A hospital for post-ICU patients with

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A hospital for post-ICU patients with long term
mechanical ventilation in Japan A.Okamura,
T.Ishitani, M.Fukuda, T.Yamamura Heiseikai InoUE
hospital S7W2 Chuo-ku, Sapporo 064-0807 Japan
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Hokkaido University (1876) Sapporo Beer
(1876) Snow Festival (1950) Olympic Games in
1972 Pacific Music Festival (1990)
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Prolonged mechanical ventilation in Japan
16,200
Total
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Problems in acute care hospitals in
Japan Japanese health care insurance system
limits the reimbursement according to the length
of stay in ICU. Prolonged ventilation lowers
patient turn-over in ICU. - unable to accept new
patients in the ICU - Prolonged
ventilator-dependent patients have to be sent to
ordinary ward, where staffs are not so familiar
with ventilator-dependent patient management.
In Japan, hospitals that specialize in
post-ICU mechanical ventilation have not been
organized.
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Acquisition of a hospital in 2003 for post-ICU
mechanical ventilation Renovation and
implementation of hardware Staff turn-over and
education Financial reconstruction
Client PC for ordering, Laboratory data,
radiology
Co-generation power supply ( Off - grid power )
Patient monitor ( Fukuda ) Ventilator ( Servo-s )
Oxygen, Artificial Air
Blood gas analyzer, Central monitor
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Organization of special teams
Risk management incident /
accident report Infection control
survey (micro bacterial, clinical) Pressure
ulcer weekly round,
treatment Education
lecture, library, scientific meeting Medical
record IT solution Process
improvement process analysis, PDCA cycle
Each team consists of doctor, nurse, care worker,
office worker. The organization and activities
satisfy the requirements of Japan Council for
Quality Health Care ( JCQHC )
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Staff education
Morning lecture Monday Friday
respiratory physiology, blood gas analysis,
VAP, VILI, ARDS, open lung strategy,
etc. Invited lecture Once a month
risk management, infection control,
professional manner, gas/power supply,
etc. Scientific meeting attending
scientific meetings presenting scientific
papers
The more the individual in an organization
grows as a person, the more the organization can
accomplish. - Landmarks of Tomorrow -
Peter F. Drucker
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Risk management
Number of reports
activity
(Year)
LTAC Long Term Acute Care
9
Infection control
4
Antibiotics (million yen)
patient
3
60/12
disposal glove ( x 104 pieces)
40/8
2
1
20/4
0
0/0
( year )
04 05 06 07 08
09 10
Certified care workers
Achievement test of suction practice
Introduction of
Tracheal suction manual
CASS (continuous aspiration of subglottic
secretions)
Standard precaution
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Original CASS ( continuous aspiration of
subglottic secretion ) system
Incidence of VAP ( ventilator associated
pneumonia )
( cases )
30
4
P lt 0.05
20
24
10
6
CASS n45
Non-CASS n81
Drainage bottle
Tracheal tube
Subglottic Suction port
Continuous suction pump
Extension tube
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Pressure ulcer treatment
Pressure ulcer treatment team
80
80
Total Patients
Specialist Doctor Nurse Pharmacist Care worker
50
50
Air mattress
Ventilated Patients
0
0
04
07
08
06
05
09
10
Pressure ulcer de novo
5
0
12
Change of ADL
Patient background and outcome
1 bed-bound 2 head-up 3 wheel chair 4 sitting 5
standing 6 walking
admission
discharge
April 2004 March 2009
280 cases ( male 176, female 104 ) average age 73
y.o.
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Financial condition
Bed occupancy rate
Revenue Ordinary profit rate
(billion yen)
()
()
30
Revenue (fiscal year)
20
10
ordinary profit rate
0
04 05 06 07 08 09
(year)
04 05 06 07 08 09
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Conclusion
The high bed occupancy rate suggested the social
need for the post-ICU mechanical ventilation
hospital in Japan. The hospital that specializes
in post-ICU mechanical ventilation is
economically feasible. Activities of special
teams decreased hospital-acquired infection and
decreased the wasteful expenditures. Staff
education and continuous process improvement
seems to be the key elements for this enterprise.
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Sapporo Concert Hall Kitara
Het Concertgebouw Amsterdam
Thank you for your attention !