Reasons For Omission Research Articles

Omissions of Medical Fees Covered by Health Insurance for Outpatients in Our Department

Economic efficiency has recently been required even in public hospitals. Medical fees from health insurance account for most of the medical income of our hospital. Medical fees were counted in units of points, with one point equaling 10yen. However, it is unclear how many points are omitted in determining medical fees to be paid by health insurance. This study investigated the extent of such omissions.The subjects were all outpatients who consulted the Department of Otolaryngology of Takarazuka Municipal Hospital between January 24 and 28, 2005. Following the completion of daily work, we examined the slip sheets actually used to calculate payments and determined the omissions. In our department, when a doctor completes the treatment and/or examination, the nurse checks the appropriate items in slip sheets.Omissions were found on slip sheets for 40 of 372 patients (10.8%). Based on the total reward receipts (322, 988 points), 5298 points (1.6%) had been omitted. Omissions for balance tests, middle ear fiberscopy and laryngoscopy were particularly common.The loss associated with this were estimated as about 2, 360, 000yen annually. The reason for omissions appeared to be the lack of presence of a nurse during treatment and/or examinations and poor knowledge of nurses about otolaryngological care.

Omitted Medication Doses: Frequency and Severity

Aims: To determine the number of omitted medication doses for hospital inpatients, identify the reasons and assess their severity.Method: The study involved intensive drug chart surveillance over a period of 5 days in two wards that included a wide range of medical and surgical specialties of a metropolitan teaching hospital. Inpatients receiving regular or once‐only medication for at least 5 days were monitored. A multidisciplinary committee assessed the severity of the omitted doses on a visual analogue scale of 0 to 10, where 0 is no potential harm to the patient and 10 is the potential for death.Results: Drug charts for 67 inpatients were audited. A total of 4887 doses were prescribed of which 369 (7 .6%) were recorded as dose omissions. In 273 of the 369 (74%) omitted doses, there were documented reasons for omission. 120 of the 369 doses omitted were scored for severity, with 86% (103/120) of these considered to have placed the patients at some risk of harm. No omitted doses were rated above 7 in severity.Conclusion: This study identified a substantial number of doses omitted, and a significant proportion of these were for no clear reason. The majority of the omitted doses were considered to have a potentially negative effect on the patient. Greater awareness of the extent of this problem has facilitated a collaborative effort, led by pharmacists, to improve the medication administration system.

Omission of polysomnography in treatment of snoring: common reasons and medico-legal implications.

Although polysomnography (PSG) is an important investigation in the treatment of snorers, it was observed that a large number of patients did not have pre-operative PSG assessment in a tertiary hospital in Singapore. Of the 118 Asian patients who underwent surgery for snoring from January 1997 to December 1998, 36 (30.5 per cent) of patients did not have pre-operative PSG and only 21 (17.8 per cent) of patients had post-operative PSG. In this cohort, 43 (36.4 per cent) patients presented with snoring as their only complaint and not associated with symptoms indicative of obstructive sleep apnoea syndrome (OSAS). Thirty-one of these 'simple snorers' underwent sleep studies with the following outcome: two (6.5 per cent) true simple snorers, two (6.5 per cent) upper airway resistance syndrome, nine (29 per cent) mild OSAS, seven (22.6 per cent) moderate OSAS and 11 (35.5 per cent) severe OSAS. Our study showed that without the aid of PSG, it would be difficult to predict the severity of sleep apnoea based on clinical history alone. In an increasingly litigation-conscious society such as Singapore, there is therefore little justification in omitting PSG in the treatment of snoring. The common reasons for omission of pre-operative PSG and the medico-legal implications are also discussed.

Improving the use of aspirin in myocardial infarction: a district strategy

Following a high‐profile publicity campaign across South Tyneside aimed at professionals and patients, 52.4 per cent of all patients admitted with suspected myocardial infarction during a six‐month period received 300mg of aspirin. Twelve months later GPs’ performance had improved from 25 per cent to 52.9 per cent of patients directly admitted by GPs being prescribed aspirin when first seen. Following a definite myocardial infarction 78.4 per cent of patients were discharged taking 75mg of aspirin, with no valid reason for omission in 6.6 per cent of patients. Six months after discharge 71.8 per cent of patients were still taking aspirin. Twelve months later 90 per cent of discharged patients were taking aspirin. GP PACT data showed a marked increase in prescribing 75mg aspirin during the period. The use of a publicity campaign to disseminate the message to both professionals and patients has resulted in a beneficial increase in aspirin prescribing for myocardial infarction across the district.

Strategy Implementation Pedagogy: A Survey of AACSB-Accredited Business Schools

Abstract American business schools are increasingly criticized for producing graduates incapable of meeting the needs of action-oriented employers. A case in point is the overemphasis on strategy formulation and insufficient attention paid to strategy implementation. A mail survey concerning the state of the art of strategy implementation pedagogy was sent to 264 AACSB-accredited business schools. Analysis of 149 usable responses (56.4%) revealed the teaching methods commonly used, popular and heavily covered strategy implementation topics, and reasons for omission of certain topics.