ASOURCE Times

Introduced cost accounting system

Our hospital, located in Koga City, Ibaraki Prefecture, is a medium-sized acute care hospital (secondary emergency) with a total of 325 beds. In 2007, it was designated as a regional cancer medical treatment cooperation base hospital, and the following year, it was certified as a DPC target hospital. Since it is located on the prefectural border and the JR Tohoku Line runs from north to south, many patients come from Tochigi and Saitama prefectures.

The business environment is really tough for private hospitals. As the population ages and social security costs continue to expand, the national "medical cost control" measures can be said to be equal to "hospital income reduction" measures. The number of hospitals that are required by the government, such as creating a system to ensure the safety and security of medical care, continues to increase year by year. In addition, due to the sophistication of medical care, the cost of purchasing drugs and medical devices is increasing. In order to keep the hospital alive, more management power than ever before will be required.

It is difficult to see the economic situation of each clinical department in hospital management. I have always felt that cost accounting is necessary, so I introduced a new cost accounting system last year. As a result, it has become almost possible to grasp the profits of each medical department. According to the analysis, the cost figures that were perceived as "somehow" were unexpected. In other words, the medical department, which was thought to be profitable due to its high income, is actually in the red due to the high cost of purchasing and maintenance of medical equipment and the large number of nurses and technicians. It was. I was very shocked by this. After all, I keenly realized that it is important to visualize it as a concrete numerical value.

We have also introduced a DPC analysis benchmark system. We try to use clinical pathways for efficient treatment, but according to the system, we have found that some diseases have a longer length of stay than other hospitals. After all, the profit of the medical department was not good, and I decided that improvement was necessary.

Basically, acute care is provided in the 7: 1 ward, and patients who have left the acute phase are transferred to the community-based comprehensive care ward (39 beds) to provide necessary rehabilitation and return to home. We are also focusing on the palliative care unit (14 beds) for cancer patients. We respect the feelings of patients and their families, and support patients and their families with a multidisciplinary team of specialists so that they can spend their time in their own way and calmly.

Patients view medical information

In June of this year, we introduced a system that allows patients to view their medical information on their PCs and smartphones for free. Patients can view the results of blood tests and other test results received at our hospital, the contents of prescribed medicines, and images of X-rays, CT, MRI, and endoscopy. This service is available to patients who have consented to the secondary use of medical information. Patients can ask doctors questions based on their medical information, and can also use it as a reference when seeking a second opinion at another medical institution. I would like my family doctor at the local clinic to see the patient's medical information and use it when coordinating medical examinations.

Since our hospital is a secondary emergency medical institution, we may transport emergency cases such as heart disease and brain disease to tertiary emergency medical institutions such as Dokkyo Medical University Hospital, Jichi Medical University Hospital, and Tsukuba University Hospital. Is it about 10 cases a year? Until now, patients were transported by ambulance to a soccer field 1.3 km away from the hospital, and then by a helicopter for emergency medical care that landed there. A new heliport was built next to the hospital parking lot in March. The total construction cost was 25 million yen, but I think it can be used in the event of a disaster as well as strengthening the emergency medical system.

Aiming for further enhancement of cancer treatment

Even if it is a cancer treatment cooperation base hospital, it is difficult to cover all areas of cancer because the doctors involved in cancer treatment are not sufficient in rural areas. Our hospital faces similar problems and has always suffered from a shortage of doctors such as respiratory surgeons. Fortunately, since last year, a skilled respiratory surgeon has become a full-time employee, and it has become possible to perform surgery for lung cancer patients at our own hospital. We would like to add respiratory surgery to the cancer treatment centered on gastrointestinal surgery, which is our specialty, and strive to further enhance cancer treatment. As part of cancer treatment, gastrointestinal surgery is also focusing on stoma care after colorectal cancer. With the increase in colorectal cancer, it is said that the number of patients wearing a stoma is 200,000. In the stoma outpatient department once a week, nurses provide 30 to 60 minutes of medical treatment time for each ostomate and provide personal care and consultation.

Toward the enhancement of regional medical care in the future

About 60% of the causes of death in Japan are lifestyle-related diseases such as cancer, heart disease, and stroke. Medical examinations are important for the prevention and early detection of lifestyle-related diseases. We have set up a comprehensive medical examination center next to our hospital, and we carry out inhabitant examinations, company examinations, docks, etc., but the number of cases is 17,000 per year, which is saturated. I would like to create a new facility that can handle about 50,000 cases a year.

My dream for the future is to realize perinatal care. Currently, there are only two facilities in Koga City that can deliver, and in a few years it may be zero at worst. Perinatal medical care requires a comprehensive system from both obstetrics and pediatrics, which requires labor, but I would like to explore the possibility of giving birth in the community with peace of mind.