Objectives: We have developed and utilized a computerized clinical pathway (CP) system for community-acquired pneumonia (CAP). The quality of pneumonia treatment and the effectiveness of the CP system were evaluated by clinical indicators (Cls).

　Methods: We introduced a CP system from September through December 2005, and implemented it for the inpatients therapy for CAP with non-ICU settings. The CP system consisted of four pathways: CAP, atypical pneumonia, mild or moderate aspiration pneumonia, and severe aspiration pneumonia. We utilized Cls as the parameters for effectiveness of the CP system. Cls included success rate of initial antimicrobial therapy, average length of hospital stay, and pneumonia mortality rate as the outcome indicators; CP implementation rate and detection rate of pneumonia pathogen as the process indicators. The quality of CP treatment was periodically analyzed with these Cls for the CAP in patients every six months from April 2005.

　Results: The improvement of success rate of initial antimicrobial therapy (80.0→83.3→83.7→82.2→87.5%) was observed in concordance with increase of the CP implementation rate (4.6→61.4→91.3→94.1→96.1%) from April 2005 to September 2007, and the average length of hospital stay decreased remarkably. The detection rate of pneumonia pathogen was 44%, and Streptococcus pneumoniae was the most common (44%). New CPs were added based on the process indicator regarding the detection rate of pneumonia pathogen. A further improvement of the success rate of initial antimicrobial therapy and the CP implementation rate was observed after introducing the new CPs. The pneumonia mortality rate showed gradual decrease of about 5%.

　Conclusion: The Cls for pneumonia therapy could be utilized as parameters for evaluating the effectiveness of the pneumonia treatment with CPs and the improvement of the CP system.

　Operations under general anesthesia on an outpatient basis are growing. Careful health management by patients themselves and their families is very important during their pre-operative periods. Therefore, the clinical pathway for improving the efficiency and quality of medical treatment is essential.

　The purpose of this study is to analyze the variance of risk factors regarding safety and comfort for Day Surgery pre-operation― using nursing assessment criteria. Through a survey on 380 adult and child patients who were to have outpatient operations under general anesthesia and had received preoperative telephone interviews, investigations were made on risk factors for deviation from nursing assessment criteria on three points before the operations: 1. exploration by anesthetists, 2. telephone interviews, and 3. exploration by anesthetists on the operation day. More than half of the patients were at variance with the clinical path. The number of cancellations was 6 (2 percent).