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PubMed1995

Managing meningitis in children: audit of notifications, rifampicin chemoprophylaxis, and audiological referrals.

Important aspects of the management of meningitis in children include notification to local officers for control of communicable diseases; chemoprophylaxis for index cases and close contacts in cases of meningococcal or Haemophilus influenzae meningitis; and a formal hearing assessment for all survivors. A retrospective audit of these aspects of management was carried out for children admitted with meningitis in 12 months from 1 September 1990 to 31 August 1991 at the Royal Belfast Hospital for Sick Children. Only 20 of 36(56%) cases were notified by medical staff. Chemoprophylaxis was arranged for all close family contacts but to only five of the 23(22%) index cases for whom it was indicated. Appointments for audiological testing were arranged for only 19 of the 32(59%) survivors. Subsequently all doctors, including each intake of junior doctors, were given written information on the importance of notification and locally agreed guidelines for chemoprophylaxis and hearing assessments for survivors before discharge. Guidelines were also displayed prominently in each ward. A repeat audit from January 1992 to December 1992 showed significant improvement in these aspects of care. Twenty eight of 32 cases (88%) were notified, chemoprophylaxis was given to 20 of 22(91%) index cases for whom it was indicated, and 25 of 29(86%) survivors had hearing assessments arranged before discharge. Correct management of some aspects of care cannot be assumed, even if statutory (notification), nationally agreed (chemoprophylaxis), or generally agreed good practice (hearing assessments). These aspects of care improved after the first audit but the authors conclude that the notification rate remains below 100% and a repeat audit is necessary.

Adolescent↗
PubMed2000

The social work ethics audit: a risk-management strategy.

In recent years, social work's knowledge base related to professional ethics has expanded significantly. However, most practicing social workers concluded their formal professional education at a time when comprehensive ethics education was not a critical or mandated component of the curriculum. This article integrates current knowledge on social work ethics and introduces the concept of a social work ethics audit to aid social workers in their efforts to identify pertinent ethical issues; review and assess the adequacy of their current ethics-related practices; modify their practices as needed; and monitor the implementation of these changes.

Decision Making↗
PubMed1982

How general practitioners manage depressive illness: developing a method of audit.

A model of process is necessary if it is to be audited. A model derived by a group of general practitioners for an audit of their management of depressive illness is described, together with the recording form used and the results of the audit. It is suggested that other general practitioners could test the validity of the model by using the recording form to audit their own management of depressive illness.

Depression↗
PubMed2002

A critical audit of the surgical management of intractable epistaxis using sphenopalatine artery ligation/diathermy.

An audit of the local practice of sphenopalatine artery (SPA) ligation/diathermy was undertaken following its introduction to the unit in April 1998. The authors looked to the literature for evidence of what was to be taken as a successful result and were surprised at the lack of published data on its efficacy or lack thereof. Fivehundredsixtythree patients were admitted for inpatient management of epistaxis over a two-year period. Ten of these patients required surgical control of epistaxis and went on to have either sphenopalatine artery ligation or diathermy. One had concomitant anterior ethmoidal artery diathermy. Postoperatively, the patients stayed between one to ten days (mean 3.3 days). The mean follow up in the clinic was 42.7 days. A recurrent bleed rate of 33% was found, which is higher than previously published results. Of these failures one had internal maxillary embolization followed by anterior ethmoidal artery ligation. The other two failures were successfully corrected with anterior ethmoidal ligation. The authors discuss and illustrate the possible reasons for failure.

Aged↗
PubMed2001

Effects of mental health training and clinical audit on general practitioners' management of common mental disorders.

OBJECTIVE: To evaluate the effects of a seminar-based training program and clinical practice audit on general practitioners' (GPs') knowledge and management of common mental disorders. DESIGN: Survey of GPs' knowledge before and after training, and clinical practice audit and re-audit after feedback. PARTICIPANTS AND SETTING: GP volunteers from around Australia in 1998-1999: 1008 completed the pre-training test, 190 the post-training test, 386 the first audit (33235 patients), and 157 of these the re-audit (13280 patients), with 57 undertaking both audit and training. INTERVENTIONS: Four-seminar, 12-hour training program focused on improving GPs' capacity to identify and manage patients with depression and anxiety; practice audit with patient- and practice-based feedback on diagnosis and treatment of common mental disorders. MAIN OUTCOME MEASURES: Scores on pre- and post-training knowledge tests; self-rated improvements in confidence in managing patients with mental disorders after training; rates of psychological diagnoses and treatment by GPs on first audit and re-audit. RESULTS: GPs' knowledge of pharmacological treatments and clinical management improved after the training program (P<0.001), and 97% of GPs reported increased confidence in their management skills. GPs who undertook training had higher diagnosis rates for common mental disorders in the first audit than those who did not undertake training (36% versus 29%; P<0.001), and their diagnosis rates increased over time (36% to 39%; P<0.01), while those of GPs who did not undertake training were unchanged. Similarly, GPs who undertook training provided more mental health treatments than those who did not (30% versus 27% in the first audit [P<0.001], and 31% versus 24% at reaudit [P<0.001]). They also place greater emphasis on use of nonpharmacological treatments (24% versus 21% at first audit [P<0.001], and 25% versus 19% at re-audit [P<0.001]). CONCLUSION: Clinical audits may heighten awareness of mental disorders, but, on their own, they do not improve mental health practice. A relatively brief but skills-based training program may contribute to better management of patients with common mental disorders by increasing GPs' confidence and competence.

Adult↗
PubMed2003

Cancer pain management in Lanarkshire: a community-based audit.

BACKGROUND: A prospective, longitudinal audit of pain management in patients with cancer was conducted in an unselected community population in Lanarkshire, Scotland. METHODS: Using a modified Delphi technique, a recording form was developed and a dedicated project manager was appointed to oversee the development and implementation of the audit. Community staff recorded pain level and analgesic prescribing on consecutive home visits to patients with cancer-related pain. Areas of good and poor prescribing were assessed using standards previously developed for the Scottish Cancer Pain Audit. These results were fed back to prescribers in a variety of ways and used as a focus for a programme of primary care-based education. RESULTS: Five hundred and forty-one patients have been entered in the audit between May 1999 and end October 2002. A total of 3259 visits have been recorded and 88% of general practices in Lanarkshire submitted forms during this period. Pain scores were recorded in 90% of visits. Specific gaps in prescribing practice were identified. CONCLUSION: The audit demonstrated that it is possible to engage primary care teams in a continuing audit of cancer pain management, which is achievable within the context of normal care. It provided a means to collect and analyse serial data on pain level and pain management and to identify areas of prescribing in need of improvement. Concerted efforts to establish the legitimacy and relevance of the project in the eyes of key stakeholders proved fundamental to encouraging longer-term behavioural change in the management of cancer pain.

Analgesics↗
PubMedDate not supplied

The balanced scorecard--measures that drive performance.

Frustrated by the inadequacies of traditional performance measurement systems, some managers have abandoned financial measures like return on equity and earnings per share. "Make operational improvements and the numbers will follow," the argument goes. But managers do not want to choose between financial and operational measures. Executives want a balanced presentation of measures that allow them to view the company from several perspectives simultaneously. During a year-long research project with 12 companies at the leading edge of performance measurement, the authors developed a "balanced scorecard," a new performance measurement system that gives top managers a fast but comprehensive view of the business. The balanced scorecard includes financial measures that tell the results of actions already taken. And it complements those financial measures with three sets of operational measures having to do with customer satisfaction, internal processes, and the organization's ability to learn and improve--the activities that drive future financial performance. Managers can create a balanced scorecard by translating their company's strategy and mission statements into specific goals and measures. To create the part of the scorecard that focuses on the customer perspective, for example, executives at Electronic Circuits Inc. established general goals for customer performance: get standard products to market sooner, improve customers' time-to-market, become customers' supplier of choice through partnerships, and develop innovative products tailored to customer needs. Managers translated these elements of strategy into four specific goals and identified a measure for each.

Commerce↗
PubMedDate not supplied

[Management of suicidal adolescents: a clinical audit in 76 hospitals].

We describe the implementation and results of a clinical audit of the management of suicidal adolescents in hospital that was carried out as part of the French national suicide prevention programme. The ANAES definition of a clinical audit is: "an assessment method using defined criteria that compares care practices with accepted standards and measures the quality of these practices and the results of care with a view to improving them". Standards for the audit were derived from the clinical practice guidelines published by ANAES (French National Agency for Accreditation and Evaluation in Health) in November 1998. They comprised 15 criteria covering ressources available and procedures implemented: patient management in hospital (9 criteria), contacts made with the patient's environment outside hospital (2 criteria) and preparation for discharge from hospital (4 criteria). Participation in the audit was voluntary. Overall, 76 hospitals from the 10 regions of France with a suicide prevention programme took part in the audit and made 1,554 observations. The number of observations per hospital ranged from 1 to 42. Compliance with the criteria was > 80 % for 5 criteria, 50-80 % for 3 criteria, and < 50 % for 7 criteria. A total of 26 hospitals, proposed a structured improvement plan, ie, scheduled, ordered and ranked measures with a definition of responsibilities and follow-up. Of these 26 hospitals, 15 had implemented the three ANAES recommendations (setting up a working group for the project, using a grid to analyse results, drafting a structured report) whereas only 5 of the 50 hospitals that did not come up with an improvement plan had done so. An operational outcome thus seems related to compliance with the audit method. Three years after the audit was set up, 17 hospitals took part in a second round. Improvements were noted for 12 criteria, mainly for those giving poor results in the first round. However, these improvements concerned few hospitals (eg just 4 hospitals for the criterion with the worst result in the first round). A worsening of compliance was noted for 3 criteria. In conclusion, hospitals were found to comply with guidelines relating to the management of suicidal adolescents in hospital. However, compliance with guidelines relating to making contact with the patient's environment outside hospital and preparing for discharge was less good. Although the hospitals taking part in the audit endorsed our method, our experience showed that, to be effective, clinical audits need methodological support and a well-defined time schedule.

Adolescent↗
PubMed2006

Financial benchmarks for Ontario hospitals.

Since the inception of the Hospital Reports in 1998, researchers have focused on three separate but related problems--how to measure performance; how to evaluate performance; and how to transfer knowledge about excellent performance to the field. This article describes a method to address the second problem--how to evaluate performance by benchmarking two indicators of financial performance and condition through three years of recent data for Ontario hospitals.

Benchmarking↗
PubMed2006

Management of early pregnancy loss--a complete audit cycle.

This is a complete audit of the management of early pregnancy within Glasgow hospitals using the Royal College of Obstetricians & Gynaecologists (RCOG) Clinical Green Top Guideline 25 as the set standard. The Effective Gynaecology in Glasgow Group (EGGG) developed a document to record the current practice of the management of early pregnancy loss within Glasgow hospitals over a 4-week prospective period. Results were centrally collated and distributed to individual units. All units were formally instructed in the current RCOG guideline and a repeat audit cycle was undertaken to determine any difference in management. There was improvement in all categories analysed, as outlined in Table I. We have demonstrated that a dedicated group can improve clinical management through the audit process.

Abortion, Spontaneous↗
PubMed1998

An audit of pancreatic pseudocyst management and the role of endoscopic pancreatography.

BACKGROUND: A rational algorithm for the management of symptomatic pancreatic pseudocysts is necessary with the increasing availability of radiological, surgical and endoscopic methods of treatment. METHODS: A retrospective audit of the management and outcome of all patients who presented with symptomatic pancreatic pseudocysts to the Auckland Hospital over a 9-year period (1988-96) was made. RESULTS: There were 44 patients (28 men, 16 women; median age 50; range 18-81) in this series. Initial management was not based on pseudocyst size, duration, location, wall thickness, the patients' symptoms and comorbidity, or the aetiology of pancreatitis. Of the 27 patients who had initial conservative management, 15 pseudocysts (56%) completely resolved. Of the 17 patients who were initially or subsequently treated with percutaneous catheter drainage (PCD), 10 pseudocysts (59%) completely resolved without additional treatment. Of the 13 patients initially or subsequently treated by surgery, all but one completely resolved after the first procedure. Two patients were successfully treated with endoscopic pancreatic stent placement. Complications arose in eight patients treated with PCD (47%) and four patients treated with surgery (31%). There was no mortality. The decision for active treatment was not preceded by delineation of the pancreatic duct by ERCP (endoscopic retrograde cholangiopancreatography) in 60% of patients. CONCLUSIONS: More than one-third of all patients with symptomatic pancreatic pseudocysts can be managed conservatively. Surgery yields excellent results but PCD has a high failure rate in patients with an underlying pancreatic duct stricture. A rational management algorithm is presented, based on pre-intervention ERCP, which should improve patient selection and outcome.

Adolescent↗
PubMedDate not supplied

The performance of material management in health care organizations.

This paper studies the hospital supply chain. The analysis of the operational and financial data of hospital administrative structures has permitted the discovery of the characteristics of work carried out by the employees and the different strategies used by the managers. Firstly, hospital supply chains must be classified into two groups influenced by medical factors (short-term and long-term hospitals). Secondly, two different management approaches can be observed when the supply chain operations are analysed. The first approach assigns a larger budget priority to inventory control, packages reception and internal distribution. Thus, the purchasing services have relatively fewer resources. In the second approach, contract negotiation and product ordering processes are enforced by the deployment of, relatively, more personnel. In both cases, the central store service performs merchandise reception and distribution according to the strategies determined by the purchasing service.

Budgets↗