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At least 1,009 records · Page 56Linked to original sources
PubMed1993

Day surgery: development of a national comparative audit service.

OBJECTIVES: To develop software for hospitals to analyse their own survey data on patients' experiences of day surgery and to create and test the feasibility of a national comparative audit service. DESIGN: Software development and testing; database analysis. SETTING: Eleven general hospitals in England. PATIENTS: 1741 day surgery patients undergoing procedures during 1991-2. MAIN MEASURES: Postoperative symptoms, complications, health and functional status, general satisfaction, and satisfaction with specific aspects of care. RESULTS: Software for data entry and analysis by hospitals was successfully used at the pilot sites. The overall response rate for the 11 hospitals using the questionnaire was 60%, ranging from 33% to 90% depending on the way the survey was managed. Data from all 11 hospitals were included in the national comparative audit database. Hospitals showed little variation in measures of patients' overall satisfaction (around 85%), but significant differences were apparent for specific aspects such as receiving adequate written information before admission (range 50%-89%), provision of adequate parking facilities (14%-92%) and experiencing a significant amount of postoperative pain (8%-42%). The proportion of day case patients undergoing procedures that could have been performed in outpatient departments varied from 0 to 27% between hospitals. Further comparisons of outcome, in particular measures of effectiveness, must await the development of validated case mix adjustment methods. CONCLUSION: Establishing a comparative audit database is feasible but several methodological problems remain to be resolved.

Ambulatory Surgical Procedures↗
PubMed2004

The effect of time delay on infection in open long-bone fractures: a 5-year prospective audit from a district general hospital.

OBJECTIVES: To determine whether a time delay of greater than 6 h from injury to surgical debridement affected the infection rate in open long-bone fractures in a typical district general hospital in the UK. DESIGN: Prospective audit over 5 years. METHODS: 142 open long-bone fractures in 130 patients were seen over a 5-year period between 1996 and 2001 in our hospital. 115 fractures in 103 patients were available for study. The data were collected prospectively in weekly audit meetings. Patients were followed until clinical or radiological union occurred or until a secondary procedure for non-union or infection was carried out. RESULTS: Surgical debridement was carried out in less than 6 h from injury in 60% of cases and in greater than 6 h from injury in 40% of cases. Infection rates were 10.1% and 10.8%, respectively. CONCLUSIONS: We could not demonstrate a significantly increased infection rate in patients in whom surgical debridement occurred greater than 6 h after injury.

Adolescent↗
PubMed1982

Clinical audit of an intensive care unit.

A computer-based data storage and analysis system has been used to examine data obtained from 1257 patients admitted to an intensive care unit. The system readily provides administrative and clinical information which can be used to assess the workload, therapeutic efficiency and cost-effectiveness of such a unit. As the data-based expands, we expect that we will be able to identify sensitive predictors fo both complications and mortality and thereby permit the more efficient use of intensive therapy.

Aging↗
PubMed1999

Helicobacter pylori treatment and antibiotic susceptibility: results of a five-year audit.

BACKGROUND: Helicobacter pylori eradication treatment has been a rapidly evolving field. Audit of treatment results provides reassurance that trial data can be translated into routine clinical practice. METHODS: Data were collected prospectively over five years. Patients were given four different treatment regimens over the audit period 'standard' triple therapy, two types of clarithromycin-based treatment or ranitidine, amoxycillin and metronidazole. Eradication was proven by a urea breath test at least four weeks after completing treatment. RESULTS: Eradication treatment for H. pylori was given to 665 patients; 89% had follow-up data. H. pylori eradication was significantly associated with treatment type (p<0.0001) and smoking (p=0.04) by univariate analysis, but was not associated with sex, age, alcohol consumption, endoscopic diagnosis, recent treatment with anti-secretory drugs or NSAIDs. By logistic regression analysis, only treatment type was significant (p=0.0001). H. pylori culture and sensitivities were available for 255 patients. Metronidazole resistance was shown for 84 isolates (32%) and clarithromycin resistance for 18 isolates (6.8%). Metronidazole resistance was significantly associated with younger age (p=0.02), ethnicity (p=0.02), female sex (p=0.02), and year of endoscopy (p=0.04), but was not associated with clarithromycin resistance. Clarithromycin resistance was not associated with age, sex, or ethnicity. Metronidazole resistance significantly affected H. pylori eradication for regimens containing metronidazole without clarithromycin. Eradication with metronidazole without clarithromycin was achieved in 90% of sensitive strains but only 55% of resistant strains (p<0.001). Metronidazole resistance was not significantly associated with treatment failure when metronidazole was combined with clarithromycin. Eradication with metronidazole and clarithromycin was achieved in 86% of sensitive strains and 78% of resistant strains (p=0.42). CONCLUSION: Treatment type and antibiotic susceptibility are the most important determinants of treatment success.

Adolescent↗
PubMed2001

Nurses' ethical perceptions of health care and of medical clinical research: an audit in a French university teaching hospital.

Very few data exist in France on: (1) nurses' knowledge and behaviour concerning ethical decisions in clinical practice; and (2) their knowledge of ethical rules in clinical research. This questionnaire-based audit tried mainly to assess these questions in a large French university teaching hospital. Of the 257 questionnaires distributed to nurses in 23 clinical units of the hospital, 206 were returned (80% response rate). When responding to the vignette describing a clinical situation requiring an ethical decision to be made, most nurses acted as the patient's advocate although they have had no formal training in ethics. Indeed, 66% of nurses responding considered that the patients themselves should be the primary decision makers in situations that relate to their health and medical care. For children or comatose patients, the decision should be left to the relatives according to 72% of the responses. The results indicated that the role of health care professionals in ethical decisions made for a given patient should be marginal. Nurses' knowledge concerning research protocols, particularly their ethical requirements and consequences, is poor at present and information from and communication with doctors should be improved.

Adaptation, Psychological↗
PubMed1992

Reasons for contact in family practice. An Icelandic multicentre study on content of practice.

To establish data on the patient's reasons for a contact, as a part of data on content of Icelandic family practice, a prospective practice audit was made of 16 Icelandic health centres with computerized contact data from 1 January to 31 December 1988. The study comprised 16 community health centres in Iceland and their target population, 12 rural and four urban. The reasons for contact in the study group are analysed. A total of 284348 reasons for contact were analysed; 36-39% were for symptoms and 44-50% were initiated by health professionals. The latter included renewal of prescriptions, which comprised 17-18% of all reasons for contact. Musculoskeletal symptoms were the most common symptomatic complaint, 6.6-7.3% of all reasons for contact. The five most often stated symptoms were: rash, cough, cold, lower limb symptoms, and fever. A "reason for contact" record increases the understanding of the patient's presenting complaint, as well as the patient's agenda in each contact. This record gives an opportunity to follow the presenting complaint in the continuous process of care i. e. reason for contact diagnosis, management, and follow-up. We are reminded that common things are common in family practice; nevertheless more research is needed to understand the process of care.

Community Health Centers↗
PubMedDate not supplied

Effects of high-risk pregnancies on families.

PURPOSE: To examine the psychosocial impact a high-risk pregnancy has on the family and to identify family strengths and how these strengths help families meet the challenges inherent in high-risk pregnancies. STUDY DESIGN AND METHOD: A descriptive study using naturalistic inquiry was used to interview women who were currently pregnant and had differing high-risk obstetric health issues. Data collection for this study included semi-structured, one-on-one audiotaped interviews, observations, and a biographic profile completed by the participant. The audiotaped interviews were transcribed and data were examined, coded, clustered, and sorted into specific categories. Trustworthiness included member checks and audit trails. RESULTS: Three themes emerged from the data about psychosocial impact. Mixed Emotions described the women's perception of a high-risk pregnancy; Adjustment and Support was how the women described their family's experience with the high-risk pregnancy; and Informative Care arose from the women's explanation of care received. The most common family strength identified was the ability to manage stress and crisis, followed by commitment, appreciation and affection, a sense of spiritual well-being, and enjoyable time together. The least common strength identified was positive communication. CLINICAL IMPLICATIONS: A high-risk pregnancy not only affects women, but it also causes an alteration in family functioning. Nurses need to become familiar with family strengths and help families recognize their strengths when faced with significant life events.

Adaptation, Psychological↗
PubMedDate not supplied

Making the most of audit.

This article explores the steps in making the most of audits conducted in primary dental care. Audit is the principle method of measuring consistency in quality assurance systems and so is an essential part of clinical governance.

Data Collection↗
PubMed1994

The Scottish Otolaryngology Audit--laryngeal cancer audit.

Regional otolaryngological societies offer a valuable mechanism for the conduct of medical audit. The experience of the audit subcommittee of the Scottish Otolaryngological Society over the last few years is reviewed and a description is given of the findings of an audit of the management of laryngeal cancer in Scotland. The data collection infrastructure currently employed is described and emphasis is placed on the importance of 'ownership' of audit by those participating.

Aged↗
PubMed2003

The cost effectiveness of tacrolimus versus microemulsified cyclosporin: a 10-year model of renal transplantation outcomes.

INTRODUCTION AND OBJECTIVE: In 1983, the launch of cyclosporin was a significant clinical advance for organ transplant recipients. Subsequent drug research led to further advances with the introduction of cyclosporin microemulsion (cyclosporin ME) and tacrolimus. This paper presents the results from a long-term model comparing the clinical and economic outcomes associated with cyclosporin ME and tacrolimus immunosuppression for the prevention of graft rejection following renal transplantation. STUDY DESIGN: A model was developed to project the costs and outcomes over a 10-year period following transplantation. The model was based on the results of a prospective, randomised study of 179 renal transplantation recipients receiving either cyclosporin ME or tacrolimus, which was conducted by the Welsh Transplantation Research Group (median follow-up: 2.7 years). METHODS: The short-term costs and outcomes were the averages from the actual head-to-head trial data. From this, the long-term costs and outcomes were extrapolated based on the rate of change in patient and graft survival at 3, 5 and 10 years post transplant, as reported in the 1995 United Kingdom Transplant Support Service Authority Renal Transplant Audit. PERSPECTIVE AND YEAR OF COST DATA: The analysis was conducted from the perspective of a UK transplant unit. Costs were at 1999 prices (pounds sterling 1 = dollars US 1.42 = Euro 1.5) and costs and outcomes were discounted at 6% and 1.5%, respectively. RESULTS: The model estimated that 10 years after transplantation, the proportion of patients surviving was 56% of the cyclosporin ME cohort and 64% of the tacrolimus cohort. The cumulative cost of maintenance therapy at 10 years was pounds sterling 23204 per patient maintained on cyclosporin ME versus pounds sterling 23803 per patient on tacrolimus. The cost per survivor at 10 years was pounds sterling 37000 (tacrolimus) versus pounds sterling 41000 (cyclosporin ME) and the cost per patient with a functioning graft was pounds sterling 39000 versus pounds sterling 45000. A Monte Carlo simulation of the model (10000 simulations) gave an average cost at 10 years of pounds sterling 23279 (SD pounds sterling 3457) for cyclosporin ME and pounds sterling 22841 (SD pounds sterling 3590) for tacrolimus. A (second order) probabilistic sensitivity analysis was also performed. The average cost at 10 years from a simulated cohort of 1000 was pounds sterling 23473 (SD pounds sterling 2154) for cyclosporin ME and pounds sterling 24087 (SD pounds sterling 2025) for tacrolimus. CONCLUSION: Renal transplant recipients maintained on tacrolimus have better short- and long-term outcomes than patients maintained on cyclosporin ME. The long-term use of tacrolimus is a more cost-effective solution in terms of the number of survivors, patients with a functioning graft and rejection-free patients.

Adult↗
PubMed2000

A RACOG sponsored pilot study of a quality assurance program regarding management of labour by provincial Fellows. Royal Australian College of Obstetricians and Gynaecologists.

OBJECTIVE: To develop an effective and practical self-administered obstetric audit program for use by clinicians within their own practice. SETTING: The private and public practices of specialists in provincial practice. SAMPLE: Two periods of 3 months in each Fellow's practice, separated by a period of 3 months to allow for data review, resulting in the review of management of 6708 singleton births. METHODS: All provincial Fellows in active practice in Australia in early 1998 were invited to take part in a voluntary 'quality cycle' obstetric practice audit. The data from the first 3 month period was fed back to participating Fellows for review before a second 3-month audit period was undertaken. RESULTS: One hundred and twenty provincial Fellows were invited to take part; 62 registered for the study, 58 commenced the project, and 52 completed the entire cycle. 60.1% of the 6708 women studied laboured spontaneously, 25.8% had labour induced, and 14.1% had elective Caesarean sections. 87.8% of the 5759 women who laboured gave birth vaginally. There was little change in the incidence of intervention in labour between the first and second study periods. CONCLUSIONS: It is possible to design a worthwhile self-administered clinical audit in obstetric practice with which specialists in full-time practice can cope and which provides useful personalised feedback for the specialist.

Australia↗
PubMed1996

[Availability of the Alcohol Use Disorders Identification Test (AUDIT) for a complete health examination in Japan].

OBJECTIVE: The Alcohol Use Disorders Identification Test (AUDIT) is an instrument designed to identify hazardous drinkers, harmful drinkers and alchoholics. It was translated into Japanese using the WHOQOL method. The concurrent validity and reliability of the Japanese version of AUDIT were evaluated in a complete health examination. The instrument was also compared with the CAGE questionnaire. METHOD: The subjects were 93 applicants attending for health checks in a human dry dock. They completed self-report questionnaires containing the Core AUDIT and CAGE. and underwent a semi-structured interview conducted by a professional physician. RESULT: From the semi-structured interview, it was determined that 23 of the subjects were problem drinkers and 10 were alcoholics. Analyses indicated that the Core AUDIT was sufficiently sensitive and specific for discriminating problem drinkers and alcoholics. Core AUDIT was also superior to CAGE for discriminating problem drinkers from non-problem drinkers, as well as identifying alcoholics. CONCLUSION: The data suggest that the Japanese version of AUDIT is useful for early detection of hazardous or harmful drinkers.

Aged↗
PubMed1992

On content of practice. An Icelandic multicentre study, population, practices and contacts.

To establish data on the content of Icelandic family practice, a prospective practice audit was made of all Icelandic health centres with computerized contact data from 1 January to 31 December 1988. The study comprised 17 community health centres in Iceland and their target populations, 13 rural and four urban. The main subjects for study were population characteristics, practice sizes, types of health care providers, and contacts. The study population, 50,865 subjects, comprised 20.2% of the Icelandic population. Rural and urban populations were different and are described separately. The 17 health centres had a mean of 1,152 subjects/doctor. The target population had a total of 257,188 contacts: 155,526 rural contacts, 5.1/subject (3.3 office-, 1.1 phone-, and 0.4 home-contacts); 101662 urban contacts, 5.1/subjects (2.8 office-, 1.6 phone-, and 0.4 home-contacts). During 1988, 88.9% of the rural target population made contact. These data are comparable to data from other countries; the observed office and home contact rates were similar, but phone-calls were more frequent. Computer systems in family practice provide a feasible way to collect data on a regular basis for epidemiological purposes and for performance review.

Community Health Centers↗
PubMed1993

Barely auditable?

Explore the source record for details and available documents.

Ambulatory Surgical Procedures↗
PubMed2001

The nursing management of diarrhoea and constipation before and after the implementation of a bowel management protocol.

Intensive care unit (ICU) patients frequently suffer problems associated with both diarrhoea and constipation. Strategies to optimise the management of these conditions need to focus on improving the communication between staff and ensuring effective treatment is implemented. The team involved in this study developed a Bowel Management Protocol (BMP). The effect of this BMP on the documentation of assessment and management of diarrhoea and constipation was evaluated using a quasi-experimental research design. Data were collected via a retrospective audit of medical records. Two groups of patient records were randomly sampled. The records of 60 patients who were admitted to ICU in the 6 months before the introduction of the BMP were accessed together with the records of 60 patients admitted in the 6 months following the introduction of the BMP. Data were collected regarding patient demographics and the assessment and management of bowel function before and after BMP introduction. The results indicated that a BMP improved documentation of the assessment of bowel function. In addition, there was an improvement in the documentation of nursing intervention in the presence of constipation and diarrhoea. These results have to be interpreted with caution because, despite random sampling over two 6 month periods, there were statistically significant differences in age, length of stay, method of feeding and medical diagnosis between the two groups. Further research into the effectiveness of using a BMP is recommended.

Adolescent↗
PubMed1990

Evaluation of a computerised system for medical records in an accident and emergency department.

This paper deals with the impact of the installation of a computerised record and data handling system in an urban Accident and Emergency department. This system became fully operational on the 14th of August, 1989 and replaced the previous manual method of administration. The new system allows 'real time' handling of patient details and generation of letters to both specialists and general practitioners. Audit of the department workload and data generation for research are improved. The current situation is described as well as potential benefits and constraints of the system.

Attitude to Computers↗
PubMed1993

Incompleteness and retrieval of case notes in a case note audit of colorectal cancer.

Hospital case notes are a crucial source of data but are subject to two major biases: incompleteness of data and non-retrieval. To assess these biases in relation to colorectal cancer a study was performed of all cases of colorectal cancer listed in the Thames cancer registry in patients resident in one of four districts in South Thames regions with a diagnosis in 1988. Five medical record sites were involved. Retrieval rate for all case notes for districts combined was 80%. In two districts the rates were too high for further investigation; in the other two respectively patient survival and whether treatment was given were positively associated with retrieval. Among the four districts incompleteness of notes ranged from 38% to 62% for staging, 8% to 40% for treatment, and 70% to 25% for diagnostic tests. Information about treatment was missing in 3% to 20%; survival data were omitted in less than 5%. In all districts completeness of case notes was inadequate and in some non-retrieval compounded the problem. Missing data reduce the quality of cancer registry data and potentially undermine interpretation of epidemiological studies and evaluation of care. Further research is warranted into the standards and resourcing of medical records departments and their effects on retrieval and data quality. Structured proformas could be applied across specialties to identify missing items in case notes, to identify areas where standards are required, or to audit notes where standards have already been agreed. A staging protocol to set standards for colorectal cancer has been adopted in one district, and a prospective audit is being established.

Colorectal Neoplasms↗