Patients with mild disease visiting outpatients services at night, on holidays or in the after-hours （so-called convenient visits） present various problems to the emergency medical system.　In this study, we describe models that we developed to identify patients with mild disease from the data on health insurance claims for outpatient services and a medical record survey to estimate the number of these patients.　A survey of the medical records of outpatients who presented to any one of the 2 medical institutions belonging to the National Hospital Organization at night, on holidays or in the after-hours, excluding those hospitalized on the same day, identified patients with mild disease, and logistic regression analysis using health insurance claim data led to the construction of 3 patient identification models.　Of these, （1） the medical examination category model and （2） medical examination content-medical cost model, which can estimate the number of patients from the data on health insurance claims for outpatient services alone, were used to estimate the number of outpatients with mild disease who presented to any of the 84 hospitals with 200 or more beds belonging to the National Hospital Organization at night, on holidays or in the after-hours, excluding those hospitalized on the same day.　The analyses using models （1） and （2） revealed that the proportion of such patients was 43.8% and 42.8%, respectively, with significant differences, according to estimation by both models, in the proportions of patients with mild disease between institutions with 200-299 beds and those with more than 500 beds （Dunnett’s t　p=0.01, p<0.01）.　The results suggest that guidance should be provided to patients attempting to visit hospitals during after-hours to improve the efficiency of the emergency medical system.

The purpose of this study was to clarify the career development of directors of nursing qualified as certified nurse administrators.　Questionnaire and interview surveys were conducted of 13 directors of nursing qualified as certified nurse administrators and the data were analyzed using a modified grounded theory approach.

Based on the results, the career development of directors of nursing qualified as certified nurse administrators was classified into 7 categories: <career choice>, <meeting with people in work and life>, <self-affirmation>, <acquisition of resources>, <awareness that they have been supported>, <feeling of gratitude> and token of gratitude for the support received.　The subjects’ feelings of gratitude led to their intention to return the courtesy to their juniors, organizations and society, and contributed not only to their individual growth, but also to improving the quality of nursing in organizations to which they belonged and to the development of the entire organizations.　It was suggested that career development of directors of nursing qualified as certified nurse administrators is not only helpful for the career development of next-generation nurse administrators, but also leads to great benefits for organizations.

The relationships of the hospital type （national/municipal, public or private）, hospital distribution （number of diagnosis procedure combination ［DPC］ hospitals in a primary care zone）, hospital size （number of beds） and degree of sufficiency of doctors （number of doctors per bed） to the length of hospital stay for cerebral infarction （without surgery） were quantitatively compared among DPC hospitals in 4 prefectures in the Tokai district （Aichi, Gifu, Shizuoka and Mie）.　In Aichi Prefecture, the impact of the hospital type was stronger and the length of stay in public hospitals was shorter.　In Gifu Prefecture, the greater the number of DPC hospitals in a primary medical care zone, the shorter the length of hospital stay, and the hospital location was considered to be more influential than the hospital type.　In Shizuoka Prefecture, the greater the number of beds, the longer the length of hospital stay, and the length of stay in public hospitals was longer than that in the other types of hospitals.　It was confirmed that factors affecting the length of hospital stay vary among prefectures.　In addition, when the sample size was increased by using all the data for the 4 prefectures, the length of hospital stay for cerebral infarction （without surgery） was represented by a cubic function of the number of doctors per bed, suggesting that this may be an indicator reflecting the efficiency and mobility of hospitals.

In the FY 2012 revision of medical fee, additional medical remuneration points for providing organizational patient support were newly established, which led to consideration of the assignment of medical coordinators in medical institutions. We studied the current status of medical coordinator deployment and organizational patient/patient family support in medical institutions. Given the results, we discussed the expected role of the medical coordinators and the future development of patient/patient family support systems. The subjects were medical institutions that filed-in Measures for Medical Safety Supplement 1 or 2 （N=3,479）.

Responses to the survey were obtained from 976 medical institutions （response rate: 28.1%）. Most of the medical institutions considered “appropriate response to patient/patient family consultation” and “facilitation of smooth interdepartmental team work and mediation” to be the most effective functions among other roles of medical coordinators.

Medical coordinators are expected to respond to consultation regarding medical accidents and claims and educate hospital personnel on these issues. They are also expected to continuously upgrade their skills. A hospital-wide organizational effort with close coordination with the medical safety manager is required in order to establish an effective and efficient patient/patient family support system.