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PubMed1996

An audit of lipid screening and management in patients undergoing diagnostic cardiac catheterization. Brompton House Officer Audit Group.

The aim of this study was to audit the management of hyperlipidaemia in a cohort of 206 consecutive patients, with known or suspected coronary artery disease, referred for diagnostic coronary angiography. The association of lipid subfraction values with the presence and extent of coronary artery disease was explored to identify the indices of greatest potential value to the hospital cardiologist, in the management of secondary prevention. Patients were questioned about previous lipid tests performed, advice received and treatment prescribed. Referral letters and hospital notes were reviewed to identify documentation of lipid results and treatment strategies. De novo fasting lipid estimations were obtained on 205 subjects at the time of catheterization. In only 46/206 (22%) cases was some form of lipid result recorded in the existing hospital notes or referral documentation. No patient was aware of the levels of the high or low density lipoprotein cholesterol subfractions (HDL, LDL) nor were these specifically recorded, or the subject of clinical comment, in any of the referral documentation. Patients who knew their total cholesterol (in mmol.1-1) result either as a value or as a "high' or "normal' categorization proved accurate witnesses. In keeping with other angiographic studies, we found that low values of HDL and high TC/HDL ratios were significantly associated with both disease presence and extent. Total cholesterol, calculated LDL and triglyceride levels had no such association. In the group as a whole and despite current therapy, 169/206 (82%) patients had a total cholesterol > 5.2 and 163/206 (79%) a TC/HDL ratio > 5. Only 22 (11%) patients were on drug therapy with a further 43 (21%) practising dietary modification. In the vast majority of subjects receiving some form of lipid intervention, target lipid levels had not been achieved. This study identifies the need for more intensive management of hyperlipidaemia in patients with coronary artery disease. Knowledge of HDL levels may be of value in guiding lipid secondary prevention management in the patient population evaluated at an angiographic centre.

Age Factors↗
PubMed2000

Using a national guideline: an audit of the management of gonorrhoea in Newcastle upon Tyne.

The management of cases of gonorrhoea in the Genitourinary Medicine Department (GUM) of Newcastle upon Tyne in 1999 was audited. The sensitivity of microscopy in diagnosis was 90.4% for male urethral gonorrhoea and 26.6% for female genital gonorrhoea. The sensitivity of laboratory culture was 98.5%. Screening for Chlamydia trachomatis co-infection or treating for presumed co-infection was done in 98% of cases of gonorrhoea and the rates of co-infection were 36.4% in women and 8% in men. Effective first-line therapy was given to 95.4% of cases of genital gonorrhoea. Re-attendance for tests of cure within one month of treatment was achieved in 68.2%. Discussion of partner notification was documented in 94.3% of cases of genital gonorrhoea. In 65% of cases of gonorrhoea, there was documented attendance of sexual partners. The value of a national guideline with auditable targets is discussed.

Adolescent↗
PubMed1988

Audit of the management of pelvic inflammatory disease in general practice.

There has been a change in the causative organisms of pelvic inflammatory disease over recent years - Chlamydia trachomatis is now the commonest infecting organism. Pelvic inflammatory disease is often managed in general practice and it is important that each episode is treated adequately in order to prevent recurrent infection, with its short term morbidity and long term risk of infertility and ectopic pregnancy.In an attempt to document the current management of pelvic inflammatory disease in general practice, a questionnaire was sent to all 143 general practitioners in the Torbay area health authority. The response rate was 78.3%. Investigation methods and treatment regimens varied, with almost half (46.4%) of the respondents taking endocervical specimens but only 25.0% providing antibiotic therapy against C. trachomatis. Only 39.3% of the doctors considered investigation or referral of the male partner.It is concluded that general practitioners are willing to participate in clinical audits of this kind and that the management of pelvic inflammatory disease in general practice is often incomplete.

Adolescent↗
PubMed2003

An audit of the management of induced abortion in England and Wales.

OBJECTIVES: To assess the quality of care provided to women undergoing induced abortion. METHODS: The design was a single round audit questionnaire aimed at the providers of abortion services throughout England and Wales (NHS hospitals, clinics under NHS, agency agreements and private units. The levels of care were assessed against agreed audit criteria. RESULTS: Responses were received from 240 (74%) of the 324 units providing abortion care in England and Wales. These units undertook 80% of the 176,000 termination procedures. Generally standards of care were appropriate, but there were clear areas for improvement including choice of method, infection screening, and delays in referral. A number of unnecessary investigations were still evident, including cross-matching, while lower doses and alternative drug regimens might reduce costs. Only half of the units audited procedures and complications. CONCLUSIONS: This audit was carried out prior to the publication of the RCOG evidence-based guideline and a further round of audit to assess the impact of the guideline should now be considered.

Abortion Applicants↗
PubMed1997

A simple technique for data management in general dental practice audit.

General practice audit is essential in the process of developing an evidence-based approach to dental care. The CHAID (CHi-Squared Automatic Interaction Detector) statistical software package is both practical and user-friendly for many simple applications. The types of questions asked in general practice audit projects will frequently be suitable for analysis using this technique. This may include the identification of patients who are likely to fail appointments and place an additional financial burden on the practice. This paper illustrates the potential value of CHAID to general dental practitioners (GDPs) by using examples of commonly cited dental audit topics. This paper aims to illustrate how a simple statistical package (SPSS CHAID) may be of use for both audit and practice management activities.

Appointments and Schedules↗
PubMed2001

Audit of pain management at home following tonsillectomy in children.

The pain experienced at home and the burden this places on primary care resources is considerable following tonsillectomy in children. This was audited by postal questionnaire in 52 patients (36 responders). We found a significant proportion of patients experiencing moderately severe to severe pain and a high rate of consultation with general practitioners (50 per cent) for pain-related issues. These findings lead to changes in practice which included the provision of five days discharge medication (paracetamol/ibuprofen in non-asthmatics; paracetamol/dihydrocodeine in asthmatics) and improved written discharge advice. On re-auditing a year later in 100 patients (56 responders), we found reduced rates of consultation with general practitioners (27 per cent). However, the proportion of children experiencing moderately severe to severe pain was not reduced probably because most children were given the recommended analgesia during the first audit. We also found that paracetamol and ibuprofen was superior to paracetamol and dihydrocodeine for analgesia (p <0.05). Suggestions for further improvements are discussed.

Acetaminophen↗
PubMed1994

Multicentre criterion based audit of the management of induced abortion in Scotland.

OBJECTIVES: To assess and improve the quality of care provided to women undergoing induced abortion. DESIGN: Two rounds of prospective, criterion based case note review audit. SETTING: Ten NHS gynaecology units throughout Scotland. SUBJECTS: 2004 patient episodes of abortion care identified consecutively during two rounds of audit. The first round comprised 967 cases and the second round 1037. INTERVENTIONS: Dissemination of results from the first round of audit and recommendations for change in the form of a written report and at postgraduate meetings in participating hospitals. MAIN OUTCOME MEASURES: Improvements in quality of care as assessed against 16 previously agreed criteria, both overall across the 10 study hospitals and within individual hospitals. RESULTS: Overall, four significant improvements occurred: increased availability of early medical abortion, decreased utilisation of surgical abortion at very early gestation, increased use of mifepristone priming before second trimester medical abortion, and increased provision of follow up. At the individual hospital level 42 of 150 elements of care studied were "close to optimal" at the time of the first round of audit, rising to 54 at the second round (NS). A total of 31 significant improvements in individual elements of care occurred, but 11 significant deteriorations also occurred (at the P < 0.05 level). CONCLUSIONS: The prospective multicentre audit proved feasible and achieved the aims of any form of audit in terms of identifying deficiencies and variations in care. The audit results prompted objective review of local abortion services in participating hospitals. At least for some elements of care in some hospitals significant improvements were detectable.

Abortion, Induced↗
PubMed2005

A knowledge audit of the managers of primary care organizations: top priority is how to use routinely collected clinical data for quality improvement.

Technology has provided improved access to the rapidly expanding evidence base and to computerized clinical data recorded as part of routine care. A knowledge audit identifies from within this mass of information the knowledge requirements of a professional group or organization, enabling implementation of an appropriately tailored knowledge-management strategy. The objective of the study is to describe perceived knowledge gaps and recommend an appropriate knowledge-management strategy for primary care. The sample comprised 18 senior managers of Primary Care Trusts: the Chairman, Chief Executive Officer, or Research and Development Lead. A series of interviews were recorded verbatim, transcribed and analysed. Knowledge requirements were broad, suggesting that a broadly based knowledge-management strategy is needed in primary care. The biggest gap in current knowledge identified is how to perform needs assessment and quality improvement using aggregated routinely collected, general practice computer data.

Data Collection↗
PubMed1993

Agreeing criteria for audit of the management of induced abortion: an approach by national consensus survey.

OBJECTIVE: To obtain a national consensus view of suggested criteria for good quality care in induced abortion to serve as a basis for standards for audit to assess current clinical practice. DESIGN: Postal, questionnaire survey assessing consensus agreement with criteria identified from a literature review and refined by an invited panel of four gynaecologists and the gynaecology audit project in Scotland (GAPS) committee. SETTING: Scotland. SUBJECTS: All 132 practising consultant gynaecologists. MAIN MEASURES: Overall level of agreement with each of 20 suggested audit criteria. RESULTS: 121 completed questionnaires were received (response rate 92%), of which 119 were returned in time for analysis; 107 came from consultants who practised abortion routinely and were included in the analysis. Nineteen of 20 suggested criteria were validated by an overall balance of agreement. The most strongly supported criterion (agreement score +93) was for ascertaining rhesus status of the woman and prophylaxis after abortion, if indicated. The only criterion to elicit a negative agreement score (-27) was that dilatation and evacuation is the best method of abortion at 12-15 weeks' gestation. The ranked and prioritised criteria resulting from this exercise are being used within a national audit project. CONCLUSIONS: A postal questionnaire survey among interested clinicians resulted in a good response rate and enabled the audit criteria to be validated and ranked more objectively and among more clinicians, than would have been possible by group discussion.

Abortion, Induced↗
PubMed2002

An audit of outpatient management of pelvic inflammatory disease.

Pelvic inflammatory disease (PID) is a common condition presenting to Genitourinary Medicine clinics in the UK. It is unclear what is the best therapeutic option in the outpatient setting. A clinical audit of current standard of care in women presenting with PID was conducted. A total of 150 women were diagnosed clinically during a six-month period. Chlamydia and gonorrhoea were identified in 30% and 4% of patients respectively. The clinical and microbiological cure rates of oral doxycycline and metronidazole were assessed. In 57% of patients their symptoms resolved, but 18% had persistent signs and symptoms; 25% did not attend for follow up visit. Partner notification was discussed in 87% of patients. With a treatment failure rate of 18% we felt it appropriate to change the antibiotic regimen of PID in our department.

Ambulatory Care↗
PubMed2004

Surgical mortality score: risk management tool for auditing surgical performance.

Existing methods of risk adjustment in surgical audit are complex and costly. The present study aimed to develop a simple risk stratification score for mortality and a robust audit tool using the existing resources of the hospital Patient Administration System (PAS) database. This was an observational study for all patients undergoing surgical procedures over a two-year period, at a London university hospital. Logistic regression analysis was used to determine predictive factors of in-hospital mortality, the study outcome. Odds ratios were used as weights in the derivation of a simple risk-stratification model-the Surgical Mortality Score (SMS). Observed-to-expected mortality risk ratios were calculated for application of the SMS model in surgical audit. There were 11,089 eligible cases, under five surgical specialties (maxillofacial, orthopedic, renal transplant/dialysis, general, and neurosurgery). Incomplete data were 3.7% of the total, with no evidence of systematic underreporting. The SMS model was well calibrated [Hosmer-Lemeshow C-statistic: development set (3.432, p = 0.33), validation set (6.359, p = 0.10) with a high discriminant ability (ROC areas: development set [0.837, S.E.=0.013] validation set [0.816, S.E. = 0.016]). Subgroup analyses confirmed that the model can be used by the individual specialties for both elective and emergency cases. The SMS is an accurate risk- stratification model derived from existing database resources. It is simple to apply as a risk-management, screening tool to detect aberrations from expected surgical outcomes and to assist in surgical audit.

Adult↗