An audit of surgical waiting lists.
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Humans↗
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Results for “Management Audit”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Value for money audit: why do it?
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Canada↗
Cost-effective prescribing of proton pump inhibitor therapy: an audit in general practice.
General practitioners must prescribe cost effectively to control drug expenditure and provide optimal treatment for patients requiring long-term management. An audit was implemented in general practices to review the management of dyspepsia, improve care, rationalise therapy and reduce costs. Policy included identifying patients receiving proton pump inhibitor (PPI) therapy and changing to low-dose cost-effective therapy. If PPI therapy was not required, patients were changed to antacids, H2 receptor antagonists or no treatment. This was an audit in general practice, not a clinical trial, therefore findings reflect outcomes in normal clinical practice. This paper describes the implementation and findings of the audit between January 1997 and July 1999 in 91 general practices involving 7121 patients. Extrapolation of the results concluded that savings of up to 50,000 Pounds could be made in a practice of 10,000 patients, allowing reinvestment in health improvement plans and optimal care.
Adolescent↗
Conducting a security audit.
Prior to conducting a full-fledged security survey in order to meet requirements of JCAHO and other agencies, it is essential to conduct an initial audit that will assess your hospital's vulnerability. The information from this audit can guide and direct the survey process. This article describes what is involved in preparing for the initial audit and includes a sample security audit report.
Data Collection↗
[Concepts for the regulation of mixtures of toxic pollutants in environmental hygiene].
In view of the increasing accumulation of large-scale livestock production facilities in the western parts of Lower Saxony the question rises how ecology and economy can be conciliated and how the protection of human health can be assured. Based on existing legislation this is hard to achieve because of the weak legal position of the administration when trying to prohibit the further expansion of livestock production as opposed to the strong legal position of owners and investors. Presently there is no agreement within the scientific community on safe limits for airborne pathogens and it is quite obvious that thresholds for peak concentrations do not solve the problem of background level exposures. Apart from the unsatisfactory current practise to licence farm animal units in the outskirts of existing villages only, in future the introduction of the EC Environmental Management and Auditing Scheme (EMAS) in animal production may improve the situation. This management system is intended to permanently reduce the environmental impact of a production site and implements the ALARA-PRINCIPLE (as low as reasonably achievable) which is known from protection measures against radiation. As the implementation of the EMAS so far works only on a voluntary basis, an incentive is needed. If dealers and consumers give preference to products from producers having adopted the EMAS, this would be a very efficient incentive. Before this could be put into practise, however, the EMAS criteria originally designed for industrial production sites will have to be adapted to the special conditions of animal production.
Animal Husbandry↗
Validation of the laboratory information system.
OBJECTIVE: To present an organized and practical approach to the validation of laboratory information systems. SOURCES: Personal experience, published papers, technical manuals, and Food and Drug Administration guidelines. DATA: Validation of the laboratory information system is the continuing process of proving the system fit for its intended use, initially and over time. It consists in defining, collecting, maintaining, and independently reviewing evidence that the system will perform consistently according to specification. Validation is tedious, difficult, and costly, but it must be done to assure that the system is fit for use and is working according to specification. In addition to professional and licensing bodies, laboratories making blood products fall under the regulatory requirements of the Food and Drug Administration. The buyer of a system is responsible for verifying that the developer has complied with all regulations and that the software products are validated to an appropriate degree, that the hardware is certified to perform its designated functions, that an appropriate period of acceptance testing has been done and documented, and that the system in use performs to specification and is under control. CONCLUSION: System validation demonstrates to all concerned, inside and outside the laboratory, that the laboratory information system manages information well, with the expected accuracy and reliability, file integrity, auditability, and management control.
Clinical Laboratory Information Systems↗
Acute laryngo-tracheo-bronchitis (croup): an audit of hospital practice.
The objective of this study was to audit the management of acute laryngo-tracheo-bronchitis in a paediatric unit. This was achieved by retrospective case note audit and a review of the investigations and management of all admitted patients in light of the current literature. There was inappropriate use of radiography and outmoded therapies. There has been an increasing use of adrenaline and steroids in the past 4 years. Prescribing of adrenaline was lax and was associated with potential danger to the patient. For a common condition such as croup, an agreed protocol taking into account current published recommendations is warranted and has been introduced into this unit following this audit.
Adrenal Cortex Hormones↗
Radioisotope laboratory audits.
Elsewhere in this issue, Robin Elliott outlined a successful program for performing annual radiation safety management program audits. The results of such audits provide a useful means of evaluating and correcting deficiencies or weaknesses in a radiation safety program. At our institution we also perform an annual audit of each radioisotope lab oratory for the same reasons.
Humans↗
Diagnostic yield and management benefit of laparoscopy: a prospective audit.
A prospective audit of the diagnostic yield and management benefit of laparoscopy was undertaken in 220 consecutive patients. The procedure was performed electively in 180 patients and as an emergency in 40. The indications for laparoscopy in the elective group were suspected hepatic disease, staging of intra-abdominal malignancy, diagnostic problems, and chronic abdominal pain. Emergency laparoscopy was performed in patients admitted with acute abdominal pain. Diagnostic benefit varied with the indication for the procedure: liver disease 71%, tumour staging 87%, uncertain diagnosis 74%, acute abdominal pain 100%, and chronic abdominal pain 41%. Clinical management was significantly influenced by laparoscopy in 15 of 21 (71%) patients with liver disease, 10 of 30 (33%) with intra-abdominal malignancy, 5 of 19 (26%) with uncertain diagnosis, 32 of 40 (80%) with acute abdominal pain, and 15 of 110 (23%) patients with chronic abdominal pain. A wrong assessment of the nature or stage of the disease was made by laparoscopy in 3 of 220 (1.0%). There was no morbidity or mortality attributed to laparoscopy in the study.
Abdomen, Acute↗
The management of cervical carcinoma within the south west region of England. Expert Tumour Panel.
OBJECTIVE: 1. To audit the management of cervical carcinoma in the South West Region with the aim of identifying and addressing deficiencies. 2. To determine whether recent NHS restructuring has affected the provision of cancer care. DESIGN: Retrospective review of hospital case notes. SETTING: All hospitals in the South West Region of England. POPULATION: Three hundred and twenty-four women with a diagnosis of cervical carcinoma: 191 were diagnosed in 1989 and 133 in 1993. MAIN OUTCOME MEASURES: Documentation of patient assessment and management. RESULTS: There was a mean delay of 17 days (range 0-66) from cervical smear to cytology report and 34 days (range 1-380) from general practitioner referral to attendance at a hospital clinic. Overall, 175 women (54%) had evidence of cytological assessment prior to treatment and 137 (42%) had a colposcopic assessment; 49% had cytological assessment and 37% had colposcopy in 1989, compared with 60% and 50%, respectively, in 1993. Excluding 49 cases of micro-invasive carcinoma, 238 case notes (86%) contained evidence of clinical examination; 195 women (71%) had had an examination under anaesthesia, 115 (42%) a chest radiograph, 123 (45%) an intravenous urogram or renal ultrasound, and 92 (33%) cystoscopy. One hundred and forty-seven women (53%) had FIGO staging recorded in the notes. As first line treatment, 69 had conservative surgery (39 for Stage IA), 138 had radiotherapy, and 107 had radical surgery. Ten had radical surgery for Stage IA but eight had a > 3 mm invasion or lymphatic/vascular spread. Thirty-one had Stage IB treated with radiotherapy of whom 14 were younger than 50 years of age. Following radical surgery 30% had evidence of sampling > or = 10 nodes, and 9% had tumour extending to the resection margins. CONCLUSIONS: Record keeping was inadequate but appeared to indicate inconsistent cytological, clinical, colposcopic and radiological assessment, leading to inappropriate clinical delays and conservative surgery. Radical surgery often appeared inadequate, but poor node sampling rates may also reflect insufficient histopathological preparation or reporting. There was a reduction in the number of new cases of cervical carcinoma diagnosed in 1993, perhaps reflecting an observed increase in cytological surveillance. No other alterations in clinical practice were observed over the four-year period. We feel it is imperative to standardise assessment throughout the region with a minimum clinical and histopathological dataset.
Adult↗
Management of epididymo-orchitis in Genitourinary Medicine clinics in the United Kingdom's North Thames region 2000.
A questionnaire survey and case notes audit reviewing management of epididymo-orchitis (E-O) by 34 Genitourinary Medicine (GUM) clinics located in the North Thames was undertaken. Twenty-two clinics (65%) returned completed questionnaires and audited a total of 83 newly diagnosed cases. All participating clinics offer microscopy of urethral smears and screening for Neisseria gonorrhoeae and Chlamydia trachomatis to all patients, regardless of age. However, greater numbers of clinics would offer routine microbiology of mid-stream urine (MSU) samples (20/22, 91% versus 16/22, 73%) and scrotal ultrasound (5/22, 23% versus 1/22, 5%) to patients aged over 35, compared with men under 35. Half of the cases audited were due either to sexually transmitted infections (STIs) (41/83, 49%), or associated with ascending urinary tract infections (4/83, 5%). No obvious infectious cause was identified for 38/83 cases (46%). Reported management was appropriate for the causative conditions diagnosed and accorded with the UK National Guidelines for this and related conditions.
Adult↗
Improving health care productivity through high-performance managerial development.
High-performance managerial development improves productivity by promoting a better use of human resources. The approach offers well-focused strategies useful to any health care manager.
Efficiency↗
Generating management research on improving quality.
This article identifies areas of management research that should be pursued to develop a better understanding of barriers and facilitators to improve quality in health care organizations. Five major structural barriers to improvement of quality are discussed. Research priorities are presented with suggestions on how to encourage more meaningful research that will accelerate quality improvement in health care.
Delivery of Health Care↗
Exploring the possible reasons why the UK Government commended the EFQM (European Foundation for Quality Management) excellence model as the framework for delivering governance in the new NHS.
A brief introduction into recent developments of the EFQM Excellence Model and the United Kingdom (UK) Government's agenda for ensuring that quality is at the heart of all decision making is given. In view of the Government explicitly commending the use of the EFQM Excellence Model to all organisations within the National Health Service, the author decides to explore the possible reasons behind the commendation. When comparing the EFQM Excellence Model with the Government's vision for quality, the former emerges as a more than ideal tool for any organisation wishing to commence or strengthen their journey on the road to quality and/or excellence; particularly as the EFQM Excellence Model is based on the principles of self-assessment, continuous improvement, learning and innovation, teamwork and a culture totally focused on the customer. Finally, ten possible reasons behind the Government commending the use of the Model are given.
Benchmarking↗
A Baby Bell reexamines itself.
U S WEST, one of the seven Regional Bell Operating Companies spun off from AT&T in January 1984, reevaluated all aspects of its business from top to bottom--including its corporate culture.
Commerce↗
Measuring effectiveness: is NHS Personnel getting it right?
The material presented in this article is the result of a study undertaken at the request of NHS Personnel on behalf of the Department of Health. The central aim was to develop and validate a qualitative measure of personnel management effectiveness, which would be useful and easy to use for those working at regional and unit level.
Administrative Personnel↗
Evaluating performance outcomes measurement systems: concerns and considerations.
In today's managed care healthcare environment, there is a need for hospitals and physician groups alike to know the true quality and costs of healthcare services provided to patients. As the movement toward having providers accept risk via financial capitation escalates, quality improvement professionals involved in outcomes management are increasingly being asked to investigate information sources and systems that can prove helpful in managing effectively within these limitations. As a result, there is a high degree of interest in comparative performance outcomes measurement data based on risk-adjusted and severity-adjusted data. This article explains the key features of performance outcomes measurement systems and notes concerns that should be considered when evaluating these software systems for selection.
Benchmarking↗
NHS profile. Enter the men from the Audit Commission. Interview by Richard Smith.
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Management Audit↗