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At least 235 records · Page 13Linked to original sources
PubMed2005

The implementation of a nurse-provided, ward-based bilevel non-invasive ventilation service.

Bilevel non-invasive ventilation (NIV) is now standard of care for patients with acute hypercapnic respiratory failure (AHRF), and has an increasing role to play in patients with stable chronic hypercapnic respiratory failure (CHRF). The institution of an NIV service in a hospital setting requires major infrastructural and multidisciplinary input to be effective. This paper describes our experiences in setting up a 24-hour, nurse-provided, ward-based NIV service in a new acute teaching hospital in Dublin over a 39-month period. In addition, we provide audit data on 78 patients with AHRF treated with NIV by this service over this time period. The majority of patients (65) had their respiratory acidosis corrected and were discharged home; 11 patients failed NIV and were intubated and mechanically ventilated in the ITU; 13 patients died, 8 from respiratory causes and 5 from non-respiratory causes, indicating the critical nature of this condition.

Adult↗
PubMed2005

Computerised screening for hazardous drinking in primary care.

INTRODUCTION: Brief interventions undertaken in primary care settings have been shown consistently to reduce hazardous drinking, but they are not commonly offered in practice. The aims were to determine the uptake by young people of an offer of screening in a primary care setting; to identify patients' drinking risk levels; and to estimate the proportion who would consent to computerised brief intervention and follow-up. METHODS: Participants were 1120 patients attending a university student health service that were invited for screening while in the waiting room. Participants were also asked for their consent to be contacted for follow-up assessment 1, 6, and 12 months later. RESULTS: 1,010 patients (90%) accepted the invitation for screening. Of these, 35 (4%) failed to complete screening, thus leaving 975 with complete Alcohol Use Disorders Identification Test (AUDIT) data. Sixty percent of women and 73% of men screened positive. Twenty-three patients (4%) eligible for intervention declined follow-up assessments. DISCUSSION: The study demonstrates that the primary care setting can be used to facilitate access via computer to a large number of individuals whose drinking is hazardous. Limitations of the study include the use of an educated segment of the population who may be more receptive to computerised screening than other groups. Strengths of the study include the high rate of participation and the naturalistic setting in which the data were collected.

Adolescent↗
PubMed1994

Security Audit Center--a suggested model for effective audit strategies in health care informatics.

As dependence upon interorganizational and international health care informatics becomes absolute, and with increased vulnerability of information networks and applications and the cunning sophistication of computer criminals, it becomes imperative to implement tight information systems security to ward off any possible threat to these vital life-dependent information systems. In a rapidly decentralizing environment, the author proposes centralized security control, implemented in a Security Audit Center under the direct supervision of an Information Systems Security Manager who is a high-ranking organization staff member. Of the various components of the Security Audit Center, the most significant is the security audit expert systems which analyze audit data files according to security rules and present a precise status of systems security and realtime suspicion alert of the various breaches and intrusions.

Automation↗
PubMed1977

An automated clinic management system for a family planning network.

The medical information, financial, and logistic aspects of a comprehensive computer-based Appointment, Registration, Information System, and Evaluation (ARISE) are analyzed for the management of a family planning program serving 30,000 patients annually. An overview of the existing computer system network is presented with descriptions of the interactive master patient index, the batch appointment process, the management statistics package, and Department of Health, Education, and Welfare (HEW) reporting. Emphasis is placed on the financial management control system which includes 1) procedures for third-party submission of claims for payment, in particular Titles IVA, XX, and XIX (Social Security Act), together with discussion of related administrative requirements; 2) technics of auditing data integrity including systematic sampling of collected data; and 3) the process of billing and receipts collection. Methodology and implementation aspects of ARISE may have wide applicability to other family planning and similarly structured clinical programs.

Computers↗
PubMed1995

Quality auditing of chromatographic data.

We have developed a method for consistent, in-depth audit of the integrity of chromatographic records. The approach includes definition of the analyte, the method of analyte sample preparation and analysis, and the analyte concentration range. Acceptance criteria (if any) defined in the protocol or method are compared to the data. Run parameters are compared to those specified in the methodology. Certification of the standard is verified and the limit of quantitation for each run is identified and compared to data. Reasons for data discard and/or reassay are examined. If calculation software is not validated, representative calculations are recomputed and chromatograms are examined for attributability. These parameters are examined in addition to other Good Laboratory practice considerations such as sample identity, sample integrity, and transcription accuracy.

Chromatography↗
PubMedDate not supplied

Clinical audit.

Explore the source record for details and available documents.

Data Collection↗
PubMedDate not supplied

Transforming an EPA QA/R-2 quality management plan into an ISO 9002 quality management system.

The Environmental Protection Agency's (EPA) Office of Emergency and Remedial Response (OERR) requires environmental data of known quality to support Superfund hazardous waste site projects. The Quality Assurance Technical Support (QATS) Program is operated by Shaw Environmental and Infrastructure, Inc. to provide EPA's Analytical Operations Center (AOC) with performance evaluation samples, reference materials, on-site laboratory auditing capabilities, data audits (including electronic media data audits), methods development, and other support services. The new QATS contract awarded in November 2000 required that the QATS Program become ISO 9000 certified. In a first for an EPA contractor, the QATS staff and management successfully transformed EPA's QA/R-2 type Quality Management Plan into a Quality Management System (QMS) that complies with the requirements of the internationally recognized ISO 9002 standard and achieved certification in the United States, Canada, and throughout Europe. The presentation describes how quality system elements of ISO 9002 were implemented on an already existing quality system. The psychological and organizational challenges of the culture change in QATS' day-to-day operations will be discussed for the benefit of other ISO 9000 aspirants.

Environmental Monitoring↗
PubMed1999

Supporting practice-based audit: a price to be paid for collecting data.

BACKGROUND: There has been considerable investment by health authorities in the funding of support staff whose job is to collect data for audit purposes. It is important to understand what costs are involved in such a data collection exercise. The cost advantages of using existing practice staff or externally funded staff are not known. AIM: To assess the cost of transposing data on workload to computer software for audit purposes and retrieving data on five chronic diseases from case records. METHOD: Four audit support staff monitored the time taken to collect specific data as part of a broad audit programme in 12 training practices within one health board area in the West of Scotland in 1997. The time taken was used to estimate comparative costs for using a receptionist or practice nurse for carrying out a similar exercise. RESULTS: Average costs for collecting data per 1000 patients for waiting time, appointments, recall, and telephone audits were 5.24 Pounds for reception staff, 5.64 Pounds for audit support staff, and 9.68 Pounds for a practice nurse. The average cost for collecting data per patient with diabetes, asthma, epilepsy, hypertension, or rheumatoid arthritis was 1.48 Pounds for reception staff, 1.60 Pounds for audit support staff, and 2.74 Pounds for a practice nurse. CONCLUSIONS: The cost of collecting data varies considerably depending on which staff are chosen for the purpose. Practices should consider carefully how best to collect data for audit in terms of cost.

Allied Health Personnel↗
PubMed1993

Criteria audit: making use of existing data.

The first steps in setting up a criteria audit are presented with the aim of serving as a guide for starting quality assurance activities in Papua New Guinea. These activities need to be based on data, and the systematic and critical analysis of any available data on the process or outcome of health care delivery is a simple, cheap and useful basis for its improvement. Criteria are defined and the completeness and relevance of the data audited are discussed. Recommendations on the use of available recorded data and on the improvement of record-keeping practices are made.

Demography↗
PubMed1988

The Hollywood surgical-audit programme: a computer-based discharge and data-collection system for surgical audit.

This article describes the development of a computer-based system for the prospective collection of data for surgical audit and peer review with the generation of a surgical discharge letter. The software has been developed for an IBM personal computer and is suitable for any compatible computer. The system has potential advantages for teaching hospitals as it enables patients to obtain a definitive discharge letter on their discharge from hospital. It is also of potential benefit to surgeons who wish to collect clinical data and to audit the quality of their surgical practice.

Computers↗
PubMed1990

Obstetric audit using routinely collected computerised data.

OBJECTIVE: To examine the use of routinely collected computerised data in clinical audit. DESIGN: Retrospective review of all analyses of obstetric practice based on a computerised data system from January 1983 to June 1988. SETTING: Maternity department of the regional referral hospital in Oxford. MAIN OUTCOME MEASURES: Congruence with the principles of clinical audit; that is, comparing clinical practice with previously agreed standards and changing practice to meet these standards if necessary. RESULTS: Over the five and a half years of the study the data formed the basis of 130 special inquiries into different aspects of obstetric practice. Most inquiries seemed to be aimed only at describing current activities and identifying trends. Genuine clinical audit was rare. Simple audits--for example, concerning induction for pregnancy after term--could be supported by the computerised data, but for detailed and wide ranging audits--for example, reducing antenatal clinic visits for low risk multiparas--the data had to be supplemented from other sources. CONCLUSIONS: Routinely collected computerised data enable ongoing clinical audit, but it becomes a reality only when clinicians agree on standards of practice and have a flexible attitude towards change. Even then, genuine clinical audits of obstetric practice demand more detailed and comprehensive data than are generally available on such systems.

Data Interpretation, Statistical↗
PubMed2001

Completing the audit cycle: the outcomes of audits in mental health services.

AIMS: To assess how far those UK National Health Service mental health settings that tested, and prior to publication, used the Newcastle Clinical Audit Toolkit for Mental Health (NCAT) completed the audit cycle. DATA SOURCES: Twelve clinical audit project reports, each focused on one of the five modules in the NCAT, from four rounds of activity over a 2-year period; clinical and managerial staff in the settings where audit projects had taken place. DATA EXTRACTION: Interviews with audit project team members about the recommendations of the 12 audit project reports and about contextual issues; all projects had reported at least 2 years previously. RESULTS OF DATA SYNTHESIS: In analysing the audit project outcomes, five categories of inaction were discernible and five further categories were needed to describe varying states of progress. It was necessary to discriminate between actions attributed to the NCAT audit projects and actions attributed mainly to other initiatives. In total, 26.4% of audit recommendations were still under discussion or in progress. A relatively low proportion of recommendations from audit report findings (34.7%) had been implemented, and these were divided almost equally between recommendations attributed to the NCAT projects (38) and those attributed to other initiatives in the organization (37). CONCLUSION: Investigation of the medium-term outcomes of clinical audit projects has provided an insight into what might usefully be termed the process of completing the audit cycle. The time-scales required to reach the point at which action is deemed to have been implemented or not may be as long as 3 years. Conceptualizing the action stage of the cycle as a single discrete event fails to do justice to the complexity of the process, and attributing the implementation of change in clinical settings to single causes such as individual audit projects is problematic.

Health Care Surveys↗
PubMed1998

Avoiding pharmacy fraud through automation and audit.

Pharmacy data offer some of the most reliable and evaluative information in managed care today. As fraud constitutes up to 10% of our total health care expenditures, the author explains how monitoring the pharmacy network for fraud and abuse is an easy way of reclaiming some of these losses.

Electronic Data Processing↗
PubMed1997

NCQA implements new outcomes audit standards.

Faulty data gathering and auditing techniques have put in question the comparability of HEDIS outcomes standards. The National Center for Quality Assurance has moved to shore up its data's credibility with new auditing standards. A new class of certified auditors must be trained. Until then, the Health Care Financing Administration will have Medicare managed care organizations audited by independent firms.

Health Benefit Plans, Employee↗
PubMed1991

European Good Laboratory and Clinical Practices: their relevance to clinical pathology laboratories.

The requirements for Good Laboratory (GLP) and Good Clinical Practices (CGP) were established as a matter of urgency by the United States in the early 1970s. These were in response to gross misconduct and, in many instances, fraud. Over the next 15 years, a plethora of regulatory principles, guidelines, and regulations was produced by many countries of the world, culminating in single standards for European, Japanese, and United States authorities. Although with regard to GLP this has basically become a worldwide recognized standard within the preclinical (toxicology) studies, in the veterinary, chemical, agrochemical, and pharmaceutical industries, the GCPs are now seeing a rebirth. Within a clinical trials environment, there is most certainly a requirement for compliance with GCP, especially with regard to the harmonization of data within the European Community. The goal of this article is to cover the following aspects: Why should we have good practices? Why should laboratory data be audited? Why is there a need for a QA unit or function? What is the QA operational approach? How does a laboratory audit take place within laboratories? In discussing the laboratories and their subsequent data audits, the pitfalls and benefits are addressed and an examination of the data from the sponsor's viewpoint is compared with that produced by the laboratory. The types of laboratories present in a clinical environment are examined. They obviously comprise clinical pathology, microbiology, and analytical as well as ancillary hospital areas such as X-ray and cardiology. These laboratories may also be in the private sector, the National Health Service, contract laboratories, universities, or the general practitioner population.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗