Sound management of hospital in Japan in general has become more and more difficult with frequent reductions in the fees officially paid to medical institutions for medical examinations and treatments, and this current situation obviously necessitates a more efficient way of hospital management and ardent efforts at improvement on the part of our hospital as well. The Division on Nursing has set the goals to implement thoroughgoing cost-management strategies and to strengthen cooperation with other divisions. For this purpose we visited the hospital wards jointly with other personnel from the Divisions of Medical Materials and Dispensary to check inventories of medical materials and to make them optimum. As a result, it was found that medical materials were often improperly placed, stored excessively, or returned inaccurately. The instructions for redefining the proper quota of the medical materials per ward, putting them in order and returning them properly in case of excess facilitated direct communication and cooperation between divisions, and resulted in inventory reduction and thus the annual costs of returning them. These efforts successfully inspired each staff member to participate voluntarily in the management of our hospital, which eventually led to reasonable inventory control of medical materials. It would be important for each division, while demonstrating its specialty, to realize the importance of cooperation to reach far greater achievements.
Hospitals ; Materials ; seconds ; cooperation ; Medical

The removal of aspiration objects is often required for aspiration, which takes place at the time of a video fluoroscopic examination of swallowing (VF) for the assessment of dysphagia rehabilitation. We report our approach against correspondence for aspiration at VF.　　As subjects for this report, we sampled 6 patients (average age: 78.3±3.0, four males and two females) from 19 patients, who had aspiration of barium sulfate or meal with barium contrast medium at the time of VF form October 1, 2009, to March 31, 2011. For the first step of correspondence for aspiration at VF, we dealt with coughing, huffing, suction and postural drainage under the guidance of a Speech-Language-Hearing Therapist and, depending on the case, a Physical Therapist who dealt with chest physical therapy. When expectoration was found impossible, we checked to see if it was necessary to perform biphasic cuirass ventilation with a clinical engineer. We assessed the chest X-ray films and existence or non-existence of expectoration immediately after aspiration, and fever, inflammatory response, respiratory symptoms and gastrointestinal symptoms one week after the examination, and retrospectively checked the influence of aspiration.　　As a result, three patients had residue as revealed on chest X-ray films, and the three remaining patients had none. For the former three patients, we intervened in a team approach and succeeded in removing the residue from two patients (one with initial correspondence, and the other with execution by the Physical Therapist). Though two patients had fever and inflammatory response one week later, It was hardly possible that aspiration at the time of VF became a direct cause. No patient had either the respiratory or gastrointestinal symptom.　　Correspondence for aspiration was attained by establishing a team approach system. Even if a patient had heavy aspiration, it was not reflected on chest X-ray films, depending on the case, and therefore deliberation was required for correspondence.