Osaka City General Hospital is a large metropolitan general hospital with 1063 beds. This hospital also serves as a regional critical care center and has psychiatric wards for adult and child/adolescent psychiatry. In the year 2010, adult psychiatry had a closed ward containing 33 beds, including two secured beds and six private beds. In April 1996, we started to provide critical care and involuntary admission services for psychiatric patients in the city of Osaka. In October 2003, we started to provide inpatient treatment for psychiatric patients with physical complications who had been referred by psychiatric hospitals in Osaka Prefecture. However, as reported previously, providing inpatient care for psychiatric patients with physical complications posed a major challenge for many hospitals, and our hospital was no exception. In 2008, the regulating authority introduced a new hospital fee system for inpatient care of psychiatric patients requiring critical care or treatment for physical complications. Thereafter, we began to prepare for this new system. After considerable discussion of all problem areas, including the architectural layout of the ward, we increased the number of private beds in the psychiatric ward. Thus, the ward now has 28 beds, including 2 secured beds and 14 private beds (six of these 14 beds were prepared for the physical complication treatment unit). Finally, we were able to meet all of the requirements for the new fee system. In September 2012, we started using the new system of a “hospital fee for inpatient care of psychiatric patients requiring critical care or treatment for physical complications.”
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