The purpose of this study was to clarify the relationship among nursing services, healthcare manpower, and occurrence rate of near misses/errors in acute-care units. Self-reported daily information concerning working conditions and near misses/errors was recorded prospectively for 7 days by 580 staff nurses from 25 acute-care units of 6 teaching hospitals. The relationship between near misses/errors, nursing services, and healthcare manpower was analyzed by logistic regression analysis. The number of nursing errors reported was 41.2 per 1,000 patient days, a number eight times higher than the number of reported incidents/accidents. Near misses/errors often occurred when the number of admissions, number of operations and examinations, the hours of handling admissions, and the hours of patient transfers was high. We suggest that the safety of patients can be secured by modification of the nurse staffing basis on the number of admissions and bed occupancy rates, rather than under the current system of nurse-patient ratio.

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<Objectives> This study was undertaken to identify the essential points in planning the design of activity centers within hospitals through analysis of the current activities of the palliative care teams.
<Methods> The current activities of palliative care teams were investigated at 3 designated cancer care hospitals, and a survey by interview of the palliative care team members was conducted at 2 designated cancer care hospitals.
<Results> The interview-based survey revealed the composition of the palliative care teams, the details of the activities undertaken by the teams and the status of the activity center arrangement at 2 of the facilities. In the survey of the current activities of the palliative care teams, it was found that the major activities of the teams were interviews of individual patients, checking and documentation of medical records, and communication among staff members, and that these activities accounted for about half of the total activity time of the team at each of the 3 facilities. The major sites of activity of the teams were the wards, nurse stations and hospital corridors, and more than half of the total activity time was spent at these locations.
<Conclusion> Analysis of the current status as to the time, place and details of activities of the palliative care team activities revealed that adequate space and facility designs to facilitate the activities at wards (interviews), nurse stations and corridors would be desirable when designing environments supporting the activities of palliative care teams in general wards. The results of the survey also indicate that when activity centers are designed at designated cancer care hospitals, emphasis needs to be laid on (1) the assumption that palliative care will be provided at both the outpatient and inpatient departments and (2) facilitating smooth communication among team members and individual members with expertise.

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The purpose of this study was to quantitatively show the causal relationship between “the responsiveness of the emergency medical service system” and “the amount of medical services provided” that represents the whole scale of the hospital system in stroke patients admitted to the emergency department. The subjects in this study were 48 moderate stroke patients of the 144 patients who visited the emergency outpatient clinic of A hospital in Tokyo in 2008, and who were diagnosed as having had a stroke and admitted to the emergency ward.
The relationships between observed variables such as “time to CT,” “the score of involved physicians” and “the number of emergency outpatients” were represented by undirected independence graphs in graphical modeling and, based on the results, the causal relationship was investigated using structural equation modeling (SEM) with “the responsiveness of the emergency medical service system,” “the amount of medical services provided” and “the degree to which emergency outpatients are received” as structural concepts. The results suggested that “the amount of medical services provided” and “the degree to which emergency outpatients are received” have the same level of influence on “the responsiveness of the emergency medical service system.” In addition, a correlation was shown between “the amount of medical services provided” and “the degree to which emergency outpatients are received.” From this, it was considered necessary in hospital management to grasp in a timely and objective manner both conditions, i.e., the amount of medical services provided and the degree to which emergency outpatients are received, and to establish a function with the power to make adjustments between outpatient department, ward section, clinical laboratory and so on, to enhance the responsiveness of the emergency medical service system.

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