ASOURCE Times

After returning from the United States, he struggled to open an ER type emergency department.

When I was a student, I watched the American TV drama "ER" and learned about the existence of an ER-type emergency department, which made me interested in it.
I also wanted to study abroad in the United States, so I worked at the US Navy Hospital and Urasoe General Hospital in Okinawa after the initial training in order to study for study abroad. Taking advantage of my work experience in English there, I was able to work in the emergency department at the Mayo Clinic in the United States from 2006.

After returning to Japan, there was talk of launching an "ER type emergency" at the Tokyo Bay Urayasu Ichikawa Medical Center in Urayasu City, Chiba Prefecture, where I spent my student days, and I was approached as the director of the emergency department. I was at a loss because I was 35 years old and had no experience as a manager, but I asked Professor Shuichi Terazawa of the University of Fukui, who was another reason for me to become an emergency doctor. I was pushed back and challenged to launch an ER type emergency from scratch.

In a nutshell, ER-type emergency is a style in which an emergency doctor treats all emergency patients at an emergency medical center regardless of severity, type of injury or illness, and age. There are two university hospitals in the southern Tokatsu medical area where the Tokyo Bay Urayasu Ichikawa Medical Center is located, and it looked like a fulfilling environment. However, the transport rate of emergency patients transported from the Urayasu Ichikawa area to other areas was as high as 22% at the time of 2011, so if we make an ER type emergency that does not refuse, the Urayasu Ichikawa area and eventually the Tokatsu Southern Medical Area I thought I could contribute to the whole.

Start with 16 young doctors 3 to 10 years after graduation

In a new business, success or failure depends on how to secure management resources for people, goods, and money. First of all, we recruited "human resources" (human resources) by pushing the point that "you can learn American-style postgraduate training in practice without going to the United States". As a result, motivated young doctors 3 to 10 years after graduation gathered, and when it was opened in 2012, it was possible to start with 7 emergency specialists and 9 late major doctors.

By establishing the pillar of American-style training, we were able to create a common ambition for the departments of general internal medicine, general surgery, and intensive care, which are important partners for the emergency department, and laid the foundation for management. In addition, it has gained a reputation as an acute care hospital centered on a new style of emergency, and many nurses and comedics have gathered.

Regarding “things”, we also focused on the design of the emergency outpatient department, which is the core of ER. By the time I was posted, I had already created a blueprint with five examination rooms and three ambulance receiving spaces. However, I insisted that "without well-equipped facilities, we would not be able to provide full medical care," and after much discussion, we ended up with an emergency outpatient clinic with six examination rooms and nine beds of ambulance reception space. rice field. We have introduced a 320-row state-of-the-art CT and shortened the lead to the elevator that can go directly to the ICU and operating room.

Regarding "money" (budget), I am very grateful to Mr. Michiyasu Yoshishin, Chairman of the Japan Association for Development of Community Medicine, and Mr. Jun Kamiyama, CEO of Tokyo Bay Urayasu Ichikawa Medical Center. He listened to the story of a young emergency doctor returning from the United States, saying, "We will create an ambulance department that accepts 10,000 ambulances a year," and challenged us to "try it."

Introducing a shift system to prevent staff exhaustion

At the beginning of the establishment, we received opinions from nearby clinics and hospital teachers, such as "I do not want to introduce to hospitals with only young doctors" and "That hospital is only young doctors and the quality is low". However, patients and medical institutions who want to "carry to Tokyo Bay" and "want to send to Tokyo Bay" while continuing to "feel free to receive referrals without refusing" and "carefully reverse referrals". Has increased. In the evenings and Saturday afternoons outside of the practitioner's doctor's consultation hours, a dedicated line called the "practitioner hotline" that introduces patients to Tokyo Bay was sometimes left on.

The number of ambulances transported was about 7,000 in the first year, but it soon increased to 10,000. This is the result of our efforts as an ER to maintain a high demand rate and become the "last bastion in case of trouble". We have also accepted patients who have been refused more than 10 cases from areas more than 30 km away. With emergency (firefighting), information such as the outcome of the accepted patient is exchanged in exchange notes, and by holding a retrospective conference once a year, cooperation with the emergency services becomes closer. I did.

As the number of patients accepted increased, the staff became hectic, as a matter of course. At emergency centers nationwide, there are many staff members who accumulate fatigue and “burn out”. We continued to devise and make efforts so that the staff would not be exhausted and could keep their motivation.

First of all, I myself continued to stand in the clinical setting. I actually worked with other staff at night and shared the busyness, pain and pain. We shared the joy of being able to save a dramatic life, solving the problems of difficult cases, and collaborating well with other departments. Through such daily communication, I think that the philosophy of "medical care that contributes to society" that I have maintained without shaking was conveyed, and it became the basis for maintaining the motivation of the staff.

Next, we changed the work system to a shift system and shortened the night work hours to 10 hours from 22:00 to 8:00. Most clinical departments are on duty for 16 hours from 17:00 to 9:00, but that is not enough. And I decided to have three emergency department doctors on standby at night. It can be said that the system was realized because there were 16 people.

Furthermore, we asked the staff to "praise," "caring," and "gratitude" to each other. I thought that if the workplace had smooth relationships, I could work with high vitality. We also implemented the three principles of information disclosure, delegation of authority, and easy-to-understand rules. I can share the information I have within the department as much as possible, and assign the authority to the staff in charge of infectious diseases, trauma, addiction, etc. I made it a mechanism.

Initiatives in a new environment

After working at the Tokyo Bay Urayasu Ichikawa Medical Center, I moved to the International University of Health and Welfare. Currently, we are also treating patients who are likely to be infected with the new coronavirus that is rampant. In the emergency outpatient department of this hospital, the space is divided into three zones, a green zone, a yellow zone, and a red zone, as a measure against infectious diseases. Of these, we provide medical care in two spaces except the yellow zone where PPE (Personal Protective Equipment) such as protective clothing is attached and detached. Medical treatment in the green zone is for people who do not have symptoms such as fever, cough, taste / smell disorders, hypoxemia, dyspnea, close contact with infected people, travel and dinner in Tokyo. The target is the Red Zone, which has two negative pressure clinics, and treats people who have symptoms or are likely to have close contact. Patients who come on foot will be examined in the red zone if there is a strong suspicion of being infected with the new coronavirus, and those with low suspicion may be examined in the negative pressure examination room just in case.

Including these efforts, we may move to a new environment and put more effort into it. That is “human resources education”. We believe that it is important to educate a large number of human resources in order to change emergency medical care. At the Tokyo Bay Urayasu Ichikawa Medical Center, less than 100 younger students could be in contact with each other in a year, but at the International University of Health and Welfare, there are about 400 students and trainees from the Faculty of Medicine, Nursing, and Healthcare. You can teach emergency medical care. In this way, we will continue to work on practice and human resource development with the aim of transforming emergency medical care in Japan.