Last few years, safety management has been an urgent issue in hospitals of US, Europe and Japan. According to chart reviews in US and Europe, average frequency rate of medical accidents in hospital was 0.432% for one hospitalized patient. In order to prevent accidents, incident reporting system hasbeen introduced at hospital and national level. In Japan, Ministry of Health Labor Welfare has started incident reporting system since 2001 and already collected 10, 000 cases all over Japan. Root cause analysis (RCA), one of case analyzing methods for accident/incident cases was also reviewed in this article.

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We retrospectively studied clinical features of consecutive 34 patients (74.4±14.7 years) with unconscious who were admitted to our department between Feb. 2000 and Jan. 2002, and made critical path for unconscious patients. 82% of patients had previous illness. Examinations done during the hospitalization were as follows; brain CT (100%), cervical ultrasonography (88%), cardiac ultrasonography (88%), 24 hours holter electrocardiogram (68%), electroencephalogram (62%), brain MRI and MRA (35%). Clinical diagnosis were vasovagal syncope (12 cases), TIA (5 cases), epilepsy (3 cases), angina pectoris (3 cases), hypotension (2cases), sick sinus syndrome (1 case), hypoglycemia (1 case), and undetermined (7 cases). The average days of hospitalization was 9.1±7.0 days. From these data, we determined the goal of critical path, examinations, observation items, and the days of hospital stay.

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In the Department of Ophthalmology, critical path for patients after lateral cataract surgery has been applied since September 2001. To evaluate its effect, the length of hospital stay and the grade of self-care were compared between 27 cases treated in 2000 (pre-path group) and 23 cases treated in 2001 (post-path group).
As a result, postoperative hospital stay was 6.9±1.7 days in the pre-path group and 5.4±1.3 days in the post-path group, and total hospital stay was 10.0±2.5 days in the pre-path group and 8.6±2.2 days in the post-path group.There are significant differences between these two groups. With respect to self-care, both self-administration of eye drops and ability to carry our shampoo were evaluated. Of the postoperative days when the patient became capable of self-administration of eye drops, it took 2.8±0.9 days in the pre-path group and 2.1±1.0 days in the post-path group. As regards shampooing, it took 3.6±1.1 days in the pre-path group and 3.0±0.6 days in the post-path group. In both parameters, the postoperative days when patients became capable of self-care were shortened significantly in the post-path group in comparison with the pre-path group.
The implementation of the critical path for patients after lateral cataract surgery is effective for the shortening of hospital stay and the improvement of the self-care capability.

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To clarify utility of the blood glucose control critical path for two weeks in diabetic patients, length of stay, plan achievement rate, and discharge standard achievement rate were examined by comparison to those in blood glucose critical paths for three weeks. There was no significant difference in the number of patients, age, length of stay, and the discharge standard achievement rate except a plan achievement rate between both critical paths. However, when both groups were compared except for those who not achieved discharge standard, the length of stay in the blood glucose control critical path for two weeks (21.3±7.7 days) was significantly shorter than that for three weeks (18.2±7.5 days) (p=0.02). There was no significant difference in a plan achievement rate between both groups (57.6% vs 42.6%). Furthermore, while correcting variance of the plan achievement, the blood glucose control critical path for two weeks used in succession was divided into the first half and the latter half. In comparison to these both groups, the age in the latter half (65.9±10.0years) was significantly higher than that in the first half (59.3±14.7years) (p=0.05), but the length of stay in the latter half (20.4±7.27days) was significantly shorter than that in the first half (16.0±7.3days) (p=0.02). Besides, the discharge standard achievement rate (58.0%) in the latter half was significantly higher than that in the first half (26.7%) (p=0.02). As the length of stay variance, it was 53 patient factors (delays of recovery 33, lack of understanding 19, onsets of complication 33), staff factors 20 (an insulin treatment introduction delay), hospital factors 8 and, as for the discharge standard achievement variance, it was recognized 14 cases in a patient factor entirely.

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Parkinson's disease is a neurodegenerative disorder with a slowly progressive course. Information was obtained through a questionnaire on 114 outpatients. As many as 60.5% of the patients wanted to know more about the entire course of the disease. Approximately 30% of the patients were interested in drug therapy and its adverse effects, available social resources, proper feeding, home safety measures, and rehabilitation. These results prompted us to develop an outpatient critical path providing information essential to the decision-making process by the patients. Multidisciplinary information was described in the style of Gantt chart with an abscissa in Yahr stages. The information included an overview of the symptoms and complications of the disease, treatment, rehabilitation, and available social resources. In the CP also indicated is how to obtain detailed information.
After reading the CP, approximately 60% of the patients answered that they became more informed about the symptoms and the entire course of the disease. As a measure of patient satisfaction, we determined the ratio of patients who felt to be informed by reading the CP to patients who needed information. The ratio was 65.2% for information about symptoms and complications and 56.9 % for about the entire course of the disease. This CP is a useful tool for the provision of multidisciplinary information.

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Critical path has been developing containing so many merits which allows us to discuss it, s importance of the management of the process and also the outcomes in the many medical institutes. However there is few institutes which has the guideline and general monitoring system of Critical path. So we developed the standards appraisal system of Critical path which enable us to have most efficient usage of Critical path system.The contents of standards of the outcome of Critical path showed reasonable results. This system acts us the useful method of management and evaluation of Critical path.

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We reviewed practices for the prevention of adverse drug events (ADEs) from the Making Health Care Safer (AHRQ) or interviewed to key persons of best-practice hospitals in Japan. The practices have been arranged in the order of importance or easiness for introduction with regard to relationship with the process of drug administration. Our recommendation of ADEs prevention is as follows: (1) a patient safety committee, reviewing all ADEs cases by reporting system, should be arranged in each hospital to detect defects in the process; (2) a patient safety committee analyses the task in the drug administrating process by using of Failure Mode Effect Analysis; (3) a patient safety committee should discuss (1) abolition of hand-written transcription, (2) use of consistent medical devices (infusion pumps), (3) protocols for high-risk drugs, (4) selection of look-alikeor soundlike drugs, and role of clinical pharmacists. We also hope source-marking for all drugs of Japan will be in widespread use in near future.

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We have developed a management system of pressure ulcer as a part of the hospital risk management, considering that the occurrence and worsening of pressure ulcers as risk factors to the hospital management. This system consists of following 6 elements: 1, Introduction of the common 2-step standard of the pressure risk assessment (primary and secondary judgment) to all staffs of the hospital and construction of the care standard for pressure ulcer based on the assessment. 2, Centralization of reports on the occurrence of pressure ulcer and the supply of the pressure relieving mattresses. 3, Intervention of the nutritionists to the hyponutritious patients. 4, Introduction of the critical path (CP) to the treatment of pressure ulcer. 5, Submission of the incident reports on the case of worsened ulcer. 6, Education system for the hospital staffs (6 times of wound care seminar every year). There have been effects of introduction of this system as followings; 1, With the two-step scientific assessment, man-power could be reduced to the minimum and adequate preventing measure and care could be offered. 2, Centralized control system has made it possible to give the precise knowledge of the occurrence of pressure ulcer and to make an adequate distribution and effective usage of the pressure relieving mattresses. 3, Introduction of the CP have made it possible to have a standardized and high-grade care and to reduce the length of the hospital stay. 4, Both the occurrence and the worsening of the pressure ulcer have been highly reduced.
In conclusion, in making an adequate measure for pressure ulcer as a whole hospital, it is very important to make an adequate system of management and education.

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The medical accident is increasing year by year including small mistakes. To prevent these accidents, hospitals should make some actions. In Chukyo-Hospital, the pharmacists are doing medicine management for all patients in 1998 and afterwards. The ward pharmacists check every prescription by doctors after grasping the inpatients backgrounds. This medicine management system is effective to prevent accidents by drug misuse.
This time, we report the result of checking about 8, 500 injection prescription sheets and internal prescription sheets for inpatients during past six months in a mixed ward. 165 sheets of unsuitable directions and prescriptions were found. 56 sheets of 165 were double medication of gastric internal medicines from our hospital and other hospitals. 12 sheets were also double medication of medicine by injections and by internal medicines. These mistakes seem not so serious. On the other hand, we found serious mistakes. 12 examples were over-medications for patients whose kidney functions were reduced. 9 examples were contraindicated prescriptions. 5 examples were allergy inducers for the allergic patients. 4 examples were unsuitable drug combinations. Three examples seemed making bad effects against operations. 3 examples were all serious and we could prevent accidents beforehand.
We want to work active as risk managers in our hospital to protect inpatients from accidents and to be trusted by inpatients.

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We examined a cross-sectional survey to investigate the relationship between waiting time, time with a physician, physician continuity and patient satisfaction on outpatient setting. Fifteen hundred outpatientin an educational hospital were sampled and asked about time spent for waiting and for meeting with aphysician. Five-ranked response choices were adopted. For asking patient satisfaction, we used 14 item questionnaire that included three dimensions of patient satisfaction; satisfaction for physicians (PSMD), satisfaction for nurses (PSNS), and general satisfaction (PSGN).
For the concrete question item “How much extent are you satisfied with the meeting with the physicians today?” 86% of the respondents answered “very satisfied” or “satisfied”. Subgroup statistics showed that all mean scores of the PSMD, PSNS, and PSGN scales significantly higher among patient groups whose meeting time with a physician were “5-10 minutes” and “10-20 minutes” than those with shorter or longer meeting time. The patients with whom the same physician continuously made appointments had higher score in PSMD and PSGN than those who saw different physicians. Our results suggested the importance of appropriate meeting time with physicians and clinical continuity for service delivery on outpatient setting.

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This article is trying to analyze the efficiency of the information-Technology (IT) in the medical services. IT has the efficiency to affect every part of service delivery equation, from concept and strategy to equality, cost, production and delivery. Then we practiced analysis how we can use IT in the medical services and cited the example and the study analysis which can be easily making use of by medical institutions themselves through the Telemedicine.

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It is guessed the causes of the Medical Fault Prevention to be the information transmission or defective in knowledge and technology or discontinuation of the work or urgent time. This study is in focus to the section of nurses that to be the direct offerers in the medical service then analyzes by the Information and Knowledge for the Medical Fault Prevention.

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