Gifu Prefecture is divided into five medical service areas: Gifu, Seino, Chuno, Tono, and Hida. The number of hospital beds was estimated to be excessive in all medical areas in Gifu by the regional healthcare vision for 2025. Discussions took place in each area, focusing particularly on reducing acute and chronic care beds. Furthermore, in September 2019, three hospitals of JA Gifu Koseiren were suddenly included in a list of hospitals that require particular discussion regarding restructuring and integration. At the time, JA Gifu Koseiren had seven hospitals, and including one hospital slated for designated management toward integration, they had been restructuring beds based on the regional healthcare vision in each medical area.
　In the Gifu medical area, Gihoku Kosei Hospital was the only hospital and underwent a solo downsizing in September 2020. In the Seino medical area, bed restructuring was carried out for the two Koseiren hospitals: Ibi Kosei Hospital in the north and Nishimino Kosei Hospital in the south. A new hospital (Seino Kosei Hospital) had been newly constructed in the northern part of the Seino area in October 2025, involving the complete relocation of Ibi Kosei Hospital and the transfer of acute care beds of Nishimino Kosei Hospital. In the Hida medical area, Takayama Kosei Hospital, which only offered long-term care beds, was closed in October 2023, and its beds were transferred to Kumiai Kosei Hospital. In the Tono medical area, Toki Municipal General Hospital was placed under Koseiren’s designated management, and a new hospital was constructed for integration and relocation with Tono Kosei Hospital in February 2026. As a result of this bed restructuring, Koseiren expects to consolidate the number of hospitals from eight to six and reduce the number of beds from 2,427 to 1,997 up to February 2026.
　In the future, Chuno Kosei Hospital will take the lead in establishing a Community Healthcare Partnership Promotion Corporation in the Chuno area. The goal is to efficiently utilize scarce healthcare and long-term care resources, including human resources, and to build an effective collaboration system across hospitals, home healthcare, long-term care, and welfare, thereby contributing to the sustainability and development of the region.
　Securing doctors for hospitals that have abolished acute inpatient beds or for outpatientonly clinics is becoming increasingly difficult. To continue providing healthcare, close functional collaboration with key hospitals and improving access for patients to visit them are crucial. As hospital consolidation accelerates toward 2040, a system must be built to rectify the healthcare disparities arising within each area and provide seamless medical care. This requires developing a future plan that predicts the healthcare demand in each medical area and appropriately allocates available medical resources.

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　A 71-year-old man underwent pancreatoduodenectomy for distal bile duct cancer with accompanying celiac artery stenosis. Although the celiac artery stenosis was moderate, the presence of hepatic artery branching anomalies raised concerns about postoperative interruption of hepatic artery blood flow. An intraoperative gastroduodenal artery clamping test showed no reduction in hepatic blood flow. However, re-evaluation after resection of the dorsal pancreatic artery showed a significant decrease in hepatic blood flow. To address this, a median arcuate ligament release was performed, successfully restoring blood flow. This case highlights the importance of preoperative diagnosis and intraoperative reassessment of hepatic blood flow to prevent upper abdominal organ ischemia. We report this case as an example of successfully preventing blood flow disturbances in the upper abdominal organs through thorough preoperative and intraoperative evaluation.

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　The number of deaths in forestry accidents is decreasing year after year and was reported to be 27 in 2024. We report 2 cases of severe abdominal trauma in forestry accidents. (Case 1) While a man in his 50s was working in pairs, a felled tree pierced his abdomen. He was rushed to our hospital in cardiac arrest by ambulance. Resuscitation was unsuccessful and he was pronounced dead. (Case 2) While a man in his 40s was working alone, he was struck in the abdomen by the window of a backhoe when it got caught while pulling the roots of a felled tree. He visited our hospital with his wife. Immediately after consultation, his condition was stable. After that he went into shock. Emergency intubation, transfusion, and surgery were performed. He was discharged 47 days after surgery. The rates of injury and death per 1000 workers in forestry are 10 times higher than those in all industries. Fatalities from forestry accidents often occur when tree felling is in progress. Thorough training and measures to prevent occupational accidents are being carried out, but these cases lead us to suggest that further countermeasures against abdominal trauma are needed.

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　The Admission and Discharge Support Center opened at Anjo-Kosei Hospital in May 2022. In conjunction with this, patient explanations provided prior to scheduled hospitalizations have been consolidated from each outpatient department to the Center. Before the Center opened, various clinical pathways were used for patient explanations provided prior to hospitalization. This was a major challenge with respect to centralizing patient explanations at the Center. Additionally, discrepancies were identified between the pathways for medical staff and those for patients. Therefore, we established pathways before the center opened. First, we decided on a schedule for developing clinical pathways. Next, we performed the task of ensuring the consistency between the pathways for medical staff and those for patients. Finally, pathways for patients were designed to visually represent pre-admission actions, the flow during hospitalization, and the goals to be achieved. The pathways for the medical staff were developed through interprofessional collaboration with the aim of standardizing medical care. The Medical Affairs Section assumed the role of proposing measures that took into account the number of days calculated based on the Diagnosis Procedure Combination and the intensity of medical care. We revised 235 out of 318 clinical pathways for medical staff. The new pathways were able to incorporate content related to improving the quality of medical care, such as adjusting the number of days, adding uncalculated items, reevaluating medications, and early intervention at discharge. In this paper, we report on the efforts and outcomes related to the development of clinical pathways leading up to the establishment of the Center.

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