The Journal of Japan Society for Health Care Management

The department of medical social work and discharge planning was established in the University of Tokyo hospital to ensure that patients would receive proper care at right place. The discharge planning team consists of a physician, a medical social worker and a home care coordinator.
The home care coordinator, who coordinates with the home nursing station and the primary care physician, is effective for advance of home care. The role of the home care coordinator is to relieve patients of their anxiety about home care. As a result, the number of home care patients has gradually increased.

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We evaluated whether is better to use Critical Path or not to use Critical Path by studying outcome management in the health care of laparoscopic cholecystectomy in our hospital. We studied the clinical outcome, hospital stay cost, length of hospital stay, and patient satisfaction. Regarding the clinical outcome, there was one patient with an umbilical wound infection in the Critical Path group. We suspect that insufficient umbilical treatment on the part of the medical staff was the cause of this. The length of hospital stay with the Critical Path group was almost the same as the control group. The varying factors were, a prolongation of hospital stay due to wound infection, patient uneasiness about leaving the hospital before the sutures were completely removed, the need of a decision on the date of discharge, and a shortening of the overall length of the hospital stay before the operation. In the Critical Path group the average hospital stay cost decreased 3.5% for total medical expenses and increased 4.0% for daily costs. We suspect that the cause of the decrease in expenses was the unification of drips and hematological examinations. Regarding patient satisfaction, the average Critical Path patient evaluation was over a score of 4, on a scale of 1 to 5, and more patients have had good motivation for recovery, for fighting further illness, and for receptiveness to treatment.

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We evaluated methods of detecting adverse events, through continuous management of nursing service quality, via correctness and cost. This research was conducted from July to November 2000 at a general hospital with 281 beds in Tokyo. We collected adverse events, including unplanned removal of invasive lines, medication errors, falls, pressure sores, skin deficiencies, physical restraints, and nosocomial infections, through incident reports, logs, checklists, nurse interviews, medication error questionnaires, temperature tables, urine leukocyte tests, patient interviews and medical records. Comparing the consumed investigating time against the number of detected adverse events for each method, it became clear that we could detect adverse events almost consistently and more costeffectively via incident reports, check lists, nurse interviews, temperature tables, urine leukocyte tests, and medication error questionnaires. However, it is necessary to collect longer-term data from many institutions enabling us to decide term and formula for adverse event occurrence rate calculation.

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