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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. Sapporo. N43°. Hokkaido University (1876~) Sapporo Beer (1876~) Snow Festival (1950~)

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A hospital for post-ICU patients with long term mechanical ventilation in Japan

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A hospital for post icu patients with long term mechanical ventilation in japan

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


A hospital for post icu patients with long term mechanical ventilation in japan

Sapporo

N43°

Hokkaido University (1876~)Sapporo Beer (1876~)

Snow Festival (1950~)

Olympic Games in 1972

Pacific Music Festival (1990~)


A hospital for post icu patients with long term mechanical ventilation in japan

Home Mechanical Ventilation

10,400

In Hospital Ventilation

5,800

National Hospitals

2,000

neuro-muscular disease, tuberculosis

Other Hospitals

( University, municipal, private )

3,800

post-ICU mechanical ventilation

Tatara et al : National survey in 2005

Prolonged mechanical ventilation in Japan

Total

16,200


A hospital for post icu patients with long term mechanical ventilation in japan

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.


A hospital for post icu patients with long term mechanical ventilation in japan

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


A hospital for post icu patients with long term mechanical ventilation in japan

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 )


A hospital for post icu patients with long term mechanical ventilation in japan

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


A hospital for post icu patients with long term mechanical ventilation in japan

( reports / beds)

InoUE

LTAC

(82 beds)

non-LTAC

(5375 beds)

04 05 06 07 08 (year)

Risk management

Number of reports

activity

(Year)

LTAC: Long Term Acute Care


A hospital for post icu patients with long term mechanical ventilation in japan

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


A hospital for post icu patients with long term mechanical ventilation in japan

Original CASS ( continuous aspiration of subglottic secretion ) system

Incidence of VAP ( ventilator associated pneumonia )

( cases )

30

4

P < 0.05

20

24

10

6

CASS : n=45

Non-CASS : n=81

Drainage bottle

Tracheal tube

Subglottic

Suction port

Continuous

suction pump

Extension

tube


A hospital for post icu patients with long term mechanical ventilation in japan

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

‘05

‘06

‘07

‘08

‘09

10

Pressure ulcer de novo

5

0


A hospital for post icu patients with long term mechanical ventilation in japan

Others

Neuro-muscular

disease

10%

6%

dead

weaned

Respiratory

failure

29%

31%

Cerebro

-vascular disease

16%

42%

ventilator-dependent

Hypoxic brain

damage

40%

26%

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.


A hospital for post icu patients with long term mechanical ventilation in japan

Financial condition

Bed occupancy rate

RevenueOrdinary 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


A hospital for post icu patients with long term mechanical ventilation in japan

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.


A hospital for post icu patients with long term mechanical ventilation in japan

Sapporo Concert Hall Kitara

Het Concertgebouw Amsterdam

Thank you for your attention !


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