SEARCH · PubMed Health

Results for “data auditing”

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.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 991 records · Page 55Linked to original sources

PubMed1987

The advanced life support base hospital audit for medical control in an emergency medical services system.

A large California county uses an audit of its advanced life support (ALS) base hospitals to maintain medical control of prehospital care and to improve the county emergency medical services. The audit is a rigorous, semi-annual evaluation of ALS base hospital performance using objective, written criteria. The county emergency medical service district and the base hospitals have benefited from the data that have resulted from the audits. The base hospital audit is an excellent method of assessing medical control in an emergency medical services system.

California↗

PubMed2001

Reduction of radiation dose to patients undergoing barium enema by dose audit.

Nowadays, new fluoroscopic machines are usually equipped with a dose-area product (DAP) meter for dose measurement. In our hospital, DAP meters have been used in the Diagnostic Radiology Department for dose audit since June 1997. Demographic patient data, name of radiologist, fluoroscopic duration and DAP readings of every case were recorded by radiographers. In early 1999, questionnaires were distributed to radiologists who had performed fluoroscopic examinations during the auditing period. 23 radiologists with varying years of experience completed the questionnaire and their practice was analysed. Since familiarization with the examination technique would affect radiologists' practice, these radiologists were divided into two groups for analysis. Radiologists with less than 3 years of experience were grouped together as junior radiologists, whilst others were grouped as senior radiologists. Results of the questionnaire indicated that radiologists generally found DAP meters useful for dose evaluation in the process of technique refinement. Radiologists aware of being under continuous surveillance of their practice showed significant reduction of doses (junior radiologists 25%, p<0.005; senior radiologists 36%, p<0.05) and fluoroscopic times (junior radiologists 36%, p<0.001; senior radiologists 18%, p<0.05) compared with radiologists who were unaware that they were under surveillance but with similar radiological experience. This effect is believed to be because of increased awareness of radiation dose through audit. In addition, this "audit effect" may also affect junior radiologists in decision-making regarding the number of radiographs (p<0.05), but no effect was found for senior radiologists (p>0.5).

Barium Sulfate↗

PubMed1993

[Laparoscopic surgery in pediatrics: the point of view of the anesthetist].

Data were collected from a retrospective audit in anaesthetists members of the French Association of Anaesthetists in Paediatrics (ADARPEF) and from the prospective study of the author's practice of appendectomy using open or laparoscopic surgery. Retrospective data obtained in 9 of the 16 answering centres show that contraindications include respiratory disability, cardiopathy and age lower than 5 years when surgical instruments of proper size are not available. Monitoring included electrocardioscope, non invasive arterial pressure, pulse oximetry and capnography. Three centres excluded halothane due to possible cardiovascular concern. In two institutions N2O was omitted to limit the size of potential gas embolism. Intraoperative events included high PETCO2 (37%), high arterial pressure (10%), low arterial pressure (3%), bradycardia (1%), hypoxia (0.5%) and one case of pneumothorax. In the appendectomy series, laparoscopy increased the duration of the procedure, and therefore intraoperative opioids requirements. Arterial pressure was higher in this group, irrespective to intraabdominal pressure and to PETCO2. No significant improvement in postoperative analgesia was found. It is therefore recommended to pay special attention to intraoperative anaesthetic and surgical management of children undergoing laparoscopic surgery, particularly in newborns and infants. The high incidence of minor intraoperative adverse events should be balanced by increased postoperative benefit to the patient which has not yet been demonstrated in children.

Anesthesiology↗

PubMed1995

The financial impact of management innovations by health centers.

The primary goal of The Program to Strengthen Primary Care Health Centers was to identify innovations that could improve the financial viability of health centers. This article describes the impact of program-related innovations on financial indicators. During the study period, all of the participant centers continued in existence, whereas one of the comparison centers went bankrupt. Total revenue and net income both improved significantly for the study centers relative to the comparison group. Centers that received audits of their operational systems prior to program commencement fared less well than those that did not.

Community Health Centers↗

PubMed2002

National sentinel clinical audit of evidence-based prescribing for older people: methodology and development.

RATIONALE, AIMS AND OBJECTIVES: This national clinical audit aimed to develop and implement a methodology to assess the appropriateness of prescribing for patients over the age of 65 in hospitals, general practice and nursing homes. METHODS: Organizations providing health care in the National Health Service in these three sectors were recruited into multi-disciplinary and inter-organizational local coalition teams. Prescription data and relevant clinical data were collected electronically on a customized database. The appropriateness of prescribing for specific conditions among the patients sampled was assessed by simple computerized algorithms, and users were provided with feedback to stimulate discussion and change. Use of the software tool was demonstrated to be feasible and its data reliable. Participants were re-audited, after a period of nationally guided and locally driven intervention, to evaluate levels of change. Local efforts to stimulate change and barriers to change were collected qualitatively. RESULTS AND CONCLUSIONS: The investigation revealed encouraging results and demonstrated the ability of audit to improve the quality of clinical services in given circumstances, although a multiplicity of questions relating to cost and methodology remain to be addressed.

Aged↗

PubMed2006

Accurate, practical and cost-effective assessment of carotid stenosis in the UK.

OBJECTIVES: To determine whether less invasive imaging tests [ultrasound (US), magnetic resonance angiography (MRA), computed tomographic angiography (CTA) and contrast-enhanced MRA (CEMRA)], alone or combined, could replace intra-arterial angiography (IAA), what effect this would have on strokes and deaths, endarterectomies performed and costs, and whether less invasive tests were cost-effective. DATA SOURCES: Electronic databases covering the years 1980-2003 inclusive, updated to April 2004. Key journals from 1990 to the end of 2002. REVIEW METHODS: The authors constituted a panel of experts in stroke, imaging, vascular surgery, statistics and health economic modelling. The accuracy of less invasive carotid imaging was systematically reviewed using Standards for Reporting of Diagnostic Accuracy (STARD) methodology, supplemented by individual patient data from UK primary research and audit studies. A systematic review of the costs of less invasive tests, outpatient clinics, endarterectomy and stroke was performed, along with a microcosting exercise. A model of the process of care following a transient ischaemic attack (TIA)/minor stroke was developed, populated with data from stroke epidemiology studies in the UK, effects of medical and surgical interventions, outcomes, quality of life and costs. A survey of UK stroke prevention clinics provided typical timings. Twenty-two different carotid imaging strategies were evaluated for short- and long-term outcomes, quality-adjusted life-years (QALYs) and net benefit. RESULTS: In 41 included studies (2404 patients, median age 60-65 years), most data were available on 70-99% stenosis. CEMRA was the most accurate [sensitivity 0.94, 95% confidence interval (CI) 0.88 to 0.97; specificity 0.93, 95% CI 0.89 to 0.96], compared with US, MRA and CTA, which were all similar (e.g. for US: sensitivity 0.89, 95% CI 0.85 to 0.92; specificity 0.84, 95% CI 0.77 to 0.89). Data for 50-69% stenoses and on combinations of tests were too sparse to be reliable. There was heterogeneity between studies for all imaging modalities except for CTA. The individual patient data (2416 patients) showed that the literature overestimated test accuracy in routine practice and that, in general, tests perform with higher sensitivity and specificity in asymptomatic than in symptomatic arteries. In the cost-effectiveness model, on current UK timings, strategies allowed more patients to reach endarterectomy very quickly, and where those with 50-69% stenosis would be offered surgery in addition to those with 70-99%, prevented most strokes and produced greatest net benefit. This included most strategies with US as first or repeat test, and not those with IAA. However, the model was sensitive to less invasive test accuracy, cost and timing of endarterectomy. In patients investigated late after TIA, test accuracy is crucial and CEMRA should be used before surgery. CONCLUSIONS: In the UK, less invasive tests can be used in place of IAA if radiologists trained in carotid imaging are available. Imaging should be carefully audited. Stroke prevention clinics should reduce waiting times at all stages to improve speed of access to endarterectomy. In patients presenting late after TIA, test accuracy is very important and US results should be confirmed by CEMRA, as patients with 50-69% stenosis are less likely to benefit. More data are required to define the accuracy of the less invasive tests, with improvements made in the data collection methods used and how data are presented. Consideration should also be given to the use of new technologies and randomised trials.

Angiography↗

PubMed2006

The surgical trainee log we need: minimum of work, maximum of output.

BACKGROUND: The objective of this study was to design a trainee logbook suitable for both surgical training and surgical audit. The fields of the logbook should conform to both the current requirements for surgical trainee logbooks and the minimum and recommended datasets for surgical audit. The database should be able to share information with other databases including hospital information systems. The current logbook requirements do not include much outcome data. Therefore, keeping the logbook does not train the young surgeon to collect all the information necessary for surgical audit, particularly the recently promoted minimum (12 fields) and recommended (22 fields) datasets. METHODS: An electronic logbook was developed as part of the hospital's clinical information system (CORDis). Patient identifier information was available in the system and did not need to be re-entered (e.g. name, number, date of birth and sex). The trainee only input the necessary fields for his/her logbook and was able to derive information already available from CORDis on complications, outcome and final diagnosis of the patient. RESULTS: Thirteen of 16 trainees used the program over a period of 2.5 years, and more than 4600 operative procedures were recorded. Information on outcome and complications was included in the logbook, regardless of who in the team entered the data. This also facilitated surgical audit presentations. Logbook reports for the Advanced Training Board were produced with the click of a mouse rather than by spending a whole weekend counting items in the operation register at the end of a 6-month rotation. This system could be used at different hospitals or the data can be exported to another database including databases on a hand-held device. CONCLUSION: The logbook contains all the data for reporting to the Specialty Training Board and Surgical Audit. Duplication of data entry was reduced, and presentation of unit/trainee surgical audits was facilitated. The data can be exchanged with other common databases when the trainee rotates out of Geelong.

Confidentiality↗

PubMed1995

Audit and summative assessment: a criterion-referenced marking schedule.

BACKGROUND: 1996 will see the introduction of summative assessment of general practitioner registrars (trainees). One part of this assessment is the written submission of practical work. In the west of Scotland, audit projects have been chosen as the format for practical work. A valid and reliable marking schedule for such projects is needed. AIM: A study was undertaken to develop a criterion-referenced marking schedule for assessing registrars' audit projects for summative assessment. METHOD: Medical and non-medical professionals, in a series of workshops, compiled a list of essential elements of good audit. These features were tested and refined using registrars' audit projects. All trainers in the west of Scotland were then sent a list of 14 criteria and asked to indicate whether each criterion was an essential or desirable component of a registrar's audit project for summative assessment. A final workshop was held to develop an audit marking schedule. RESULTS: Of 155 trainers in the west of Scotland, 135 replied to the list of criteria for registrar audit projects (87%). Ten criteria were deemed essential or desirable by 80% or more of the respondents. Participants in the final workshop selected five criteria which would form the audit project marking schedule for registrars undergoing summative assessment. These were: defined reason for choice of audit project, relevance of criteria chosen, appropriate preparation and planning, appropriate interpretation of relevant data and detailed proposals for change. For an audit project to pass assessment all five criteria must be present. CONCLUSION: A criterion-referenced approach to assessing registrars' audit projects, developed from their trainers' opinions of essential or desirable criteria for good audit, is described. Further evaluation of the criterion-referenced marking schedule is required.

Educational Measurement↗

PubMed1993

Computerised audit for colorectal cancer.

An audit has been performed of cases of colorectal cancer presenting over an 8-year period. The results of 242 patients are discussed with emphasis placed on the process of surgical audit. In particular, the ease of data handling by a computer database system is stressed. The figures produced on age, sex, presentation, diagnosis, treatment and outcome have allowed a more detailed and fruitful discussion of our practice at the monthly audit meeting.

Adult↗

PubMed1996

The Scottish tonsillectomy audit. The Audit Sub-Committee of the Scottish Otolaryngological Society.

Regional specialist societies offer a valuable mechanism for the conduct of medical audit. The experience of the audit sub-committee of The Scottish Otolaryngological Society in conducting an audit on laryngeal cancer encouraged us to undertake a larger audit of tonsillectomy practice in Scotland. Although the number of tonsillectomies performed has declined over the last 10 years, they still account for about 20 per cent of all operations performed by otolaryngologists and as such are a major consumer of resources (Personal communication-Directorate of Information Services, Information and Statistics Division. NHS in Scotland, Management Executive, Edinburgh). The Scottish tonsillectomy audit was devised to define current practice, review indications for surgery and recommend such modifications in practice as may be necessary to optimise patient care and the use of resources. Funding was obtained from the Clinical Resource and Audit Group (CRAG) of the Scottish Home and Health Department. Data on current practice was collected during the period February 1992 to January 1993. Proformas were completed by medical, administrative and secretarial staff in all participating hospitals, collected by an audit secretary and passed to the relevant data collection centre. Data was then entered into a specially designed database before being forwarded to the audit co-ordinator based in Dundee for collation. Six and 12 months following surgery, all inpatients were sent a questionnaire to obtain data on the efficacy of the operation. Data were obtained from a total of 9,773 patients. Two thousand and seventy-nine of these were seen as both outpatients and inpatients, 4,309 were outpatients only and 3,385 were inpatients only. Four thousand, one hundred and one patients returned at least one follow-up questionnaire. The topics audited included source and reason for referral, indications for surgery, grade of staff involved, type of surgery and length of stay in hospital. In agreement with previous studies (H.M.S.O., 1989), differences were found in the rates of tonsillectomy performed in different Health Boards. Although the highest referral and operation rates were found in the Highland region, referral and operation rates did not correlate in all other areas. Recurrent tonsillitis was the most frequent principal reason for the decision to operate although there were differences between Health Boards for other indications including obstructive symptoms. Most patients had symptoms for two to three years although some patients had been affected for 40 years prior to being listed for tonsillectomy. Some are ENT services were consultant-based while others involved more junior staff. The grade of staff involved did not appear to affect the decision made at the Outpatient Department (OPD) or the outcome of the operation. Ninety-eight per cent of patients who returned the questionnaire were glad that the operation had been performed. Recommendations regarding changes in tonsillectomy practice are given.

Adolescent↗

PubMed2001

An audit of baseline assessment of patients with HIV infection.

A multicentre retrospective medical audit was conducted on the baseline investigations of new patients with HIV infection. A total of 20 investigations were audited for men and 21 for women. Data were received on 49 newly diagnosed patients infected with HIV from 8 centres in the Yorkshire region. The audit demonstrated that half of the patients were not screened for sexually transmitted infections. However, the majority of baseline assessment considered as standard of care, had been performed.

Female↗

PubMed1994

Difficulties in assessing drug/food interactions from chart audit in an elderly Barbadian sample group.

The aim of this study was to examine the prevalence of potential drug/food interactions among 290 elderly Barbadian outpatients. These findings indicate that chart audit is insensitive to definite interactions but was able to detect the prevalence of potential interactions (1.38 per outpatient). The risk of potential interactions was significantly higher among outpatients who were older, female, and those who used a larger number of prescribed medications. There were no significant differences in the prevalence of potential interactions among diabetics and nondiabetics. The findings indicate that the absence of relevant data on patients' symptoms, and anthropometric and laboratory measures in more than 80% of patients' charts makes it impossible to assess the prevalence of definite drug/food interactions from chart audit. Weight changes, nutrient levels, and symptoms were the most frequently missing data. Chart audit is therefore an invalid and unreliable approach to estimate definite drug/food medications.

Aged↗

PubMed2000

A survey to gather sexually transmitted disease epidemiological and management data in the Solomon Islands.

A survey of 15 clinics and hospitals in the Solomon Islands (a South Pacific nation with a 45% rate of penicillin-resistant gonorrhoea) was undertaken to audit the quality of sexually transmitted diseases data collection, adherence to public health fundamentals and knowledge of the national gonorrhoea management guidelines. With the exception of one town clinic, data collection was limited, syphilis serological testing was low (28%) and correct knowledge of the national gonorrhoea treatment guidelines was also limited to 4/8 clinics (50%). Contact tracing was definitely undertaken in 2/8 (25%) of clinics. A high male/female notification ratio (3.6:1) for gonorrhoea was detected. Solomon Island clinics may be typical of other South Pacific Island communities in their inadequate attention to public health fundamentals. Every effort should be made to identify these shortcomings and provide feedback to clinic health workers to improve this service, particularly in the context of the more recent arrival of the HIV epidemic in the region.

Contact Tracing↗

PubMed1978

Blurred vision: problems of auditing elective surgery, as seen in an audit of lens extraction for cataract.

Failure to limit the topic can complicate the audit process by producing too many variations and data not relevant to all patients in the study. Because assessment of the need for lens extraction is subjective, formulating justification criteria is difficult; objective evidence that the patient actually needed the surgery may be lacking. Outpatient records showing the results of surgery, ie, whether a patient's vision has been improved, are usually not available to the audit committee. Consequently, the patient's true outcome after surgery cannot be properly evaluated unless specific follow-up criteria are developed and outpatient records are available to the audit committee. An ideal audit of lens extraction for cataract might combine outpatient records noting results of preoperative workup, the hospital chart, and the clinic record of postoperative care and results. Only with all pertinent information can a complete assessment of the quality of care be made. Because audits rely heavily on the use of data from inpatient records, other methodologies may be more appropriate for review of elective procedures. Audit committees should consider this possibility and beware.

Cataract↗

PubMed1994

Setting up regional audit in genitourinary medicine and HIV: the south east Thames experience.

Audit at regional level is a useful complement to local audit, especially in small specialties. Regional audit can reduce professional isolation and lead to the development of uniformly high standards in the care given by a variety of providers. The development of regional audit in genitourinary medicine in South East Thames (UK), and of HIV medicine in South Thames, is described. Meetings are held quarterly, and concentrate on standard setting and development of guidelines. Information about the practice of individual units is collected by questionnaire, the results presented, and guidelines developed. Participation in completing questionnaires and attending the meetings is good. Regional guidelines in eleven topics have been produced, and methods of auditing changes in practice are now being assessed. A regional common data-set is being developed to assist in the audit process.

Ambulatory Care↗

PubMed2006

Recording and auditing preferred place of death.

Explore the source record for details and available documents.

Attitude to Death↗

PubMed1992

Urban-rural differences in the management of breast cancer.

We conducted a population-based study with medical-record review of breast cancer patients as part of a larger study of an oncology outreach program to improve cancer management for rural patients within their community hospital. This analysis compares the breast cancer care received by the rural population before the oncology outreach program with that of the contiguous urban population. All 1986-87 cases in selected Illinois (United States) counties were identified using the Illinois State Cancer Registry. Data were obtained by hospital record audit and physician survey. Case follow-back was 98 percent complete. Rural cases were evaluated separately when they were diagnosed in an urban facility. State-of-the-art management was defined by the 1986-87 Physician Data Query and included diagnostic evaluation, prognostic evaluation, and stage-specific treatment. A summary variable incorporated whether or not the most appropriate management was offered. Compared with urban cases, rural cases diagnosed in rural hospitals were less likely to have staged tumors and more likely to have node dissections. Rural cases traveling to urban centers were less likely to have limited surgery, hormone therapy, and a biopsy as a first-step surgical procedure, and more likely to have node dissection.

Aged↗

PubMed1996

The Scottish tonsillectomy audit. Audit Sub-Committee of the Scottish Otolaryngological Society.

Regional specialist societies offer a valuable mechanism for the conduct of medical audit. The experience of the audit sub-committee of The Scottish Otolaryngological Society in conducting an audit on laryngeal cancer encouraged us to undertake a larger audit of tonsillectomy practice in Scotland. Although the number of tonsillectomies performed has declined over the last 10 years, they still account for about 20 per cent of all operations performed by otolaryngologists and as such are a major consumer of resources (Personal communication--Directorate of Information Services, Information and Statistics Division. NHS in Scotland, Management Executive, Edinburgh). The Scottish tonsillectomy audit was devised to define current practice, review indications for surgery and recommend such modifications in practice as may be necessary to optimise patient care and the use of resources. Funding was obtained from the Clinical Resource and Audit Group (CRAG) of the Scottish Home and Health Department. Data on current practice was collected during the period February 1992 to January 1993. Proformas were completed by medical, administrative and secretarial staff in all participating hospitals, collected by an audit secretary and passed to the relevant data collection centre. Data was then entered into a specially designed database before being forwarded to the audit co-ordinator based in Dundee for collation. Six and 12 months following surgery, all inpatients were sent a questionnaire to obtain data on the efficacy of the operation. Data were obtained from a total of 9,773 patients. Two thousand and seventy-nine of these were seen as both outpatients and inpatients, 4,309 were outpatients only and 3,385 were inpatients only. Four thousand, one hundred and one patients returned at least one follow-up questionnaire. The topics audited included source and reason for referral, indications for surgery, grade of staff involved, type of surgery and length of stay in hospital. In agreement with previous studies (H.M.S.O., 1989), differences were found in the rates of tonsillectomy performed in different Health Boards. Although the highest referral and operation rates were found in the Highland region, referral and operation rates did not correlate in all other areas. Recurrent tonsillitis was the most frequent principal reason for the decision to operate although there were differences between Health Boards for other indications including obstructive symptoms. Most patients had symptoms for two to three years although some patients had been affected for 40 years prior to being listed for tonsillectomy. Some area ENT services were consultant-based while others involved more junior staff. The grade of staff involved did not appear to affect the decision made at the Outpatient Department (OPD) or the outcome of the operation. Ninety-eight per cent of patients who returned the questionnaire were glad that the operation had been performed. Recommendations regarding changes in tonsillectomy practice are given.

Adenoidectomy↗