, “reduction of the staff's work burden in small-to middle-scale institutions”, and “further promotion of WLB in order to help nurses continue working in large-scale institutions”.