Targeting all member hospitals of the All Japan Hospital Association, a questionnaire survey regarding medical safety control systems and investigation systems of adverse events etc. was executed. The response rate was 24.0%(506/2108).
The survey showed that serious accidents were experienced in larger-scale hospitals. 1/3 hospitals with 200 beds or more experienced adverse events where patients died or were left with heavy sequela (serious accident). Moreover, cases which include outside members in the investigation team regarding serous accidents were still few. However, about 1/3 of the hospitals had received the support of an outside specialist normally a law person. Another result of the survey showed that only in rare cases staff, involved in these serious accidents, was given temporary holiday or psychological counseling. It is presumed that support systems for staff, involvedin serious accidents, have mostly not been established. When trying to find the cause of adverse ev nts, about 1/3 of the hospitals answered that they were embarrassed that there was neither a specialist of safety management nor a specialist of investigation at their hospital. There were also many hospitals not only troubled by the care of their patients or patient' s families but also by the care of staff involved in serious accidents. Furthermore, it has been understood that the hospital's expectations for ADR (Alternative Dispute Resolution) is very high.
For the future, there is a strong need to train and increase specialists of investigation and examine methods of introducing ADR.

View full abstract

Several incidents were reported within a few months about errors of flow volume of intravenous infusion when infusion pump was engaged to maintain accurate flow rate. These reports prompted us to inquire the actual clinical condition and to resolve underlying problems. The infusion pump used in our hospital controls flow rate by peristaltic device, where the flow rate depends on the diameter of the infusion tube. Most of the reports described that the actual infusion volume did not reach the expected volume. This fact suggests, together with the mechanical characteristic of the peristaltic method, that the insufficient flow volume might be related to a narrowed diameter of the infusion tube induced by stretching while installing it on the pump. We therefore investigated the relationship between tension by stretch on the tube and flow volume. The residual volume of infusion was measured daily for inpatients who underwent24hr continuous intravenous infusion with a pump. The residual ratio was12.2±3.2%(n=14). Then, the relationship between stretch and flow volume was investigated experimentally. Compared with the control experiment the total volume of water significantly decreased after24hr operation of the pump with mild- or strong-manual stretching of infusion tubes. A quantitative analysis with Og, 100g, 200g and 500g weight revealed an inverse relationship between weight and total flow volume. These results indicate that even a mild stretch of the infusion tube at installation on the pump can result in a decreased flow volume. This information was explained thoroughly to the nursing staff. As a result, reexamination of the clinical residual ratio showed a significant decrease of 8.1±2.4%(p<0.01, n=16) as compared with the control experiment. In conclusion, careful operation is required for the installation of infusion tubes on the pump to perform an accurate infusion.

View full abstract

The Seamless Care Study Society was established in the central and western part of Kagawa Prefecture in November. 2005, for the purpose of a continuous community-health-care cooperation without interruptions between acute stage hospital stays and patients' home. Up to July 2006 seven study workshops with36institutions and 196 persons' participating were held. Participants' occupations were various including physicians, nurses, physical therapists, occupational therapists, speech therapists, dietitians, care managers and administration officials.
The range of cooperation includes care from an acute stage hospital to being home as well as standardization of medical treatment and rehabilitation steps and the use of a common language in every institute. Liaison critical paths of “cerebral apoplexy”, of “femoral neck fracture”, and of “swallowing difficulty and NST” were drawn up by three study groups, and are already implemented.
Results will be analyzed by a case conference and a variance check and further improvement of a critical path will be implemented in the future.

View full abstract

Cerebral apoplexy, which in many cases results in various sequelae, is a typical disease which requires community healthcare management. About 40 percent of the stroke patients hospitalized at the Kagawa Rosai Hospital in 2005 have moved on to other institutions. Medical cooperation without a interruption is indispensable for offering quality medical care among stroke patients. Although an organization of medical cooperation was already established in this hospital, there were nocommon tools for interaction between institutions. For this purpose the Seamless Care Study Society was established in November 2005 and create d a liaison critical path for cerebral apoplexy. The liaison critical path of cerebral apoplexy, which works on an Excel base, enables efficient input and sharing of information. Discussions with the many regional services was useful in the creation of the liaison critical path as well as in the network formation between institutions. The liaison critical path of cerebral apoplexy has just been newly introduced and will be further improved in the future through accumulation and analysis of variances.

View full abstract

Over the period from October 2001 to January 2005 an investigation was conducted concerning the changes in glycohemoglobin and pharmacotherapy of 14type-1 and of 106 type-2 hospitalized diabetic patients, introducing the critical pathway for the management of diabetic patients. The mean glycohemoglobin for all patients (n=120) decreased significantly, from 10.4% on admission to 8.6% and 6.8% respectively one month and 3months after admission, and was maintained up to 12 months later (p<0.05). Glycohemoglobin was significantly reduced in both the type-1and type-2 group. Investigation of the pharmacotherapy before and after hospitalization and 12months later revealed that 49% of the 106 type-2diabetic patientsdid not undergo pharmacotherapy before hospitalization and only initiated pharmacotherapy in the hospital. The number of patients treated with an oral diabetic drug alone decreased from 45% before to 37% after hospitalization. The number of patients treated with insulin alone increased from4% before hospitalization to 45% after hospitalization. Of the patients treated with insulin, 18% were withdrawn from insulin therapy 12 months after their hospitalization which included the diabetes education program and 7% required no additional pharmacotherapy. The results of the glycohemoglobin examination after hospitalization for diabetes confirmed that hospitalization with a diabetes education program is useful as one of the means to decrease glycohemoglobin significantly. Furthermore, it was revealed that many patients started pharmacotherapy or changed to pharmacotherapy during their hospital stay. Therefore medication education of these patients by pharmacists is important.

View full abstract

This survey investigated 196 outpatients' waiting time during all phases of medical consultation such as waiting time at reception and separately waiting time before the actual examination, if it occurred Even though significant differences were not found for the overall waiting time for initial medical consultations, subsequent examinations and pre-scheduled examinations, the actual consultation time was longer for patients coming for a first examination than for patients coming for subsequent or pre-scheduled examinations. The actual hour of arrival for the examination was not related to waiting time. The number of treatments on patients at their first consultation was higher than for patients coming for repeated or pre-scheduled examinations. Hospital stay increased the more treatments a patient received. Since examinations of outpatients are base on each patient' s individual condition (first timer or not), outpatients waiting time must also not only be calculated based on the outpatient's condition but also on each of the medical treatments received. Affirmative action from physicians is expected, especially for improving consultation waiting time.

View full abstract

The Fukui General Hospital Medical Welfare Facility has a total number of personnel of 1, 014. In 2003 a Staff Education Committee was established and an education system for the whole staff was introduced the same year. The system consists of staff training regulations, workshop introductions and regulations related to business trips (attending academic conferences or workshops). Staff training is divided into two parts: 1. a specified mandatory training and 2. an autonomous independent training. The specified mandatory training includes training for new employees, training for those who have been working for 3 months, training for those who have been working for 3 years, and training for executive officers. The autonomous independent training is defined by presentations and attendance. Depending on the service needed, each type of training is converted into smaller units.
A target number of units is set for each type of training. The facility's workshop regulations define the approval criteria for workshops inside the center. Attendance to academic conferences or workshops outside of the center is to be approved according to presentations of the previous year. A study showed that in fiscal 2004, attendance of the new employee training was 93.5% and 90.0% for those who have been working for 3 years. The target achievement rate for attendance of the autonomous independent training is 68.2%, but presentations are evaluated only every 5 years and no results have yet been obtained. However, 73.5% of the staff never acquired even one presentation unit last year. 59 workshops and other events were held in the facility that year.
By introducing this education system for the whole staff, a consistent education and evaluation process has been made possible. In the future the target achievement rate and quality of training will need further improvement.

View full abstract