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PubMed1995

Audit of death certificates.

Information on the number and causes of death is one of the basic components of a country's health information system. Data are usually derived from death certificates and health facility discharge summaries. There are usually several causes of error in the routine collection of this information. A criteria audit of death certificates is presented to assess these sources of error in Papua New Guinea. This procedure involved the systematic and critical analysis of hospital mortality as reported in death certificates. The audit is simple, cheap and useful for monitoring the quality of the mortality information which will be used in health planning and management. Quality criteria are defined and the completeness and relevance of the data audited are discussed. Recommendations for the improvement of the health information system are made.

Adolescent↗

PubMedDate not supplied

Clinical facilitators: a new way of working.

AIM: To improve the quality and quantity of student clinical placements in an NHS trust. METHOD: When nurse training was under review, a 12-month pilot study was undertaken to introduce 12 clinical facilitators to acute and surgical wards at six trust sites on a supernumerary basis. As well as guiding the student, each facilitator liaised with a link tutor and ward staff, thereby maintaining continuity. The project team worked closely with the trust audit department and collected data using a variety of methods. The project leader developed an audit questionnaire for students, ward staff and college tutors. The initial answers were used as a baseline, then the same questionnaire was redistributed so the data could be analysed and compared. RESULTS: Most of the students felt more supported and confident to practise. The clinical facilitators were able to help ground the tutors' practice knowledge in reality, and the tutors built up the clinical facilitators' confidence in curricular issues and skills, such as presentation and teaching strategies. CONCLUSION: The clinical facilitator can strengthen partnerships between education and service and offer a model for practical facilitation.

Attitude of Health Personnel↗

PubMed2004

An analysis of the agreement between financial data between the Medicare Cost Report and the audited hospital financial statement.

Very few studies have thoroughly examined the discrepancies between the financial information in the Medicare Cost Report (MCR) and that in the audited hospital financial statement (FS). Furthermore, this type of study has never been conducted for rural hospitals. In this policy brief, we present the findings from our study, which used statistical methods to examine the agreement between the MCR and the FS of a series of financial measures in rural hospitals. The results are expected to inform policy makers of the limitation inherent in using MCR data as the single source of data to examine the financial performance of rural hospitals.

Accounting↗

PubMed1997

Joint lectureship of the Royal College of Surgeons of Edinburgh and the Academy of Medicine, Singapore--accurate long-term documentation in surgical audit and evaluation of outcomes.

The purpose of a surgical audit is to allow a critical assessment of patient care, carried out among peers and in an atmosphere of learning, open discussion, free of recriminations. The results of a surgical unit will hopefully lead to improvement in the quality of care of our patients by reducing the preventable causes of mortality and morbidity. Data from surgical audit can also be used to monitor the teaching programme in a department. It may even allow us to study the cost effectiveness of certain procedures which is obviously very important in this era of diminishing resources and cost containment.

Cleft Lip↗

PubMed2003

Quality control of the European Liver Transplant Registry: results of audit visits to the contributing centers.

BACKGROUND: The number of registries is increasing, but few of them perform reliability audits by comparing the data contained in the database with data contained in hospital charts. METHODS: The European Liver Transplant Registry (ELTR) cocoordinating committee appointed an independent team to check the reliability of data contained in ELTR. Centers were selected at random. Ten percent of each center's files were selected at random, and 25 items per file were checked during the site visits. The rates of completeness and inconsistencies and the agreement between ELTR and charts were established. We also assessed the correlation between the quality of data and the visited centers' activity. RESULTS: Seven hundred thirty-four files from 21 centers have been audited between June 1998 and June 2001. The rate of ELTR completeness was 95%, and the rate of consistency between charts and ELTR was 98%. The agreement between the ELTR and charts review was very good for all conditions (kappa value < or =0.81). However, comparisons of rates between items indicated that specific items, mostly cause of death or graft failure and patient outcome, should be targeted for improvement. No significant correlation was found between the quality of data and the experience of visited centers. The mean (min-max) and median cost per audited file were EUR 60 (8-150) and EUR 44, respectively. CONCLUSION: The results of audit visits indicate that ELTR data are reliable, and the scientific results of ELTR can be considered credible and representative of liver transplantation in Europe. The method could serve as a model for auditing a registry.

Costs and Cost Analysis↗

PubMed1998

Patterns of care study of radiation therapy for esophageal cancer in Japan: influence of the stratification of institution on the process.

BACKGROUND: To improve the quality of radiation therapy in Japan, Patterns of Care Study (PCS), a widely known QA program in the USA, was introduced in Japan. The feasibility was tested by collecting nationwide data by extramural audit for esophageal cancer. METHODS: From July 1996 through February 1997, PCS audits were performed for 29 institutions. Based on the facility survey by Tsunemoto, 13 institutes were classified as A1 (university hospital/cancer center treating > 300 patients/year), 10 as B1 (other institutes > 120 patients/year) and six as B2 (other institutes < 120 patients/year). Medical charts for 455 patients with thoracic esophageal cancer between 1992 and 1994 were reviewed based on the data format of PCS in the USA. RESULTS: Concerning external beam equipment, linear accelerators of > or = 10 MV were used for 73% of patients in A1, whereas in B1-2, 60Co machines were still used for 13% of patients (P < 0.0001). The median number of full-time equivalent (FTE) radiation oncologists was 2.7 in A1, 0.65 in B1 and 0.2 in B2. Forty-five percent of patients had received surgery in A1 and 34% in B1-2 (P = 0.0068). In the non-surgery group, a higher radiation dose of > 60 Gy was delivered in A1 than in B1-2 (P = 0.0008). Chemotherapy was administered to 51% of the patients in A1 and to 30% in B1-2 (P < 0.0001). Brachytherapy was utilized for 17% in A1 and only for 5% in B1-2 (P = 0.0001). CONCLUSION: Institutional stratification, including equipment and personnel, significantly affected the patterns of care for esophageal cancer. Therefore, to improve the quality of radiation therapy nationwide, improvement of equipment and supply of FTE personnel is extremely important. PCS was found to have great potential for the practical evaluation of how much will be required in Japan.

Adult↗

PubMed1998

Patterns of care study of radiation therapy for cervix cancer in Japan: the influence of the stratification of institution on the process.

BACKGROUND: To improve the quality of radiation oncology in Japan, Patterns of Care Study (PCS), a widely known quality assurance (QA) program in the USA, was introduced. The feasibility was tested by collecting nationwide data by extramural audit for cervix cancer. METHODS: From July 1996 through February 1997, PCS audits were performed for 29 institutions nationwide. On the basis of the facility survey by Tsunemoto, 13 institutions were classified as A1 (university hospital/cancer center), 10 as B1 (other institutions treating >120 patients/year) and six as B2 (other institutions treating <120 patients/year). Medical charts for the patients treated for cervix cancer between 1992 and 1994 were reviewed based on the data format of the US PCS. The total number of patients surveyed was 432. RESULTS: Simulation was used for >90% of the patients in both A1 and B1-2 institutions. However, in B1-2, planning for 5% of the patients was performed with only a clinical set-up (p = 0.0287). A daily fraction with a size of 200 cGy was given to >65% of patients in A1 and to <47% in B1-2. On the other hand, >50% of those in B1-2 were treated with daily fractions of 180 cGy and less compared with 25% in A1 institutions (p < 0.0001). Brachytherapy was utilized more frequently for patients in Stages II (p = 0.0365), III (p = 0.0015) and IV (p = 0.0483) in A1 than in B1-2. As for external beam equipment, linear accelerators with 10 MV or more were used for 83% of the patients in A1. However, in B1-2 institutions, machines with lower energy were used for 38% of the patients (p < 0.0001). The median number of full-time-equivalent (FTE) radiation oncologists was 2.7 in A1, 0.65 in B1 and 0.2 in B2. CONCLUSIONS: Institutional stratification, including equipment and personnel, was found to affect significantly the patterns of care for cervix cancer. Therefore, to improve the quality of radiation therapy nationwide, improvements in equipment and in supply of FTE personnel are extremely important. PCS was found to have great potential for a practical evaluation of how much improvement will be required in Japan.

Adult↗

PubMed1992

AxAudit--anaesthetic audit system.

A bar code based computerised anaesthetic audit system is described. The system consists of a data entry and validation module resident on a remote hand-held computer and a central database module resident on a desktop computer, capable of conducting extensive searches, analysis, graphing and reporting of captured data. Information is entered into the computer by 'swiping' a bar code reader across required bar codes. Information entered is constantly validated and the computer ensures a minimum data set is captured for every patient. Since data is transferred directly into a computer at the point of clinical activity, a large data set can be presented to the clinician, ensuring as complete a patient record as possible and avoiding the problems associated with traditional form-filling and the subsequent transfer of information onto a computer. The hand-held computer has data cards which can hold information on approximately 200 patients. These cards can be inserted directly into a card reader attached to a desktop computer, thus automating the process of data transfer. The AxSys Anaesthetic Audit system, AxAudit, is a bar code based, computerised audit system developed with the aim of executing effective audit in the course of normal clinical activity.

Anesthesiology↗

PubMed1991

Plastic surgery audit codes: are the results reproducible?

The effective coding of data to produce a medical audit relies on agreement between the coders. This study was designed to assess whether coders can agree on codes for diagnosis and operations in a plastic surgery unit. Information from 50 patients was presented to a panel of six coders who were required to code the data using the International Classification of Diseases (ICD-9) and the Office of Population Census Studies (OPCS-4) systems. The results show that agreement between all the panellists occurred in only 32 out of 50 patients for one diagnostic code and 30 out of 50 for one operation code. When a patient had more than one diagnosis or operation, agreement was very much worse. Expert coders produced better results than the medical coders. The results are discussed with reference to other coding systems.

Abstracting and Indexing↗

PubMed1976

Is audit relevant to the medical wards of a teaching hospital.

The initial purpose of an experimental program of close personalized supervision of ward patients by attending physicians in addition to house staff in a teaching hospital was to determine whether such personalized care would raise the quality of care and lower the cost and length of stay. By subjective measurements, an improvement in the quality of care was perceived. However, neither length of stay nor hospital charges were reduced when compared to a control population. Moreover, the data suggest that auditing the length of stay and hospital charges does not necessarily measure the quality of medical care.

Disease↗

PubMed2002

A prospective clinical audit of neonatal resuscitation practices in Canada.

PURPOSE: This is a prospective audit to determine the frequency of resuscitation interventions in the clinical setting and to compare self-reports of clinical performance with the existing Neonatal Resuscitation Program (NRP) and Canadian National Guidelines for Neonatal Resuscitation. SUBJECTS: Fifty-six level I, II, and III hospitals in Canada participated. Any infant requiring resuscitation, as defined by the need for at least positive pressure ventilation (PPV), was eligible for inclusion (n = 783 resuscitations). DESIGN AND METHODS: A prospective self-report audit was chosen and data were collected over a 6-month period in 1998. The audit focused on the use of PPV, intubation, chest compressions, free-flow oxygen, or medications during the resuscitation. The infant's temperature at the end of resuscitation was also noted. The data were analyzed with descriptive statistics. The composition of the resuscitation team and their NRP certification status were recorded. PRINCIPAL RESULTS: The need for resuscitation was not anticipated in 76% of the cases (596 of 783). Errors in the sequencing of care, such as delays in initiating PPV, provision of chest compressions before or without establishing an airway and ventilatory support, and administering naloxone before PPV, were reported. Resuscitations attended by a team of NRP certified providers had improved sequencing when compared with those in which only some individual providers were certified. Chest compressions were provided in 8% of the cases (65 of 783). Medications were used in 14% (113/783) of all cases. Providers in level I hospitals performed chest compressions more frequently than those in level II and III settings. At the end of the resuscitation, 27% of the infants were hypothermic (142 of 520), and 25% were hyperthermic (128 of 520). Overall, 52% were out of the normal neutral range. CONCLUSIONS: Clear differences between the NRP guidelines and actual clinical practice were shown. A high rate of unanticipated resuscitations, delivery room medications, and chest compressions was described. Postresuscitation hypothermia or hyperthermia were common. Improved sequencing was noted when the entire resuscitation team was NRP certified. Certification in NRP does not assure competency, nor does it ensure compliance with established standards of care.

Canada↗

PubMed1993

The role of patient satisfaction assessment in medical audit.

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Data Collection↗

PubMedDate not supplied

National Prevalence and Incidence Study: 6-year sequential acute care data.

OBJECTIVE: To provide health care organizations with a benchmark to measure pressure ulcer prevalence and incidence. SUBJECTS: Medical, surgical, and intensive care unit patients at participating health care organizations. DESIGN: Pressure ulcer prevalence was measured during a predetermined 24-hour period at each participating health care organization, using a standardized data collection form. Incidence was measured over the average length of stay determined for each participating health care organization. Patient demographics, pressure ulcer stages, pressure ulcer locations, and contributing factors were collected during the study. Collected data forms were audited prior to being submitted to a central site for database entry, analysis, and report generation. RESULTS: Pressure ulcer prevalence ranged from a low of 14% (2001 and 2002) to a high of 17% (1999). Incidence ranged from a low of 7% (2001, 2003, 2004) to a high of 9% (2000). Comprehensive reports were delivered to the participating health care organizations, with each health care organization's data compiled to create a comparison database. CONCLUSION: A standardized methodology for prevalence and incidence study data collection/reporting has been developed and used in successive studies and years. This provides a tool to help health care organizations measure the effectiveness of interventions, improve patient outcomes on an ongoing basis, and begin trending analysis.

Adolescent↗

PubMed1995

Implementation of quality assurance and medical audit: general practitioners' perceived obstacles and requirements.

BACKGROUND: The introduction of quality assurance and medical audit has been an important development in general practice. However, the introduction of such programmes does not necessarily mean they are implemented by general practitioners. AIM: A study was undertaken to describe the problems and requirements perceived by general practitioners in relation to the implementation of quality assurance and medical audit in general practice. METHOD: Interviews were carried out with a stratified sample of 120 Dutch general practitioners. Knowledge, acceptance and application of quality assurance and medical audit activities were investigated, and perceived problems and requirements in implementing quality assurance and audit activities were explored. RESULTS: General practitioners in the Netherlands were generally positive towards quality assurance activities, but had little experience of carrying out such activities. The most frequently mentioned obstacles to implementing quality assurance activities concerned lack of time, colleagues' negative attitudes and fear of assessment and criticism by colleagues. Requirements for implementing quality assurance included having regular meetings with colleagues about quality assurance, having information on the aims and methods of quality assurance, having data from other practices with which to compare performance, having support in data collection, in audit in the practice and in setting up local peer review, and having financial support. The most important factor predicting the actual application of quality assurance activities was found to be knowledge of specific quality assurance activities. CONCLUSION: Well-designed programmes for the implementation of quality assurance and medical audit, using a variety of different interventions, have to be developed. Such programmes should include the training of professionals in the concepts and methods of quality assurance as well as the provision of financial support for quality assurance activities.

Family Practice↗

PubMed2005

A feasibility study of signed consent for the collection of patient identifiable information for a national paediatric clinical audit database.

OBJECTIVES: To investigate the feasibility of obtaining signed consent for submission of patient identifiable data to a national clinical audit database and to identify factors influencing the consent process and its success. DESIGN: Feasibility study. SETTING: Seven paediatric intensive care units in England. PARTICIPANTS: Parents/guardians of patients, or patients aged 12-16 years old, approached consecutively over three months for signed consent for submission of patient identifiable data to the national clinical audit database the Paediatric Intensive Care Audit Network (PICANet). MAIN OUTCOME MEASURES: The numbers and proportions of admissions for which signed consent was given, refused, or not obtained (form not returned or form partially completed but not signed), by age, sex, level of deprivation, ethnicity (South Asian or not), paediatric index of mortality score, length of hospital stay (days in paediatric intensive care). RESULTS: One unit did not start and one did not fully implement the protocol, so analysis excluded these two units. Consent was obtained for 182 of 422 admissions (43%) (range by unit 9% to 84%). Most (101/182; 55%) consents were taken by staff nurses. One refusal (0.2%) was received. Consent rates were significantly better for children who were more severely ill on admission and for hospital stays of six days or more, and significantly poorer for children aged 10-14 years. Long hospital stays and children aged 10-14 years remained significant in a stepwise regression model of the factors that were significant in the univariate model. CONCLUSION: Systematically obtaining individual signed consent for sharing patient identifiable information with an externally located clinical audit database is difficult. Obtaining such consent is unlikely to be successful unless additional resources are specifically allocated to training, staff time, and administrative support.

Adolescent↗

PubMed2001

The health economic implications of treatment with quetiapine: an audit of long-term treatment for patients with chronic schizophrenia.

This retrospective, case series audit assessed the clinical and health-economic impact of long-term treatment with quetiapine ('Seroquel'), a new atypical antipsychotic, in patients with chronic schizophrenia. The study design was of a case series format, comprising patients entered from one centre into the open-label extension of a multicentre 6-week efficacy study. Twenty-one patients (15 male, six female; mean age 39 years) were studied, of whom 17 (81%) had been rated as 'partially responsive' to previous antipsychotics. Data on hospitalisations and information on symptoms were collected retrospectively for the 12 months before quetiapine treatment was initiated and for the 12 months after. Quetiapine was effective in reducing psychotic symptoms with mean BPRS scores reducing significantly, from 38 to 21 (P < 0.005). Motor function was also significantly improved with mean Simpson scale scores reducing from 15 to 12 (P < 0.005). Average inpatient days were reduced by 11% in year two (97 compared with 109 days) while the overall costs of treatment, including drug costs, fell by 5% (I pound sterling 20,843 to I pound sterling 19,827). Four patients had been hospitalised for longer than 5 years before starting quetiapine; these chronically institutionalised patients remained in hospital, despite improved clinical outcomes (mean BPRS scores after treatment of 34, compared with 43 before), for the full 12 months of quetiapine treatment. Were the data from this audit to be re-analysed excluding these four patients then average inpatient days would have been reduced by 33% (45 to 30 days) and overall cost of treatment by 19% (I pound sterling 8617 to I pound sterling 7011). This audit suggests that treatment with quetiapine over this 1-year period was associated with both clinical improvements and a decreased usage of inpatient services. The reduction in hospitalisation costs would appear to compensate for the increased cost of drug treatment. Significantly, potential savings appear to be greatest for those patients with a 'revolving door' pattern of repeated readmission.

Adult↗

PubMed1999

Talking on the telephone with people who have experienced pain in hospital: clinical audit or research?

The adequacy of postoperative pain management in British hospitals appears insufficient to improve patient care, and much of the research and clinical audit in postoperative pain has failed to seek the patient's perspective. This paper reports on the findings from a semi-structured telephone interview survey which formed part of a hospital-wide audit on postoperative pain at a district general hospital in the south of England. Of a total of 360 completed audit questionnaires, 114 patients left their telephone number and 29 were interviewed. Content analysis revealed five main themes: inadequate information, pain at home, staff attitudes, expectations of pain, and ward atmosphere. Several patients identified insightful strategies that potentially could improve pain management. The telephone interview generated a richness of data that had not been reported before in this important area. Some authors view clinical audit and research as having different characteristics but this work raises important questions for both approaches when using the semi-structured telephone interview. The ethical issues pertaining to collection of audit data using the telephone interview are discussed.

Clinical Nursing Research↗

PubMed2006

A 3-year review of The British Association of Urological Surgeons Section of Endourology Laparoscopic Nephrectomy Audit.

OBJECTIVE: To report and compare the data obtained from the BAUS UK national laparoscopic nephrectomy audit over the past 3 years. METHODS: Each year, consultants performing laparoscopic nephrectomy are invited to submit prospectively collected data on all patients so treated at their centres. The data from each centre is entered into a nationally established database using a standard data-collection sheet. The indications for surgery, and data during and after surgery are collected. Since 2001, data were reported on 1294 laparoscopic nephrectomies. RESULTS: Over the 3 years, the number of centres returning data has increased from 25 to 48. In 2002, data on 263 nephrectomies were returned; by 2004, this had increased to 598. In all three audits, most cases were for nonfunctioning kidneys and renal cell carcinoma, with transitional cell carcinoma and stones forming a smaller proportion. Over the 3 years, the mean (range) operative duration has reduced from 173 (89-335) to 166 (42-395) min. The median postoperative stay remained at 4-5 days, with a wide range reflecting other than clinical reasons for delayed discharge. The mortality rate remained low, at 0.7% and 0.2%, respectively, for 2002 and 2004. The mean conversion rate remained at 6-8% and the mean complication rate at 17-2%, but the proportion of major complications reduced from 10% to 4%. The transfusion rate also reduced from 10% to 7%. The operative duration, transfusion and conversion rates were higher in those centres performing fewer than 12 cases/year than in those performing at least one case per month. CONCLUSION: The BAUS laparoscopic nephrectomy audit is an effective method for ensuring both the safe and widespread implementation of this relatively new technique to the UK, and compliance with internationally accepted standards. This audit has shown differences in clinical outcomes in favour of high-volume centres, which may help to inform decisions about the centralization of urological laparoscopy services.

Humans↗