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PubMed1994

Customized dual data entry for computerized data analysis.

A major responsibility of any Quality Assurance Unit (QUA) is to ensure data integrity. Errors made during data entry can lead to many problems in the study review process and decrease the quality, accuracy, and overall efficiency of data management. One technique that can reduce the number of data entry errors in computer data sets is the use of a dual entry data system. Currently available software allows creation of customized data entry screens that either closely resemble or duplicate the data collection forms used during studies. Two data entry operators enter data into two independent data sets. The use of an on-screen display that resembles the data collection form reduces the potential for keypunch errors. The two data sets can then be electronically compared. The comparison reports differences between the two data sets. When differences exist, the correct values can be determined by reference to the original data sheets and the two data files can then be corrected. Theoretically, the only key punch errors that will exist after making these corrections are when the two independent entry operators make the same exact data entry error. Typically, the time required for two people to enter data is minimal compared to the time required to manually identify and correct data entry discrepancies. With error-free data entry, we have found that electronic data quality, accuracy, and audit efficiency are improved at every subsequent step of data management, analysis, quality assurance auditing, and report generation.

Information Systems↗
PubMed2003

Using clinical audits to identify practitioner learning needs.

Clinical audits are used in medicine to monitor practice performance, provide practice feedback, and identify learning needs. Although relatively new to veterinary practice, they hold promise as personal learning needs assessment tools. Continuing veterinary medical education providers are in a unique position to assist practitioners in the design, implementation, and evaluation of clinical audits. This paper discusses the types, the interpretation, and the potential uses of data from clinical audits in the veterinary setting and links audits to continuing veterinary medical education.

Animals↗
PubMed1999

A survey of Australasian obstetric anaesthesia audit.

In order to develop a minimal obstetric anaesthesia dataset based on current Australasian clinical audit best practice, we carried out a postal survey of 69 Australasian anaesthetic departments covering an obstetric service. We asked about data being collected, specifically concerning the high risk obstetric patient, epidural analgesia and postoperative anaesthetic review. Examples of any data collection forms were requested. Of the 66 responses, 35 departments (53%) were not collecting any audit data. Twenty-six of the 31 departments (84%) performing obstetric anaesthesia audit responded to our follow-up telephone survey. Eighteen departments believed that there had been an improvement in patient care as a result of their audit and 13 felt that the benefits outweighed the costs involved. However, only six departments (9%) had performed an audit cycle. The importance of feedback to patients or hospital staff and the incidence of post dural puncture headache (PDPH) were cited by some as priorities for obstetric anaesthesia audit. There was however no consistency as to what data should be collected. Many responses suggested a perceived need to collect clinical data without knowing what to do with it. Our survey has highlighted confusion between three distinct objectives; a dataset for obstetric anaesthesia record keeping, data required for continuing patient management in hospital and, a specific minimal dataset for clinical audit purposes. We conclude that current Australasian obstetric anaesthesia audit strategies are inadequate to develop a minimal dataset for cost-effective clinical audit.

Analgesia, Epidural↗
PubMed1992

Autopsy rate and a clinicopathological audit in an Australian metropolitan hospital--cause for concern?

OBJECTIVES: To determine the annual autopsy rates at five major Melbourne teaching hospitals between 1979 and 1989; to investigate the cause(s) of the decline in autopsy rates during that period; and to assess the importance of autopsies at the index hospital by a clinicopathological audit. DESIGN: Retrospective data for annual autopsy rates (i.e. all patients undergoing autopsy as a ratio of the total number of deaths) were obtained for five hospitals and, for the index and one other hospital, demographic data for autopsy rates within certain ethnic and religious groups for 1988. For the clinicopathological audit, clinical diagnoses from hospital charts and death certificate diagnoses were compared with the major findings for all autopsies in 1988. SETTING: The index and the other four hospitals are major Melbourne metropolitan teaching hospitals. PATIENTS: For the index hospital in 1988, demographic data for age, sex, death in a surgical or medical unit were obtained for 643 deceased patients, of whom 124 underwent a hospital autopsy. Data of ethnic background and religion were available for 557 of 643 deceased patients. At another hospital, religious affiliation was obtained for all patients who died in hospital (543) for 1989. RESULTS: Between 1979 and 1989, the autopsy rate declined from 47% to 19% at the index hospital, by relative levels of 50% at three hospitals, and showed a smaller decline at the fourth. At the index hospital in 1988, permission for autopsy was sought in 84% of deceased patients, but was granted in only 22%. The audit showed that major misdiagnoses occurred in 18 of 124 cases (14.5%), with relevance to patient management in eight cases (6%). CONCLUSIONS: The falling autopsy rate at five major teaching hospitals could be attributed to the relatively low status of the autopsy among clinicians and pathologists and the high refusal rates by relatives of the deceased since the introduction in 1983 of the Human Tissue Act 1982 (Vic.). The audit corroborated the importance of autopsies as a diagnostic tool.

Attitude↗
PubMedDate not supplied

Guidelines for surgical audit in Australia and New Zealand.

Surgical audit is an important part of the process to measure performance, reduce clinical risk and improve quality of care. Recognizing this, the Royal Australasian College of Surgeons established a Surgical Audit Taskforce as a subcommittee of the Board of Continuing Professional Standards. This study aims to review the recommendations of the Taskforce for data collection and peer review. The minimum data for whole-practice, continuing audit have been defined. The method of data collection, devices and databases are personal choices for the individual surgeon. However, there are many benefits of developing an electronic surgical audit, and these include facilitating comparison and sharing of audit data between units. Surgical audits should not only report on work carried out but also ensure that outcomes include key performance indicators such as major complications, readmissions, reoperations, transfers, incident reports, complaints and mortalities. Effective clinical governance demands that issues raised by audit need to be documented and reported together with recommendations for improvement. Surgeons should be proactive in helping to find and implement solutions to the issues arising from surgical audit.

Australia↗
PubMed1992

Implementation of surgical audit in Pakistan.

UNLABELLED: Surgical audit, while extensively practised in the West, is still widely believed an impossible attainment in developing countries owing to the high cost and technology required to implement it. It is thus a poorly understood and rarely practised exercise in these countries. In this article we attempt to demonstrate the usefulness and feasibility of implementing audit in the setting of a developing country using personal computers (PCs) with simple, inexpensive and easily available software. We discuss the results of data analysis of 18 months of audit conducted by one general surgery team (2 consultants, 4 residents) at the Aga Khan University Hospital, Karachi. OBJECTIVE: To implement surgical audit in the setting of a developing country using microcomputers with simple, inexpensive and easily available software. DESIGN: Data analysis of inpatient audit proformas filled at weekly audit meetings from January 1989-July 1990 using Dbase III Plus. SETTING: One general surgery team (2 consultants, 4 residents) in a tertiary care hospital in Karachi. MAIN OUTCOME MEASURES: Disease patterns, caseload, complication rates. RESULTS: Conditions related to the biliary system made 26.1 per cent of the admitting diagnoses; 25.3 per cent of the patients had some co-existing medical condition as well, diabetes and hypertension being most common. The overall morbidity was 12.3 per cent and the mortality 1.5 per cent. Chest infection, wound infection and urinary retention were the most common post-operative complications. CONCLUSIONS: Results of audit data analysis initiated new research projects and development of protocols to improve patient care. Audit meetings also served as teaching sessions for residents.

General Surgery↗
PubMed2005

A study on how mental health practitioners address ethical issues in clinical audit.

Although much debate has taken place within the literature on the differences between research and clinical audit, the ethical dimensions of audit have frequently been neglected. Furthermore, no research has of yet explored what ethical issues auditors consider in relation to their projects or how they manage them in practice. Using data collected from audit documentation, semi-structured interviews and a researcher-administered questionnaire, this study sought to advance this position by exploring how 14 clinicians undertook audits in one mental health Trust addressed the ethical dimensions of their project. Analysis of the data revealed that the Trust had no formal mechanisms for reviewing and monitoring audit projects whilst other informal mechanisms were not utilized by all auditors. A number of projects had contact with both clinicians and service users through interviews, focus groups and questionnaires; however, issues such as informed consent, confidentiality and anonymity were not adequately addressed by auditors. The implications of these findings are discussed and recommendations for practice outlined.

Attitude of Health Personnel↗
PubMed2005

A system of metadata to control the process of query, aggregating, cleaning and analysing large datasets of primary care data.

BACKGROUND: Metadata is data that describes other data or resources. It has a defined number of named elements that convey meaning. Medical data are complex to process. For example, in the Primary Care Data Quality (PCDQ) renal programme, we need to collect over 300 variables because there are so many possible causes of renal disease. These variables are not just single columns of data--all are extracted as code plus date, while others are code-date-value. Metadata has the potential to improve the reliability of processing large datasets. OBJECTIVE: To define unique and unambiguous metadata headings for clinical data and derived variables. METHOD: We defined the look-up tables we would use as a controlled vocabulary to name the core clinical concepts within the metadata. We added six other elements to describe data: (1) the study or audit name; (2) the query used to extract the data; (3) the data collection number; (4) the type of data, including specifying the units; (5) the repeat number (if the variable was extracted more than once); and (6) a processing suffix that defines how the data have been processed. RESULTS: The metadata system has enabled the development of a query library and an analysis syntax library that make data processing and analysis more efficient. Its stability means greater effort can be put into more complex data processing, and some semiautomation of processes. However, the system has had implementation problems. It has been particularly hard to stop clinicians using multiple synonyms for the same variable. CONCLUSIONS: The PCDQ metadata system provides an auditable method of data processing. It is a method that should improve the reliability, validity and efficiency of processing routinely collected clinical data. This paper sets out to demystify our data processing method and makes the PCDQ metadata system available to clinicians and data processors who might wish to adopt it.

Electronic Data Processing↗
PubMed1981

Data editing in a clinical trial.

In clinical research and, particularly, in multicenter clinical trials, data are collected onto study forms designed to minimize errors in the recorded data. Nevertheless, errors of various kinds must be anticipated, and it is necessary to devise means to detect, review, and correct erroneous values. General requirements of a data editing system and methods for accomplishing these tasks are presented. A general computer program for error detection and a method for updating the data base that leaves an "audit trail" of the original data and subsequent corrections are described.

Clinical Trials as Topic↗
PubMed1995

DIAMOND: a computerized system for the management and evaluation of district-wide diabetes care.

A computerized diabetic clinic management system, DIAMOND, has been developed with the collaboration of local general practitioners (GPs) to assist communication about diabetic patients across the district. DIAMOND is written in a Windows format using Microsoft Access and its dataset is in line with BDA and Diabcare recommendations. DIAMOND is user-friendly and includes displays and help messages throughout and does not require advanced computer knowledge. The main index contains two primary tables: a patient registration table with demographic data and an episode table with clinically important physical and biochemical measures. All entered data are coded to facilitate audit and an audit function, which automatically presents data, either numerically or graphically, is included in the report facility. DIAMOND also incorporates a system for patient education and training (PEATS) which may be operated by a health professional or the patient. Over 4500 patients in Newham are presently registered on DIAMOND with in excess of 15,000 episodes. Evaluation of this information is providing important clinical information both within individual GP practices and district-wide to assist future plans for health care provision.

Diabetes Mellitus↗
PubMed1995

The mammography audit: a primer for the mammography quality standards act (MQSA).

The medical audit of a mammography practice is a recognized method for evaluating mammography and the accuracy of mammographic interpretation [1-4]. As such, portions of the audit will become integral to the quality assurance activities of every mammography practice under the Mammography Quality Standards Act (MQSA) of 1992, administered by the Food and Drug Administration (FDA). The FDA Interim Rules, which became effective October 1, 1994, state that "each facility shall establish a system for reviewing outcome data from all mammography performed, including follow-up on the disposition of positive mammograms and correlation of surgical biopsy results with mammogram reports" [5]. It is expected that the proposed final rules, due to be released for public comment in 1995, will require collection of additional data for medical audits (public meeting of the National Mammography Advisory Committee, May 3, 1994). Although most mammography practices are now collecting clinical outcomes data on abnormal mammographic examinations, very few have established an organized and deliberate system of data collection necessary for a more complete mammography audit [6]. A detailed discussion of and recommendations for such an audit were recently published as part of the Quality Determinants of Mammography Guideline by the Agency for Healthcare Policy and Research (AHCPR) [7]. As members and consultants on the multidisciplinary panel that produced the guideline, we offer the following review of the various elements, definitions, and processes of the mammography audit. This is intended as a primer for all radiologists who will be performing some of the same audit activities for the MQSA.

Female↗
PubMed2003

Use of audit tools to evaluate the efficacy of cleaning systems in hospitals.

BACKGROUND: Recent publicity has highlighted both the inadequacies of hospital cleaning and high levels of methicillin-resistant Staphylococcus aureus infections in UK hospitals. "Standards for Environmental Cleanliness" (SEC) was a checklist developed in April 1999 by the Infection Control Nurses Association and the Association of Domestic Managers to evaluate cleaning services regardless of who is the provider. More recently, the National Health Service plan (July 2000) was an attempt to generate a rapid improvement in the cleanliness and tidiness of hospitals via a National Health Service patient environment audit (PEA). On the basis of models used in the food industry to manage cleaning practices cost-effectively, a risk-based audit checklist incorporating rapid hygiene monitoring was developed to assess the adequacy of cleaning programs and standards in hospitals. This checklist (Audit for Cleaning Efficacy, or ACE) as well as the SEC and PEA approaches were applied at 4 hospitals, and environmental microbial surface counts were compared. SEC and PEA rely on visual assessment, whereas the ACE approach is more comprehensive and included more specific questions relating to the management and monitoring of cleaning as well as standards on the basis of rapid hygiene monitoring. METHODS: Two wards in each of the 4 hospitals were visited on 3 separate occasions immediately after cleaning was completed. Visual assessment, adenosine triphosphate bioluminescence, and microbiologic sampling of selected environmental sites were performed to evaluate the effectiveness of cleaning. The 3 audits were completed during the final hospital visit. RESULTS: Visual assessment indicated that 90% of sites were satisfactory, whereas adenosine triphosphate bioluminescence showed that 100% and microbiologic sampling showed that 90% of sites did not meet benchmark values. There was no significant difference between the SEC and PEA audits (P =.311), which used visual assessment, and the results suggest that they both are similar in passing surfaces that have microbiologic benchmark values that are too high. However, the ACE audit showed a significant difference (P = <.001) in results compared with the SEC and the PEA audits and did not pass surfaces with microbiologic benchmark values that were too high. The ACE audit, which incorporates rapid hygiene testing, showed a much stronger association with the microbial counts; this was not apparent with the SEC and the PEA audits. CONCLUSION: The data suggest that visual assessment is a poor indicator of cleaning efficacy and that the ACE audit gives a better assessment of cleaning programs compared with the other 2 audit methods in relation to microbial surface counts. It is recommended that hospital cleaning regimes be designed to ensure that surfaces are cleaned adequately and that efficacy is assessed with use of internal auditing and rapid hygiene testing.

Adenosine Triphosphate↗
PubMed2002

Auditing patient experience and satisfaction with neurosurgical care: results of a questionnaire survey.

The objective of this study was to determine the current level of patient satisfaction with neurosurgical services from the time of initial referral to hospital discharge. The survey was camed out by a self-administered postal questionnaire survey from the National Hospital for Neurology and Neurosurgery, London, UK. The participants were 364 patients discharged from the unit within one calendar year. The main outcome measures were level of satisfaction with various aspects of care, as measured by fixed response and free text style questions. Most patients are happy with the waiting time to see a neurosurgeon and the wait for subsequent admission acceptable, but many would have preferred it to be shorter. Twenty-seven had their original admission date cancelled, but most were happy with the explanation offered. Weaknesses in the management of outpatient clinics were highlighted, 35% of patients waiting more than half an hour to be seen. The great majority were happy with various aspects of communication with the neurosurgical team. Few patients were given the opportunity to follow up their visit with literature provided or a visit to a specialist nurse (17 and 9%, respectively). However, both were considered very useful, in particular, 93% highly valued a meeting with the specialist nurse. There was a dichotomy of opinion over the course of the inpatient stay. While most aspects of care received 70-80% satisfaction, the management of discharge received the most criticism. This was thought to represent a pooling of resources around the most needy patients. The majority of patients were discharged home (76%), only a third feeling that staff did everything possible to help this process. Very few received printed information. Again, those who had seen the specialty nurse had much higher levels of satisfaction. Patient satisfaction audit gives useful data on patients' perception and satisfaction with care that may not be apparent on more traditional audit measures such as length of stay, which focus more on a unit's efficiency. This study shows generally high levels of patient satisfaction with neurosurgical practice but highlights areas needing attention and expansion, such as access to a specialist nurse and relevant literature. Dissatisfaction with various administrative arrangements are clearly shown and provide an opportunity for patient centred improvements.

Adult↗
PubMed1996

Parental attitudes do not explain underimmunization.

OBJECTIVE: This article describes the results of a community-based study to determine the effect of family knowledge and attitudes on the immunization rates of a random sample of children younger than 2 years in the poorest census tracts of Baltimore. DESIGN AND METHODS: The two sources of data were (1) parent interviews that provided data on knowledge, attitudes, and beliefs related to immunization and sociodemographic characteristics, and (2) medical record audits from which data on immunization status were obtained. The protection motivation theory, a model of behavioral change, was used to select the variables to assess the relation of parental attitudes with immunization status. A multivariate logistic regression analysis included only variables found to be significantly associated with immunization outcome in the preliminary analysis. RESULTS: Mothers were well informed and generally had favorable attitudes toward immunizations. Immunization status was more strongly associated with the sociodemographic characteristics of the children than with the protection motivation theory variables. Only two protection motivation theory variables were associated with more than one immunization outcome. The children of mothers who perceived that timing of vaccination did not matter were less likely to be immunized than children of care takers who thought that it did matter and children whose parents believed in the safety of multiple immunizations were less likely to be immunized than children whose parents did not hold this belief. CONCLUSIONS: In this study, parents' attitudes and beliefs had little effect on their children's immunization levels. Interventions intended to heighten parental awareness about immunization may have little impact. In poor urban neighborhoods, African-American children whose mothers are young, have multiple siblings, and do not use the Women, Infants and Children program may be at highest risk for delayed immunization.

Adult↗
PubMed2000

The prevalence of multiple diabetes-related complications.

AIMS: To determine the prevalence of the complications of diabetes and the interrelationship between them within a United Kingdom district health authority population. METHODS: Data extracted from a general practice diabetes audit were combined with data for patients with diabetes derived from a patient index constructed using record linkage techniques. RESULTS: A total of 10709 patients were identified as having diabetes (prevalence 2.47%). Coronary heart disease was present in 25.2%, cerebrovascular disease in 9.6%, complications of the 'diabetic foot' in 18.1%, retinopathy in 16.5% and nephropathy in 2.0%. Over a half of the patients (52.1%) had none of the studied complications, 30.2% had one, 12.7% had two, 4.1% had three, 0.8% had four and 0.1% had all five. All complications were related to both age and duration of diabetes but duration was particularly apparent for the microvascular complications (retinopathy and nephropathy). Macrovascular complications in the Type 2 diabetic population appear advanced in onset compared with Type 1. CONCLUSIONS: Multiple complications are apparent in almost one fifth of patients with diabetes. Macrovascular morbidity in Type 2 diabetes of early onset indicates that a targeted approach to treatment may prove most beneficial in both patient and health service terms.

Adolescent↗
PubMed1983

Selection of an obstetric data base for a microcomputer and its use for on-line production of birth notification forms, discharge summaries and perinatal audit.

A microcomputer system is described which stores data for perinatal audit and produces 'on-line' the statutory birth notification form and mother and baby discharge summary. The derivation of a minimum data-base and the methods used to obtain reliable data are outlined. The results of a trial of the production of the birth notification form for 195 deliveries are reported together with those of a further trial of 86 deliveries in which the system was used to produce both the notification form and the discharge summary. A study of the accuracy of the handwritten birth notification forms revealed a high error rate which was markedly reduced by the use of the microcomputer system. The system is now in routine use and further developments are outlined.

Computers↗
PubMed1977

The use of automated ambulatory medical records.

An extensive survey of the uses of computerized automated ambulatory medical record systems has been conducted. The medical services provided which seem to offer the greatest benefits include: patient profiles which are a concise summary of a patient's medical status, patient surveillance to help in preventive care and management of chronic disease, data presentation by flow sheets and graphs, and data-base searches for audit, training, and research. The close integration of medical data with patient management and administrative services such as scheduling, registration, and financial systems, gives valuable utilization and practice information. Improvement in the billing and accounting process is in itself a most important benefit. In addition, the collection and analysis of medical data for health services research, quality of care audits, and training of future providers offers much potential. A number of innovative and economically viable computerized ambulatory record systems are currently operating.

Ambulatory Care↗