徳島県立海部病院の救急医療を支えるハード（ICT）とソフト（マインド） : 医師の働き方改革と持続可能な救急医療の両立のために

In depopulated areas in Japan, it has been hard to maintain the high quality of emergency medical care system due to a lack of resident medical doctors. On the other hand, the few available clinicians work overtime to handle the medical burden, leading to social problems in Japan, especially in medical emergencies like stroke and acute myocardial infarction. To reduce the burden on healthcare personnel and promote a sustainable high-quality of emergency medical care system, we have introduced a telemedicine system known as “k-support” system at Kaifu hospital. The telemedicine system uses smartphones and Internet, and can provide medical radiological images such as CT（computerized tomography）and MRI（magnetic resonance imaging）to the smartphones of doctors employed full-time at the Tokushima Prefectural Kaifu hospital. Rapid dissemination of medical data ensures that the panel of doctors can discuss the diagnosis and treatment planning of emergency patients almost immediately. Using the telemedicine system, duty doctors can consult other doctors and can then manage the patients themselves without waiting for the arrival of on-call doctors.
We have used the k-support system in ２３９ emergency patients from February ２０１８ to December２０１９. The majority of the cases（９８%）were during hours of reduced staff availability, i. e. during the night or during holidays. The k-support system was used in neurosurgical, orthopedic, and medical diseases with proportions５１%,３９% and ８% respectively. The years of experience of doctors using the k-support system varied from under１０years（４６%）, to１０-２０years（１３%）, and to over ２０ years（２９%）. After consultation using the k-support system, on-call doctors had to physically go to the hospital in only１８% of the cases―the duty doctor could treat the patients in８２ % of the cases, without requiring additional intervention.
Equating the k-support telemedicine system to hardware, and cooperation and consultation between doctors using the system to software, we believe that a synergistic combination between the two is essential for setting up a sustainable emergency care system, which in turn would reduce the work burden of doctors in a depopulated area.