The Effect of US Styled Treatment Bundles in the ICU Implemented through Multidisciplinary Rounds

• Project/Area Number: 18K08911
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 55060:Emergency medicine-related
• Research Institution: Tokyo Medical and Dental University
• Principal Investigator: Shigemitsu Hidenobu 東京医科歯科大学, 統合国際機構, 教授 (50265782)
• Co-Investigator(Kenkyū-buntansha): 若林 健二 東京医科歯科大学, 大学院医歯学総合研究科, 教授 (20723795)
• Project Period (FY): 2018-04-01 – 2023-03-31
• Project Status: Completed (Fiscal Year 2022)
• Budget Amount: ¥4,420,000 (Direct Cost: ¥3,400,000、Indirect Cost: ¥1,020,000); Fiscal Year 2020: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000); Fiscal Year 2019: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000); Fiscal Year 2018: ¥1,820,000 (Direct Cost: ¥1,400,000、Indirect Cost: ¥420,000)
• Keywords: 集中治療 / 多職種連携 / 集中治療医学 / 質改善 / 医療安全 / 多職種回診 / システム管理、導入 / implementation science / ケアバンドル

Outline of Final Research Achievements

Multidisciplinary rounds significantly decreased ICU length of stay and mean CV catheter days in Japanese university tertiary hospital. Although there may be differences in practice and structure of ICU care compared to the US, our findings suggest that the systemic implementation of ICU multidisciplinary rounds improves the ICU outcomes.
During COVID-19 pandemic, we settled the system to carry on multidisciplinary rounds remotely so that the quality of patients’ care would be maintained. Additionally, appropriate zoning of patient care areas relative to the degree of infectious risks were implemented to optimize the flow of patient care on the platform of multidisciplinary rounds. The implemented process proved to be effective in coordinating care between various disciplines involved in the multidisciplinary approach of patient care.

Academic Significance and Societal Importance of the Research Achievements

申請者は2016年以降現施設にて米国式医療システムに基づき、多角的なアプローチから多職種回診・多職種連携を定着させた。多職種連携はICUの効果的かつ効率的な運営において不可欠であり、本研究から得られるデータは専門化の進む我が国の集中治療領域におけるモデルケースとなることが期待される。本研究により多職種回診を基盤とした、ケアバンドルなどの医療システム導入することで、「世界標準の治療の提供」と「日本発のデータを世界に向けて発信」する事が可能となると考える。

Research Products

• [Journal Article] Impact of Antibiotic Time-Outs in Multidisciplinary ICU Rounds for Antimicrobial Stewardship Program on Patient Survival: A Controlled Before-and-After Study (2023)
  • Author(s): Mishima Yuka、Nawa Nobutoshi、Asada Mizuho、Nagashima Michio、Aiso Yoshibumi、Nukui Yoko、Fujiwara Takeo、Shigemitsu Hidenobu
  • Journal Title: Critical Care Explorations Volume: 5 Issue: 1 Pages: e0837-e0837
  • DOI: 10.1097/cce.0000000000000837
  • Peer Reviewed / Open Access
• [Journal Article] Efficacy of multidisciplinary team approach with extracorporeal membrane oxygenation for COVID-19 in a low volume ECMO center (2021)
  • Author(s): Eiki Nagaoka, Hirokuni Arai, Toyomu Ugawa, Takahiro Masuda, Kanae Ochiai, Meiyo Tamaoka, Naoki Kurashima, Keiji Oi, Tatsuki Fujiwara, Masayuki Yoshida, Hidenobu Shigemitsu, Yasuhiro Otomo
  • Journal Title: Artificial organs Volume: 45 Issue: 9 Pages: 1061-1067
  • DOI: 10.1111/aor.13947
  • Peer Reviewed / Open Access
• [Journal Article] A laceration of a wired silastic tracheostomy tube: A case report and review of the literature (2021)
  • Author(s): Kotaro Noda, Nobuyuki Nosaka, Youshun Sai, Eiki Nagaoka, Michio Nagashima, Hirokuni Arai, Hidenobu Shigemitsu
  • Journal Title: Clinical Case Reports Volume: 9 Issue: 3 Pages: 1500-1503
  • DOI: 10.1002/ccr3.3809
  • Peer Reviewed / Open Access
• [Journal Article] Hydrodynamic Approach for Revealing Venous Anastomotic Stenosis Formation Within a Dialysis Arteriovenous Graft (2021)
  • Author(s): Sano, Yoshihiko; Ugawa, Toyomu; Takeda, Ayato; Hyakutake, Toru; Nakazawa, Takashi; Yanase, Shinichiro; Shigemitsu, Hidenobu; Arai, Hirokuni
  • Journal Title: ASAIO Volume: 67 Pages: 1269-1276
  • Peer Reviewed / Open Access
• [Journal Article] COVID-19 case of ventilator-induced lung injury on extracorporeal membrane oxygenation: Physicians' clinical struggle and ethical conflict in a novel pandemic (2021)
  • Author(s): Yoshiko Ishisaka, Nobuyuki Nosaka, Yuka Mishima, Takahiro Masuda, Michio Nagashima, Yosuke Tanaka, Kouhei Yamamoto, Masayuki Yoshida, Hidenobu Shigemitsu
  • Journal Title: Clinical Case Reports Volume: 8 Issue: 12
  • DOI: 10.1002/ccr3.5223
  • Peer Reviewed / Open Access
• [Journal Article] Development and validation of the predictive risk of death model for adult patients admitted to intensive care units in Japan: an approach to improve the accuracy of healthcare quality measures (2021)
  • Author(s): H Endo, S Uchino, S Hashimoto, Y Aoki, E Hashiba, J Hatakeyama, K Hayakawa, N Ichihara, H Irie, T Kawasaki, J Kumasawa, H Kurosawa, T Nakamura, H Ohbe, H Okamoto, H Shigemitsu, T Tagami, S Takaki, K Takimoto, M Uchida, H Miyata
  • Journal Title: Journal of Intensive Care volume Volume: 9
  • Peer Reviewed / Open Access
• [Journal Article] Predictors associated with clinical improvement of SARS-CoV-2 pneumonia (2021)
  • Author(s): Mitsumura Takahiro、Okamoto Tsukasa、Shirai Tsuyoshi、Iijima Yuki、Sakakibara Rie、Honda Takayuki、Ishizuka Masahiro、Aiboshi Junichi、Tateishi Tomoya、Tamaoka Meiyo、Shigemitsu Hidenobu、Arai Hirokuni、Otomo Yasuhiro、Tohda Shuji、Anzai Tatsuhiko、Takahashi Kunihiko、Yasuda Shinsuke、Miyazaki Yasunari
  • Journal Title: Journal of Infection and Chemotherapy Volume: 27 Issue: 6 Pages: 857-863
  • DOI: 10.1016/j.jiac.2021.02.012
  • Peer Reviewed / Open Access
• [Journal Article] Factors associated with the appropriate use of ultra-broad spectrum antibiotics, meropenem, for suspected healthcare-associated pneumonia (2021)
  • Author(s): Nathan Kirsch 1 , Jane Ha 2 , Hee-Taik Kang 3 4 , Tina Frisch 5 , Ji Won Yoo, Craig Grossman, Neema Oroomchi, Hidenobu Shigemitsu, Chad L Cross, Mutsumi John Kioka
  • Journal Title: Medicine Volume: 100 Issue: 40 Pages: e27488-e27488
  • DOI: 10.1097/md.0000000000027488
  • Peer Reviewed / Open Access
• [Journal Article] Conventional risk prediction models fail to accurately predict mortality risk among patients with coronavirus disease 2019 in intensive care units: a difficult time to assess clinical severity and quality of care (2021)
  • Author(s): H Endo, S Uchino, S Hashimoto, Y Aoki, E Hashiba, J Hatakeyama, K Hayakawa, N Ichihara, H Irie, T Kawasaki, J Kumasawa, H Kurosawa, T Nakamura, H Ohbe, H Okamoto, H Shigemitsu, T Tagami, S Takaki, K Takimoto, M Uchida, H Miyata
  • Journal Title: Journal of Intensive Care Volume: 9 Issue: 1
  • DOI: 10.1186/s40560-021-00557-5
  • Peer Reviewed / Open Access
• [Journal Article] 救命可能患者の生命維持治療の拒否と倫理判断 (2021)
  • Author(s): 三島有華, 重光秀信
  • Journal Title: ICUとCCU Volume: 45 Pages: 113-119
  • Open Access
• [Journal Article] 【ICUとCCUでよく見られる病態・疾患-標準的な診断・治療・管理2020-】集中治療患者の終末期医療における多職種カンファレンスの効果 Effective Medical Creation (2020)
  • Author(s): 山内 英雄, 重光 秀信
  • Journal Title: 医学図書出版(株) Volume: 44 Pages: 217-224
• [Journal Article] 日本集中治療医学会会員看護師の蘇生不要指示に関する現状・意識の変化と、ガイドラインの使用に関する調査 (2020)
  • Author(s): 丸藤 哲, 吉里 孝子, 大野 美香, 澤村 匡史, 則末 泰弘, 美馬 裕之, 植田 育也, 重光 秀信, 木下 浩作, 藤野 裕士, 氏家 良人, 日本集中治療医学会臨床倫理委員会
  • Journal Title: 日本集中治療医学会雑誌 Volume: 27 Pages: 231-243
• [Journal Article] The Japanese Intensive care PAtient Database (JIPAD): A national intensive care unit registry in Japan (2020)
  • Author(s): Irie Hiromasa, Okamoto Hiroshi, Uchino Shigehiko, Endo Hideki, Uchida Masatoshi, Kawasaki Tatsuya, Kumasawa Junji, Tagami Takashi, Shigemitsu Hidenobu, Hashiba Eiji, Aoki Yoshitaka, Kurosawa Hiroshi, Hatakeyama Junji, Ichihara Nao, Hashimoto Satoru, Nishimura Masaji
  • Journal Title: JOURNAL OF CRITICAL CARE Volume: 55 Pages: 86-94
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Immune status in sarcoidosis: one size does not fit all (2020)
  • Author(s): Papanikolaou I, Shigemitsu H, Afthinos A
  • Journal Title: Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace Volume: 90 Pages: 10408-10408
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] The Safety and Effect of Early Mobilization in the Intensive Care Unit According to Cancellation Criteria (2020)
  • Author(s): Sakai T, Hoshino C, Okawa A, Wakabayashi K, Shigemitsu H
  • Journal Title: Progress in rehabilitation medicine Volume: 5 Pages: 207-207
  • NAID: 130007881797
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] 感染性心内膜炎に合併した浸潤影を器質化肺炎と診断しステロイド治療を行った1症例 (2020)
  • Author(s): 三島 有華, 若林 健二, 大井 啓司, 荒井 裕国, 重光 秀信
  • Journal Title: 臨床麻酔 Volume: 44 Pages: 31-35
• [Journal Article] EMC(Effective Medical Creation) 奈良医大の試み (2020)
  • Author(s): 井上 聡己, 武澤 恵理子, 重光 秀信, 川口 昌彦
  • Journal Title: 臨床麻酔 Volume: 44 Pages: 31-37
• [Journal Article] 日本集中治療医学会医師会員の蘇生不要指示に関する現状・意識の変化と、ガイドラインの使用に関する調査 (2020)
  • Author(s): 丸藤 哲, 澤村 匡史, 則末 泰博, 美馬 裕之, 大野 美香, 植田 育也, 重光 秀信, 吉里 孝子, 木下 浩作, 藤野 裕士, 日本集中治療医学会臨床倫理委員会
  • Journal Title: 日本集中治療医学会雑誌 Volume: 27 Pages: 129-149
• [Journal Article] 第5章1, 東京医科歯科大学医学部附属病院のマニュアル (2020)
  • Author(s): 重光 秀信 他, 日本集中治療医学会危機管理委員会（編著）
  • Journal Title: 災害時の集中治療室 日頃の準備から発災後まで － ICUの対応ガイダンス Volume: 1 Pages: 156-157
• [Journal Article] 感染性心内膜炎に合併した浸潤影を器質化肺炎と診断しステロイド治療を行った１症例 (2020)
  • Author(s): 三島 有華, 若林 健二, 大井 啓司, 荒井 裕国, 重光 秀信
  • Journal Title: 臨床麻酔 Volume: 44(1) Pages: 31-35
• [Journal Article] The Japanese Intensive care PAtient Database (JIPAD): A national intensive care unit registry in Japan (2020)
  • Author(s): Irie Hiromasa, Okamoto Hiroshi, Uchino Shigehiko, Endo Hideki, Uchida Masatoshi, Kawasaki Tatsuya, Kumasawa Junji, Tagami Takashi, Shigemitsu Hidenobu, Hashiba Eiji, Aoki Yoshitaka, Kurosawa Hiroshi, Hatakeyama Junji, Ichihara Nao, Hashimoto Satoru, Nishimura Masaji
  • Journal Title: Journal of Critical Care Volume: 55 Pages: 86-94
  • DOI: 10.1016/j.jcrc.2019.09.004
  • Peer Reviewed
• [Journal Article] 【ビッグデータとICUにおけるプレシジョン・メディシン】集中治療におけるBig Data活用の歴史と今後の可能性 (2019)
  • Author(s): 石井 佑充, 重光 秀信
  • Journal Title: ICUとCCU Volume: 43(4) Pages: 177-183
• [Journal Article] 【ビッグデータとICUにおけるプレシジョン・メディシン】JIPAD(Japanese Intensive Care Patient Database）の構築 (2019)
  • Author(s): 青木 善孝, 一原 直昭, 入江 洋正, 内田 雅俊, 内野 滋彦, 遠藤 英樹, 岡本 洋史, 川崎 達也, 黒澤 寛史, 熊澤 淳史, 重光 秀信, 田上 隆, 橋場 英二, 橋本 悟, 畠山 淳司, 徳増 裕宣, 日本集中治療医学会 ICU機能評価委員会JIPADワーキンググループ(2018年度)
  • Journal Title: ICUとCCU Volume: 43(4) Pages: 185-190
• [Journal Article] 遠隔治療 -十勝南部・日高東部と帯広、東京を結ぶ救急集中治療 Tele-ICU構想- (2019)
  • Author(s): 鵜川 豊世武, 長島 道生, 山内 英雄, 重光 秀信
  • Journal Title: 臨床麻酔 Volume: 43(5) Pages: 661-662
• [Journal Article] EMC(Effective Medical Creation)：奈良医大の試み (2019)
  • Author(s): 井上聡己, 武澤 恵理子, 重光 秀信, 川口昌彦
  • Journal Title: 臨床麻酔 Volume: 43(10) Pages: 1337-1342
• [Journal Article] 【多職種で取り組む 最前線の集中治療】 多職種で考える終末期医療と臨床倫理 (2019)
  • Author(s): 若林健二、重光秀信
  • Journal Title: 救急医学 Volume: 43
• [Journal Article] A 48-Year-Old Man With Multiple Pulmonary Nodular Opacities and Elevated KL-6 Level (2018)
  • Author(s): Nakano Takayuki、Kuwahira Ichiro、Shigemitsu Hidenobu、Nakagawa Tomoki、Nagai Asuka、Ebihara Akinori、Oka Teruaki、Iwazaki Masayuki
  • Journal Title: Chest Volume: 154 Issue: 3 Pages: e77-e81
  • DOI: 10.1016/j.chest.2018.03.051
  • Peer Reviewed
• [Journal Article] クリティカル・ケアを極める-一歩進んだ総合内科医を目指して】内科クリティカル・ケア 知っておくべき知識・技術をまとめる 重症にはこれを武器に立ち向かう 輸液・血液製剤・輸血の管理と合併症対応. (2018)
  • Author(s): 塩田 修玄, 重光 秀信.
  • Journal Title: Medicina Volume: 55
• [Journal Article] 五感を活用したICUケアー - Effective Medical Creation (2018)
  • Author(s): 佐藤 幸世, 若林 健二, 武澤 恵理子, 重光 秀信
  • Journal Title: 臨床麻酔 Volume: 42 Pages: 955-963
• [Journal Article] 特集 救急現場のあるある場面別 医療機器使いかたエビデンス (2018)
  • Author(s): 重光秀信
  • Journal Title: Emergency Care Volume: 31
• [Presentation] 救急集中治療におけるEffective Medical Creation（EMC）の実践 EMCとは？集中治療室での取り組み (2021)
  • Author(s): 重光秀信
  • Organizer: 第40回日本蘇生学会
  • Invited
• [Presentation] 米国から見た日本の集中治療 (2021)
  • Author(s): 重光秀信
  • Organizer: 第49回日本救急医学会総会・学術集会
  • Invited
• [Presentation] JIPAD四方山話2021 (2021)
  • Author(s): 重光秀信
  • Organizer: 第48回日本集中治療医学会学術集会
• [Presentation] 集中治療室で始める倫理カンファレンス (2021)
  • Author(s): 重光秀信
  • Organizer: 第48回日本集中治療医学会学術集会
• [Presentation] Microvesicles are absorbed on the surface of extracorporeal membrane oxygenation circuit tubing (2019)
  • Author(s): Yoichi Iki, Shotaro Matsumoto, Michiko Abe, Kieran P. O'Dea, Hidenobu Shigemitsu, Masao Takata, Kenji Wakabayashi
  • Organizer: ISEV2019（International Society for Extracellular Vesicles）
  • Int'l Joint Research
• [Presentation] Neutrophil-Derived Microvesicles as a Novel Biomarker in Hyperoxic Bronchopulmonary Dysplasia in Mice (2019)
  • Author(s): Matsumoto S, Iki Y, O'Dea KP, Shigemitsu H, Takata M, Wakabayashi K
  • Organizer: ATS2019（American Thoracic Society）
  • Int'l Joint Research
• [Presentation] ICUでのantimicrobial stewardship programとしてのtime-out 導入効果 (2019)
  • Author(s): 三島有華、朝田瑞穂、羽田野義郎、長島道生、相曽啓史、渋谷有香、宮野七美、塩田修玄、増田孝広、丸山史、若林健二、鵜川豊世武、高橋英夫、貫井陽子、重光秀信
  • Organizer: 日本集中治療医学会関東甲信越支部学術集会
• [Presentation] Music interventions for preventing ICU delirium: a randomized controlled trial (2019)
  • Author(s): Wakabayashi K, Sato S, Nawa N, Takezawa E, Fujiwara T, Shigemitsu H
  • Organizer: ESICM2019（European Society of Intensive Care Medicine）
  • Int'l Joint Research
• [Presentation] Daily temperature variability of patients is associated with changes in ICU mortality (2019)
  • Author(s): T. Hinoshita, J. Young Seok, T. Hensman, D. Garner, S. Sturland, T. Sugawara, R. Hayes, N. Nonaka, R. Kameya, M. Izumi, M. Adomi, M. Feng, D. Pilcher, L. A. Celi, S. Hashimoto, H. Shigemitsu
  • Organizer: ESICM2019（European Society of Intensive Care Medicine）
  • Int'l Joint Research
• [Presentation] ICUにおける多職種連携 -米国と日本の経験を踏まえて- (2019)
  • Author(s): 重光秀信
  • Organizer: 総合病院土浦協同病院
  • Invited
• [Presentation] 重症患者における多職種連携 -米国・日本の経験を踏まえて- (2019)
  • Author(s): 重光秀信
  • Organizer: 市立函館病院
  • Invited
• [Presentation] MULTIDISCIPLINARY ROUNDS SHORTEN ICU LENGTH OF STAY IN A JAPANESE UNIVERSITY TERTIARY HOSPITAL (2018)
  • Author(s): Shiota Nobuhiro、Sato Sachiyo、Wakabayashi Kenji、Tsukada Yoko、Tanaka Marie、Shigemitsu Hidenobu
  • Organizer: Society of Critical Care Medicine Congress
  • Int'l Joint Research
• [Presentation] A Ten-Minute Lecture Impacted the Interpretation of Do-Not-Attempt-Resuscitation Order in Resident Physicians in Japan (2018)
  • Author(s): Mishima Y., Wakabayashi K., Shigemitsu H
  • Organizer: American Thoracic Society Congress
  • Int'l Joint Research
• [Presentation] 集中治療におけるBig Data活用の歴史と今後の可能性 (2018)
  • Author(s): 重光秀信
  • Organizer: 日本蘇生学会ランチョンセミナー
  • Invited
• [Presentation] The Japanese Story of AI in Healthcare (2018)
  • Author(s): Shigemitsu H
  • Organizer: NUS-MIT Datathon
  • Int'l Joint Research / Invited
• [Book] 災害時の集中治療室 日頃の準備から発災後まで － ICUの対応ガイダンス (2020)
  • Author(s): 重光秀信
  • Total Pages: 2
  • Publisher: 真興交易株式会社
  • ISBN: 9784880039336
• [Book] 救急・集中治療領域における感染症診療 (2019)
  • Author(s): 重光秀信
  • Total Pages: 24
  • Publisher: 克誠堂出版株式会社
  • ISBN: 9784771905214