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PubMed1999

The Clinical Oncology Information Network (COIN) Project: background, purpose and products.

The Clinical Oncology Information Network (COIN) Project of The Royal College of Radiologists is developing evidence-based practice guidelines, clinical core data sets to audit compliance and a dedicated clinical workstation with a client-server architecture that will collect the data sets as an automatic by-product of the routine delivery of care. Guidelines for the treatment of breast, colorectal, lung and prostate cancer and for the delivery of chemotherapy and radiotherapy will be published in 1999. Version 2 of a demonstrator workstation is in use at the North Middlesex Hospital, London.

Evidence-Based Medicine↗
PubMed2005

Sharing patient data: competing demands of privacy, trust and research in primary care.

BACKGROUND: Patient privacy may conflict with the advancement of knowledge through data sharing. The data contained in primary care records are uniquely comprehensive. AIM: To explore the knowledge and attitudes of patients and members of the primary healthcare team regarding the sharing of data held in primary care records, with particular reference to data sharing for research and the impact that this may have on trust between patients and health professionals. DESIGN OF STUDY: Qualitative study using quota sampled, semi-structured interviews. SETTING: Five general practices in Leicestershire, UK. METHOD: Grounded theory and framework methodology were used. Interviews were transcribed and analysed thematically. RESULTS: Twenty patients and 15 healthcare professionals and managers were interviewed. Patients had limited knowledge of the type of information held in their general practice records and the ways in which these data are shared, but appeared ready to form preliminary views on issues such as data sharing for audit and disease registration. In this climate of limited awareness, there was no suggestion that concern about data sharing for research adversely affects patient trust or leads patients to withhold relevant information from health professionals in primary care. Interviews carried out with staff suggested a lack of clear practice policies regarding data sharing. CONCLUSIONS: General practices may need to develop policies on data sharing, bring these to the attention of their patient population and improve patient awareness about the nature of the data contained in their records. Researchers should ensure that patients are adequately informed about the nature of data contained in patient records when seeking consent for data extraction.

Confidentiality↗
PubMed1998

User interface preferences in a point-of-care data system.

Point-of-care data entry is an important part of a clinical information system. Unfortunately, many health care providers refuse to perform data entry because they feel computers are difficult to use and require more time than traditional paper based forms. We designed a user interface for entry of outpatient visit information that gives the health care provider several alternative methods of entering data. The system audits the use of the individual interface elements and measures the time required for completion of the data entry.

Ambulatory Care Information Systems↗
PubMedDate not supplied

Quality assurance in Canadian emergency departments: a national survey.

This survey provides a description of quality assurance (QA) in emergency departments of Canadian hospitals, looking at QA structure, processes, outcome measurements, and applications. With survey questions addressing the existence of a written QA plan, chart audits, mortality review, data collection and reporting, the frequency of comprehensive QA programs was measured. All Canadian hospitals with 200 or more beds were surveyed by mail; 66% responded (134 of 204). Teaching and larger hospitals were more likely to respond. QA structure was reported by 81% of respondents, with 59% of these having a written plan. The majority collected data (74%), issued reports (75%), and had QA committees (50%), but only 34% were computerized. QA processes included chart audits (78%), review of laboratory, radiology, or ECG reports (73%, 46%, 54%, respectively), and mortality review (91%). Comprehensive QA existed in only 12% of responding hospitals.

Attitude of Health Personnel↗
PubMed1999

Use of collaborative audit to assist local implementation of the SIGN guideline for prevention of visual impairment in diabetes.

OBJECTIVES: To use audit to inform the local implementation of a national clinical guideline for the prevention of visual impairment in diabetes. DESIGN: Computer and patient record search in hospital and general practice to determine levels of morbidity and follow-up. Questionnaire to each practice to determine models and techniques of eye screening. SETTING: Ayrshire and Arran Health Board area, Scotland. SUBJECTS: All known diabetic patients. MAIN MEASURES: Proportion of diabetic patients who have had diabetic eye review and monitoring of risk factors within one year. Proportion of diabetic patients who have risk factors recorded within target level. Proportion of eye screening centres with recommended mechanisms in place. RESULTS: Both district general hospitals, and 59 of the 63 general practices, in the area took part in the audit. A total of 6,217 diabetic patients were included; the prevalence of diabetes in this population was 1.65%. Twenty-seven per cent were insulin treated. Seventy-two per cent of diabetics who were not registered blind had a record of having had fundoscopy performed through dilated pupils within one year. Sixty-nine per cent of those who were not registered blind had had corrected visual acuity measured within one year. Eighty-five per cent of diabetics had HbA1C recorded within one year and of these 65% had a level of 8% or less. Eighty-eight per cent had a blood pressure recording within twelve months and 52% of recorded pressures were 140/90 mmHg or less. Smoking status was recorded for 89% of patients and 75% of patients with a record were non-smokers. Representatives of 57 practices returned a completed questionnaire. All these practices had a Snellen chart, but only 83% had near vision testing equipment and only 54% had a pinhole occluder. CONCLUSIONS: An area wide collaborative audit provided local data to inform the process of guideline implementation and baseline data from which to evaluate this process. Wide stakeholder involvement increased interest, motivation and support for the process. The audit highlighted specific areas for change and provided the local stimulus for change.

Cooperative Behavior↗
PubMed1997

Clinical information system: a "gateway" to the 21st century.

This article describes the selection, design, and implementation of a clinical information system that includes order entry, results reporting, physical assessments, and critical care. The benefits of implementing this data management system such as cost savings, chart-as-you-go documentation, use of wireless technology, online quality improvement audits, and rapid data retrieval will be explained.

Decision Making, Organizational↗
PubMed2004

Emergency general surgery and the implications for specialisation.

BACKGROUND AND PURPOSE: To examine the overall spectrum of emergency general surgical admissions and operations in Edinburgh, to identify the influence of an Accident and Emergency (A&E) department and observe the current practice of sub-specialisation. PATIENTS AND METHODS: Data for all general surgical admissions and operations in the two main Edinburgh hospitals are recorded prospectively using the Lothian Surgical Audit system. These data were examined for 1999. RESULTS: 5346 patients were admitted to the two hospitals with acute surgical conditions. Head injuries (n = 1069, 20%) and Non Specific Abdominal pain (NSAP) (n = 855, 16%) made up a third of all emergency surgical admissions. The most common single category of operations were those done on the appendix (n = 348, 15%). The Royal Infirmary, with the only A&E department had more acute surgical admissions (n = 4071) than the Western General Hospital (n = 1275), surgeons in the Royal Infirmary also operated on a much lower percentage of patients (30% v 55%). In the Royal Infirmary, upper gastrointestinal surgeons treated a significantly higher proportion of patients with upper gastro-intestinal and hepatobiliary/pancreatic conditions than either the general or colorectal surgeons and, similarly, the colorectal surgeons treated a higher proportion of patients with colorectal conditions than either the general or upper gastro-intestinal surgeons. CONCLUSION: The spectrum of emergency admissions and operations in Edinburgh is consistent with previously published data. An A&E department alters the spectrum of diagnoses and, therefore, the overall workload. Specialisation in emergency surgery is already quite advanced. These results all have important implications in future healthcare planning.

Abdominal Pain↗
PubMed1985

NTP Toxicology and Carcinogenesis Studies of Chrysotile Asbestos (CAS No. 12001-29-5) in F344/N Rats (Feed Studies).

Lifetime toxicology and carcinogenesis studies of short-range (SR) and intermediate-range (IR) fiber length chrysotile asbestos were conducted in groups of 88-250 male and female F344/N rats. Both forms of asbestos were administered at a concentration of 1% in pelleted diet for the lifetime of the rats, starting with the dams of the test animals. Subgroups of 100 male and female IR chrysotile-exposed rats also received 0.47 mg/g IR chrysotile asbestos in water by gavage during lactation (preweaning [PW]). At 9 weeks of age, additional subgroups (125-175) of control and IR chrysotile-exposed rats received 7.5 mg/kg (male) or 15 mg/kg (female) 1,2-dimethylhydrazine dihydrochloride (DMH) by gavage every other week for a total of five doses. When the survival of either the control or test group reached 10%, both groups were killed. Neither type of fiber affected fertility or litter size. The offspring from mothers exposed to SR chrysotile were similar in body weight to the controls at birth but were slightly smaller (13%) at weaning and remained so throughout their lifetimes. Feed consumption and survival were comparable among the SR and IR chrysotile asbestos groups and controls. The DMH-exposed groups showed decreased survival due primarily to the development of lethal neoplasms. The administration of SR chrysotile for the lifetime of exposed male and female rats did not cause any overt toxicity. In addition, no neoplastic or nonneoplastic disease was associated with SR chrysotile exposure. Male and female rats exposed to IR chrysotile asbestos did not show any adverse clinical signs. Benign epithelial neoplasms (adenomatous polyps) were observed in the large intestine of IR chrysotile asbestos male rats (9/250, 3.6%). Although not statistically significant (P=0.08) compared with concurrent controls (0/85), the incidence of these neoplasms was highly significant (P=0.003) when compared with the incidence of epithelial neoplasms (benign and malignant combined) of the large intestine in the pooled male control groups of all the NTP oral asbestos lifetime studies (3/524, 0.6%). The biologic importance of this finding was supported by the observation of lesions of similar morphology in the small intestine or glandular stomach of four additional IR chrysotile male rats and by a low incidence (2/100, 2.0%) of adenomatous polyps in the large intestine of male rats in the IR/PW group. A significant (P<0.05) increase in keratoacanthomas of the skin was observed in male IR (19/250, 7.6%) and IR/PW (8/100, 8.0%) chrysotile-exposed rats compared with the concurrent controls (1/88, 1.1%). The biologic importance of this observation was discounted because the incidence in these groups did not greatly exceed the rate observed in the combined male control groups from all the other NTP oral asbestos studies (19/441, 4.3%). An apparent increase in the incidence of clitoral gland neoplasms in female IR (18/250, 7.2%) and IR/PW (4/100, 4.0%) chrysotile-exposed rats compared with that in the concurrent controls (1/88, 1.1%) was also discounted because of a lack of statistical significance when compared with the pooled female control groups from the other NTP oral asbestos studies (21/441, 4.8%). Rats exposed to DMH and DMH plus IR chrysotile asbestos exhibited neoplasia in those organs known to be targets for DMH (gastrointestinal tract, Zymbal gland, liver, and kidney). There was a significant difference (P<0.05) in the incidence of DMH-induced mixed-cell tumors of the kidney between the DMH alone (13/125, 10%) and DMH plus IR chrysotile asbestos (34/175, 19%) female groups. An increased incidence of thyroid follicular cell tumors was observed in DMH plus IR chrysotile male rats (28/175, 16.0%) compared with the DMH alone group (9/124, 7.3%). The biologic importance of both observations is questionable, since neither organ represents a primary target organ for asbestos and no difference between DMH and DMH plus IR chrysotile was observed for the primary target organs (intestine and mesothelium). An audit of the experimental data was conducteIR chrysotile was observed for the primary target organs (intestine and mesothelium). An audit of the experimental data was conducted for these lifetime carcinogenesis studies of chrysotile asbestos. No data discrepancies were found that influenced the final interpretations. Under the conditions of these lifetime studies, short-range and intermediate-range chrysotile asbestos did not induce overt toxicity and did not affect survival when ingested at a level of 1&percnt; in the diet by male and female F344/N rats. There was no evidence of carcinogenicity in male or female rats exposed to SR chrysotile asbestos or in female rats exposed to IR chrysotile asbestos. There was some evidence of carcinogenicity in male rats exposed to IR chrysotile asbestos as indicated by an increased incidence of adenomatous polyps in the large intestine. The cocarcinogenesis studies of 1,2-dimethylhydrazine dihydrochloride and IR chrysotile asbestos were considered inconclusive for determining whether IR chrysotile asbestos had either a tumor-enhancing or protective effect, although an increased incidence of neoplasms was observed in the kidneys of female rats exposed to DMH plus IR chrysotile as compared with those exposed to DMH alone.

Journal Article↗
PubMed2004

Provision, uptake and cost of cardiac rehabilitation programmes: improving services to under-represented groups.

OBJECTIVES: To estimate UK need for outpatient cardiac rehabilitation, current provision and identification of patient groups not receiving services. To conduct a systematic review of literature on methods to improve uptake and adherence to cardiac rehabilitation. To estimate cost implications of increasing uptake of cardiac rehabilitation. DATA SOURCES: Hospital Episode Statistics (England). Hospital Inpatient Systems (Northern Ireland). Patients Episode Database for Wales. British Association for Cardiac Rehabilitation/British Heart Foundation surveys. Cardiac rehabilitation centres. Patients from general hospitals. Electronic databases. REVIEW METHODS: The study analysed hospital discharge statistics to ascertain the population need for outpatient cardiac rehabilitation in the UK. Surveys of cardiac rehabilitation programmes were conducted to determine UK provision, uptake and audit activity, and to identify local interventions to improve uptake. Data were also examined from a trial estimating eligibility for cardiac rehabilitation and non-attendance. A systematic review of interventions to improve patient uptake, adherence and professional compliance in cardiac rehabilitation was conducted. Estimated costs of improving uptake were identified from national survey, systematic review and sampled cardiac rehabilitation programmes. RESULTS: In England, Wales and Northern Ireland nearly 146,000 patients discharged from hospital with primary diagnosis of acute myocardial infarction, unstable angina or following revascularisation were potentially eligible for cardiac rehabilitation. In England in 2000, 45-67% of these patients were referred, with 27-41% attending outpatient cardiac rehabilitation. If all discharge diagnoses of ischaemic heart disease were considered, nearly 299,000 patients would be potentially eligible and in England rates of attendance and referral would be 22-33% and 13-20% respectively. Rates of referral and attendance were similar in Wales, but somewhat lower in Northern Ireland. It was found that referral and attendance of older people and women at cardiac rehabilitation tended to be low. It was also suggested that patients from ethnic minorities and those with angina or heart failure were less likely to be referred to or join programmes. A wide range of local interventions suggested awareness of the problem of uptake. In an NHS-funded randomised controlled trial, possibly representing more optimal protocol-led care, medical and nursing staff identified 73-81% of patients with acute myocardial infarction as eligible for cardiac rehabilitation. Excluded patients tended to be older with more severe presentation of cardiac disease. Experiences of patients suggested that uptake may be improved by addressing issues of motivation and relevance of rehabilitation to future well-being, co-morbidities, site and time of programme, transport and care for dependents. Systematic review of studies supported the use of letters, pamphlets or home visits to motivate patients and the use of trained lay visitors. Self-management techniques showed some value in promoting adherence to lifestyle changes. Studies examining professional compliance found that professional support for practice nurses may have value in the coordination of postdischarge care. Average costs in 2001 of cardiac rehabilitation to the health service per patient completing a cardiac rehabilitation programme were about GBP350 (staff only) and GBP490 (total). If services were modelled on an intermediate multidisciplinary configuration with three to five key staff, approximately 13% more patients could be treated with the same budget. Depending on staffing configuration an approximate 200-790% budget increase would be required to provide cardiac rehabilitation to all potentially eligible patients. CONCLUSIONS: Provision of outpatient cardiac rehabilitation in the UK is low and little is known about the capacity of cardiac rehabilitation centres to increase this provision. There is an uncoordinated approach to audit data collection and few interventions aimed at improving the situation have been formally evaluated. Motivational communications and trained lay volunteers may improve uptake of cardiac rehabilitation, as may self-management techniques. Experience of low-cost interventions and good practice exists within rehabilitation centres, although cost information frequently is not reported. Increased provision of outpatient cardiac rehabilitation will require extra resources. Further trials are required to compare the cost-effectiveness of comprehensive multidisciplinary rehabilitation with simpler outpatient programmes, also research is needed into economic and patient preference studies of the effects of different methods of using increased funding for cardiac rehabilitation. An evaluation of a range of interventions to promote attendance in all patients and under-represented groups would also be useful. The development of standards is suggested for audit methods and for eligibility criteria, as well as regular and comprehensive data collection to estimate the need for and provision of cardiac rehabilitation. Further areas for intervention could be identified through qualitative studies, and the extension of low-cost interventions and good practice within rehabilitation centres. Regularly updated systematic reviews of relevant literature would also be useful.

Cost-Benefit Analysis↗
PubMed1998

An audit of anthropometric measurements by medical and physiotherapy staff in patients with ankylosing spondylitis.

BACKGROUND: The main treatments for ankylosing spondylitis (AS) are physical (exercise and stretching), and one way of measuring the effectiveness of these therapies is to record spinal movements in a standardized way. Patients are often seen in both medical (rheumatology) and physiotherapy clinics where duplicate information on their progress may be obtained. The purpose of this study was to assess the completeness of data collection for patients attending both medical and physiotherapy clinics. DESIGN: An audit of data recorded in medical and physiotherapy notes. SUBJECTS: Patient records identified either from computerized databases (Huddersfield and Bradford) or from a clinic at which only AS patients attended (Leeds). Data from attendances over a defined period were retrieved and recorded on a standard form. All patients thus identified were then cross-matched against those patients attending for physiotherapy during the same period and, where a match occurred, the same data were retrieved from the physiotherapy notes. MINIMUM DATA SET FOR AUDIT: Before data collection started all participants agreed on the minimum data set required for adequate monitoring of patients with AS. The anthropometric measurements included height, chest expansion, cervical rotation, tragus to wall, modified Schober's flexion, extension, lumbar side flexion, intermalleolar abduction, and interfingertip abduction. RESULTS: Of 182 medical notes screened, 46 patients had not been seen in the defined period, leaving 136 notes to be reviewed. Of these, 52 patients had been seen in physiotherapy in the same period. In general, measurements were infrequently found in medical notes (only chest expansion in 58%, Schober's flexion in 48% and tragus to wall in 47% were measured with any regularity by medical staff). In contrast, corresponding data from physiotherapy notes were more complete (Schober's flexion and lumbar side flexion in 96%, height in 87%, intermalleolar distance in 87% and cervical rotation in 83%). CONCLUSIONS: Follow-up and monitoring of AS patients in these medical clinics is clearly inadequate. Physiotherapy-led clinics have already been started in one of the study hospitals and the other centres are reviewing their arrangements for AS follow-up, including the possibility of a combined approach to patient management.

Anthropometry↗
PubMed1991

Auditing audits: the method of Oxfordshire Medical Audit Advisory Group.

OBJECTIVES: To develop a systematic method for both summative and formative audit of practice audits, and to use the method to review Oxfordshire practice audits and to plan improvement. DESIGN: Development of a coding system for the audit cycle subsequently used prospectively to assess audits reported to medical audit advisory group coordinators on practice visits. SETTING: All 85 general practices in Oxfordshire, of which 80 were visited by Oxfordshire Medical Audit Advisory Group coordinators. MAIN OUTCOME MEASURES: Satisfaction of criteria for different levels of audit (full, partial, potential, planning or no audit) according to coding scores for practice audits. RESULTS: 46 (58%) practices were classified as doing audit, the remainder doing no audit or only collecting data for family health services authority returns. Of audits being undertaken, 55/102 (54%) included planning care or the setting of targets. CONCLUSIONS: The coding system offers the prospect of formative assessment for practices to help them improve their audits, and summative assessment for the family health services authority to satisfy the needs for professional accountability. Its use in Oxfordshire disclosed considerable deficiencies in the process of practice audit. IMPLICATIONS AND ACTION: Practices in Oxfordshire should improve their audits. The advisory groups target to March 1992 is for 50% of practices to be doing full or partial and 25% potential audit and half of the remainder planning audit. Practices are encouraged to include in their audit implementing change, planning care, and agreeing criteria for further assessment.

England↗
PubMed2005

A working around "it": the experience of occupational therapy students with a disability.

The purpose of this qualitative study was to gain an understanding of the experiences of students with disabilities in occupational therapy (OT) programs. Telephone and email interviews were conducted with five students from different universities who volunteered to participate in the study. Interviews were transcribed, and researchers used the constant comparison method for data analysis. Trustworthiness was assured by using an audit trail, triangulation of data analysis, and member checking. Results revealed that students with disabilities (1) have a strong desire to "work around it," (2) desire support and understanding both within and outside the academic environment, (3) understand that disability is an essential part of who they are as people, and (4) believe that having a disability will enhance their own practice. The discussion includes ways to optimize the experience of being an OT student with a disability.

Adult↗
PubMed2000

Audit in practice: the referral of dying patients to palliative care.

Audit should be an integral part of any palliative care service. Terminal care is a continuum of palliative care. When looking for an objective measure for referrals to a new palliative care service within a specialist cancer hospital in Ireland, patient death was used as an end point. Audits were carried out looking at inpatient deaths during two separate 8-month periods. All inpatient deaths during the study periods were noted and records compared to find those who were referred to the palliative care service before death. The first audit revealed that relatively few dying patients were referred to the newly formed palliative care team; by the time the second audit was carried out, referrals had increased. For many patients their final hospital admission was for active anti-cancer treatment and was of short duration. Data from these audits were presented on several different occasions to both nursing and medical staff. This article describes these audits in detail and highlights some of the issues raised. Audit in palliative care is discussed.

Adult↗
PubMed2002

Attributes of clinical recommendations that influence change in practice following audit and feedback.

The object of this study was to determine which attributes of clinical practice recommendations influence changes in clinical practice following audit and feedback. This was an observational study using multilevel modeling to examine the relationship between attributes of clinical practice recommendations and compliance with the recommendations before and after audit and feedback. Sixteen hospital gynecology units in Scotland participated in a national audit project. Clinical practice recommendations covering selected gynecological topics were developed and data collected to assess baseline (preintervention) compliance. Summaries of performance were fed back to consultant gynecologists in each hospital and follow-up (postintervention) data were collected. Trained audit assistants used standardized forms to abstract data from case notes. Compliance data were available at baseline and follow-up for a total of 42 clinical practice recommendations. Altogether, 4,664 case notes contributed to baseline data and 4,382 to follow-up data. Thirteen attributes describing clinical practice recommendations were developed, based upon previous work, and pretested. A panel of seven consultant gynecologists rated the extent to which each of the 42 recommendations possessed each of the 13 attributes. The main outcome measures were the association of each attribute with compliance and with changes in clinical practice. Recommendations compatible with clinician values and not requiring changes to fixed routines were independently associated with greater compliance at baseline and follow-up. However, recommendations incompatible with clinician values were independently associated with greater change in practice following audit and feedback. Attributes of recommendations may influence the effectiveness of audit and feedback in secondary care. Recommendations seen as incompatible with clinician values are associated with lower compliance but greater behavioral change following audit and feedback.

Attitude of Health Personnel↗
PubMed2005

The updated BSR guidelines for anti-TNF in adults with RA: what has changed and why?

In 2001 the British Society for Rheumatology (BSR) published guidelines for prescribing TNF-alphablockers in adults with rheumatoid arthritis (RA). In an unusual move, the National Institute of Clinical Excellence (NICE) accepted the BSR guidelines and published them unchanged and included them in their own Technology Appraisal (National Institute of Clinical Excellence, 2002). The field of anti-TNF in RA is rapidly changing, and the BSR Standards, Guidelines and Audit Working Group decided in 2004 to update the guidelines. These were published in February 2005 (Ledingham and Deighton, 2005). This article summarizes the key changes, and attempts to justify them, using further data that has emerged since the updated guidelines were produced, and audit data from the Derby Rheumatology department.

Journal Article↗
PubMedDate not supplied

The role of field auditing in environmental quality assurance management.

Environmental data quality improvement continues to focus on analytical laboratoryperformance with little, if any, attention given to improving the performance of field consultants responsible for sample collection. Many environmental professionals often assume that the primary opportunity for data error lies within the activities conducted by the laboratory. Experience in the evaluation of environmental data and project-wide quality assurance programs indicates that an often-ignored factor affecting environmental data quality is the manner in which a sample is acquired and handled in the field. If a sample is not properly collected, preserved, stored, and transported in the field, even the best laboratory practices and analytical methods cannot deliver accurate and reliable data (i.e., bad data in equals bad data out). Poor quality environmental data may result in inappropriate decisions regarding site characterization and remedial action. Field auditing is becoming an often-employed technique for examining the performance of the environmental sampling field team and how their performance may affect data quality. The field audits typically focus on: (1) verifying that field consultants adhere to project control documents (e.g., Work Plans and Standard Operating Procedures [SOPs]) during field operations; (2) providing third-party independent assurance that field procedures, quality assurance/ quality control (QA/QC)protocol, and field documentation are sufficient to produce data of satisfactory quality; (3) providing a defense in the event that field procedures are called into question; and (4) identifying ways to reduce sampling costs. Field audits are typically most effective when performed on a surprise basis; that is, the sampling contractor may be aware that a field audit will be conducted during some phase of sampling activities but is not informed of the specific day(s) that the audit will be conducted. The audit also should be conducted early on in the sampling program such that deficiencies noted during the audit can be addressed before the majority of field activities have been completed. A second audit should be performed as a follow-up to confirm that the recommended changes have been implemented. A field auditor is assigned to the project by matching, as closely as possible, the auditor's experience with the type of field activities being conducted. The auditor uses a project-specific field audit checklist developed from key information contained in project control documents. Completion of the extensive audit checklist during the audit focuses the auditor on evaluating each aspect of field activities being performed. Rather than examine field team performance after sampling, a field auditor can do so while the samples are being collected and can apply real-time corrective action as appropriate. As a result of field audits, responsible parties often observe vast improvements in their consultant's field procedures and, consequently, receive more reliable and representative field data at a lower cost. The cost savings and improved data quality that result from properly completed field audits make the field auditing process both cost-effective and functional.

Environmental Monitoring↗