The operating room is the ultimate place for team healthcare. Physicians and staff must be conscious of the value of communication among team members so that surgeons can perform the best surgery. Surgeons also must focus completely on their work in the operating room, which may involve diverse tasks and complicated procedures. It is important to develop a consciousness of medical professionalism and the need for quality improvement in nursing and medical staff. It is necessary to share information, especially among job categories during minimally invasive surgical procedures, which have increased in number in recent years. Surgeons should clearly state that sudden equipment failures as well as complications could possibly occur on the informed consent forms. Medical professionals must respond to change and behave as a model group, functioning with the highest ethics and morality to maintain public trust. The author believes that we must work to build the team medical healthcare appropriate to the times.
In the past, most duties in perioperative management were carried out directly by surgeons themselves. However, in that conventional approach, the experience and knowledge of the responsible surgeon made a difference to the postoperative course. As hospital stays have become shorter in recent years, the preoperative hospitalization period is now only one to two days. It has become more difficult to prepare patients sufficiently, both physically and mentally, so that they undergo surgery with peace of mind. To overcome this situation, the Perioperative Management Center (PERIO) was opened at Okayama University Hospital in 2008, and patients undergoing esophageal cancer surgery have been accepted since 2009. In PERIO, multidisciplinary medical staff share information on patients throughout the organization, and team medical intervention is performed from the preoperative outpatient period. The introduction of PERIO has resulted in earlier postoperative resumption of mobility and shorter postoperative stays. Furthermore, according to a patient survey, PERIO provides an environment that enables patients to face surgery calmly. As the next stage, intraoperative and postoperative interventions in PERIO should be enhanced for a safer perioperative environment and even greater peace of mind for patients.
A number of studies have reported that malnutrition is documented in up to 50％ of hospitalized patients, and malnutrition is closely correlated with the incidence of postoperative complications in surgical patients. The concept of a nutrition support team (NST) is to use its expertise for the entire spectrum of nutritional and metabolic support and to reduce the incidence of complications in hospitalized patients. It is widely recommended that the NST include a physician, dietitian, nurse, pharmacist, and other medical staff, and the physician should play the leading role in maintaining the activity of the NST. The clinical goals of the NST are defined as the identification of nutritionally impaired patients, making nutritional assessments that can lead to precise dietary therapy, and the provision of effective nutritional support. Educating medical students, residents, and other clinical staff in clinical nutrition will be an important role for NSTs in the near future.
The year 2007 should be remembered as the year when cancer treatment in Japan underwent a drastic change. In 2007, the Ministry of Education, Culture, Sports, Science and Technology (known as MEXT) announced its “cancer professional fostering program,” and the Japanese Cancer Act became law. This act facilitated the development of a clinical environment in which highly advanced cancer treatment is performed. A program for the education of professionals to provide cancer care was also designed. It was important to show society that professionals who can lead medical teams with distinguished medical skills are necessary. Because of the cancer professional fostering program, we were able to create a clinical environment to carry out the most advanced cancer treatment and to establish education schemes to foster medical specialists. Continuous support for the cancer professional fostering program and systems established in relation to it is expected.
A multifaceted approach with four parallel strategies including infection prevention, accurate, prompt diagnosis and treatment, prudent use of antimicrobials, and prevention of transmission is required to reduce antimicrobial resistance in hospitals. As the exclusive use of a specific antibiotic causes resistance of microorganisms to it, balanced use of different antimicrobials is mandatory to reduce the selection pressure. In Hyogo College of Medicine, an antimicrobial stewardship program led by physicians and pharmacists facilitates hospital-wide heterogeneous antibiotic usage and has been associated with significant reductions in the isolation of multiple drug-resistant (MDR) organisms. To prevent the transmission of MDR organisms, standard precautions and transmission-based precautions should be enforced by infection control nurses. The establishment of a surveillance system for MDR organisms by laboratory personnel is important for the immediate intervention by the infection control team. In an infectious outbreak by MDR organisms, a multidisciplinary approach is necessary, and outbreaks of carbapenem-resistant Enterobacteriaceae infections in our institution were controlled with the support of the facility administration division.
