We examined the effect of the introduction of critical pathway in surgical ward especially focusing on the gastric cancer case. We started 14 kinds of critical pathway including gastric cancer from August 2001. We studied the economical efficiency during two years (before and after critical pathway started) with the length of stay, the number of new hospitalization and the total amount medical expense, the average medical expenses a day of 156 gastric cancer patients (74 examples before critical pathway started and 82 examples after). The standardization of medical treatment of those patients was examined from each medical examination act such as a meal start after operation, intravenous drip medication period, an antibiotic medication days, postoperative admission days and the removal of nasal tube drain. We performed the questionnaire to them to know the degree of their satisfactory. The length of stay becomes short and the number of new hospitalization increases. The total amount medical expenses become low, but the average medical expenses a day becomes high. Medical standardization progresses among each doctor. Intravenous drip medication, the antibiotic medication period are significantly shortened. Nasal tube and drain are removed earlier than before with a significant difference. As a result patient undergone an operation begin to walk early and become to leave hospital early. The complication rate is reduced, but there is no significant difference. The degree of patient satisfactory is extremely high and not only a patient but a family can participate in medical treatment positively. We can get the economical efficiency effect, medical standardization and the patient satisfactory by critical pathway introduction.

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[Introduction] The purpose of this study was to assess the implementation of new comprehensive medicalfee system which utilizes a Diagnosis Procedure Combination (DPC) and a critical pathway (CP) for pulmonary resection with conventional thoracotomy in patients with pulmonary malignancy. [Methods] Patients in a DPC category (Diagnosis: malignant pulmonary tumor, Procedure: pulmonary resection with conventional thoracotomy for malignant tumor, Other procedures: none, Concomitant diseases: none) were divided into 2 groups. A control group (n=30) was applied to fee-for-service system without CP and the DPC+CP group (n=19) was applied to the new system with DPC and CP. We compared rationality and safety of postoperative management and the economic effects of medical care. [Results] Total hospital stay (control/DPC+CP: 29.6/17.1 days), postoperative stay (19.7/10.6 days), Intravenous drip (5.0/2.8 days), perioperative antibiotic use (10.3/3.8 times), venous blood examination (5.8/3.1 times), chest drainage tube placement (4.2/3.4 days), postoperative chest X-ray (8.9/5.1 times), postoperative oxygen therapy (80.4/74.9 hours). All parameters except oxygen therapy in DPC+CP group decreased significantly than those in control group (p<0.01). Postoperative morbidity rate was 0.33/0.44 and readmission rate was 0/0.083. There was no case of postoperative death. Although there was no significant difference between control and DPC+CP group in total medical-fee (174, 121/170, 832 points), daily medical-fee in DPC+CP group of 4, 876 points increased significantly than that in control group of 5, 318 points (p<0.001). [Conclusions] The simultaneous implementation of comprehensive medical-fee system with DPC and CP brought about improvement of postoperative management with improved quality of outcome and shortened length of hospital stay. Total medical fees with DPC were maintained at the level of fee-for-service medical care.

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[Purpose] Critical path have been developed to guide evidence-based practice in health care. We have recently cared for pediatric patients needed for surgery in the word that had been consisted of patients with internal disease. Then we adopted critical path for surgery of pediatric inguinal hernia in order to standardize the critical process of therapy and the nursing care system, and evaluated the significance of the attempt. [Patients and Methods] From April 1, 2003, through December 31, 2003, surgery was performed for sixteen pediatric patients with inguinal hernia in an acute hospital. We applied critical path for those patients. [Results] We could have some evidences as followings. (1) shortened the average length of stay (2.9±0.1days) in contrast to that before the attempt (3.6±0.3days). (2) had a increase in the cost of admission a day (80, 040 yen vs 78, 690 yen/day). (3) became fewer doctor's orders. (4) had a firm grasp of process of the treatment and the nursing care. [Conclusion] The application of critical path will bring a profound quality improvement for medical staffs and hospital management, and of course for patients.

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Using hospital database managed by Japan Hospital Pharmacist Association, 58 hospitals were randomly selected and 271 case data of inpatients who received medication counseling and instruction by hospital pharmacists were collected. Pharmacists with “check sheet ” evaluated these inpatients about understanding of medication, anxiety for medication, and compliance with medication instruction twice, just after admission and just before discharge. Using collected data, Wilcoxon matched-pair signed-rank test was performed to clarify the effects on patient outcomes by performing medication counseling and instruction. The results were as follows: (1) patient understanding of medication was significantly improved. (2) patient anxiety for medication was significantly relieved. (3) patient compliance with medication instruction was significantly improved. As the reason of the study results, there are facts that the patient outcomes about medication were significantly improved by pharmacists' performance of medication counseling and instruction in hospitals.

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In the field of sports medicine, it is not always possible for team physicians or physiotherapists to accompany the team to competitions or training camps. In cases such as these, it is desirable to have a collaboration system that enables the team physicians or physiotherapists to respond from a distance to the players' or the team's needs with regard to conditioning or to injuries and other disorders. We constructed a sports medicine support system using “Net Office HIKARI ” -a collaboration system that is currently in the process of research and development at NTT- and conducted evaluation tests using the Internet. Based on the results of these tests, we reached the following conclusions: (1) In PHS and similar mobile environments, communications can be achieved using 80×64 dot images at a speed of about two frames per second, and consultations are possible assuming a simple interview scenario. (2) Using a B-flets or similar broadband line, communications can be achieved using 320×256 dot images at a speed of about ten frames per second, and consultations are possible even assuming that the two parties are meeting for the first time.

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[in Japanese]

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In the section of gynecology in Saitama Red Cross Hospital, we have introduced critical path to gynecologic laparotomy since 2002, and now using six paths to gynecologic operation and three paths to chemotherapy. We made out the staff manual at the beginning of the critical path, and that made it easy to introduce the critical path.
Making out and preservation the staff manual are useful for moving staff and education and training the first year nurse. It will be able to decrease mistakes in the transmission of the order, and prevent medical accidents.

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From March 2002, we stated to use the critical path for breast cancer chemotherapy, which was the first critical path for chemotherapy in our hospital. At the first edition, only the names of anticancer drugs and the schedule of treatment were preprinted on the critical path sheet. Because we had to write the patient's name and the dose of the anticancer drugs in the critical path sheet, there were the risks of the patient misconception or wrong dosage of drugs by mistakes in writing. Moreover, the various uses of these drugs in our hospital increased the difficulty of check for wrong dosage and increased the risks. In order to prevent these errors, we revised critical path with automatic calculating system by using spreadsheet software. In the new critical path system, we are able to check easily the dose of these drugs during making the critical path sheet. After check the drugs and treatment schedule, the critical path sheet is printed out automatically. Our system is thought to be effective not only to prevent medical accidents but also to share medical information among all of the staff without spending much cost.

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Background) Cancer chemotherapy has been shifted from in-patient therapy to out-patient therapy. The outpatient unit for cancer chemotherapy was opened at July 2002 at our hospital. This study was conducted to evaluate the results and problems of our unit. Methods and Results) The monthly numbers of patients treated at our unit were 132 case at the beginning, 227 cases at April 2003, 270 cases at December 2002. The total number was 3, 726 cases with 9-26 new cases in a month. The dairy number increased from 9.4 at the beginning to 22.5 cases at December 2003, with a maximum number of 37 cases. The largest number of cases was recruited from Department of Surgery followed by Gynecology, Gastroenterology, Hematology, and Thoracic Oncology. Infusion therapy was most frequently applied for patients with a number of 3, 298 cases, followed by intraarterial infusion, centrovenous catheter route, and iv bolus injection. One case of extra-vasation was observed and managed correctly to obtain good healing. Patients showing grade 3 toxicity were treated by emergency administration. Opinionaires for patients disclosed deep satisfaction with the treatment environment. The present problems for management were a lack of information on previous in-patient treatments and an insufficient education system for assistant nurses. Out-patient unit for cancer chemotherapy secured safety and comfort for chemotherapy. Enhanced information exchange and education are mandatory for further improvement.

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Medical accident concerning dispensation of pharmacy succeed one another, and it has a new appreciation of the importance of pharmacy in these days. The contents of prescription inquiry were totaled from a viewpoint of risk management, and the result was analyzed.
Electronic patient record system and the ordering system were introduced in 2002 in order to improve medical quality. Among 159, 354 prescriptions (visitor 125, 723 prescriptions, hospitalization 33, 631 prescriptions) from January to December in 2003, 1, 010 affairs that were distinguished between “pharmacological inquiry” and “prescription formal inquiry” compared and analyzed.
The rate of inquiry to the total prescription number of sheets is 0.63% (0.54% of visitors, 0.98% of hospitalization). The rate of inquiry of hospitalization was significantly higher (p<0.05) than the rate of inquiry in visitors. In both of visitors and hospitalization, as for the rate of inquiry, “prescription formal inquiry”exceeded “pharmacological inquiry” In addition, the rate of prescription change after inquiry was high, and was 91.6% (90.3% of visitors, 92.1% of hospitalization) on the whole
As a result of accepting our inquiry with rationality, it was suggested that it was useful to risk management.

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