To address the aging of society, the Ministry of Health, Labour and Welfare has been promoting the concepts of comprehensive community care systems and regional medical services. To fully achieve these concepts, it is essential to share information between attending physicians and the related local facilities, including acute hospitals. One of these details that should be shared is the information in patient referral documents (Format 11). In this study, with the view of standardizing patient referral documents for secondary use after patient referrals, we analyzed the actual entry status of 1,000 patient referral documents and examined the conformity of the entries to the current Format 11. Consequently, it was revealed that more than half of the cases had misplaced entries (i.e., entries that were not placed in the respective designated sections). To counter this problem, we categorized the referral purpose and the content construction of medical progress and structured Format 11 as an information scheme. This enabled us to construct a medical information-sharing system that automatically classifies input data by labeling and intensively accumulates information for secondary use.
Errors related to drugs, drain tubes, and falls are three high-frequency incident types. This study aimed to clarify the differences in related factors between these three incident types. This was a retrospective observational study secondarily using incident reports collected at a medical institution (investigation target). Of all 36,364 incident reports from 2012 to 2018, 16,383 (45.1%) in which entries were noted in the three incident types and all variables were subjected to multivariate Poisson regression analysis with the number of incidents as the objective variable. The numbers of drug-related, drain-related, and fall-related incidents were 7,877, 5,716, and 2,790, respectively. Regarding the occurrence of the three incident types, characteristic tendencies were observed with site/hour of occurrence from the organization factors, reporter’s clinical/department experiences and related professions from the medical practitioner factors, and sex, age, and attributes from the patient factors. Conversely, common tendencies were noted with manual descriptions and time of occurrence from the organization factors and characteristic auditory disorder from the patient factors.
To reveal the difficulties and measures peculiar to nurses employed at fee-charging all-private-room medical complexes (hereinafter “private-room wards”) from the perspective of environmental factors, semi-structured interviews were held with 11 nurses who were employed at private-room wards for more than 1 year. Their narratives about difficulties and measures were then classified, coded, and categorized by physical, human, and cultural environmental frameworks.
Consequently, the difficulties peculiar to nurses at private-room wards included [difficulty of efficiently providing high-quality nursing services surrounded by structures specific to all-private-room wards] and the measures taken included [preparations/adjustments for efficiently providing high-quality nursing services]. The environmental factors that compounded and complicated nursing practices included a one-floor structure that requires a long time for migration, closed private rooms that make it difficult to notice abnormalities in patients, patients who select fee-charging private rooms, and a framework for responding to multiple medical departments. Finally, the nurses appreciated the structures and patient expectations peculiar to private-room wards, had knowledge/expertise comparable to nurses at various medical departments, and dealt with difficulties to efficiently provide high-quality nursing services.