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
A.Okamura, T.Ishitani, M.Fukuda, T.Yamamura
Heiseikai InoUE hospital
S7W2 Chuo-ku, Sapporo 064-0807 Japan
Hokkaido University (1876~)Sapporo Beer (1876~)
Snow Festival (1950~)
Olympic Games in 1972
Pacific Music Festival (1990~)
Home Mechanical Ventilation
In Hospital Ventilation
neuro-muscular disease, tuberculosis
( University, municipal, private )
post-ICU mechanical ventilation
Tatara et al : National survey in 2005
Prolonged 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.
Acquisition of a hospital in 2003
for post-ICU mechanical ventilation
Renovation and implementation of
Staff turn-over and education
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
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 )
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.
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
( reports / beds)
04 05 06 07 08 (year)
Number of reports
LTAC: Long Term Acute Care
( x 104 pieces)
( year )
’04 ’05 ’06 ’07 ’08 ’09 ‘10
Certified care workers
Achievement test of suction practice
Tracheal suction manual
CASS (continuous aspiration of subglottic secretions)
Original CASS ( continuous aspiration of subglottic secretion ) system
Incidence of VAP ( ventilator associated pneumonia )
( cases )
P < 0.05
CASS : n=45
Non-CASS : n=81
Pressure ulcer treatment
Pressure ulcer de novo
Change of ADL
3 wheel chair
April 2004 – March 2009
280 cases( male 176, female 104 )
average age 73 y.o.
Bed occupancy rate
RevenueOrdinary profit rate
Revenue (fiscal year)
ordinary profit rate
04 05 06 07 08 09 (year)
04 05 06 07 08 09
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.
Sapporo Concert Hall Kitara
Het Concertgebouw Amsterdam
Thank you for your attention !