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At least 433 records · Page 24Linked to original sources
PubMed1996

Turnaround time of in-patient discharge letters: a simple system of audit.

This user-friendly audit system, successfully developed and implemented in a district general hospital for use across all clinical specialties, is able to calculate the turnaround time of final discharge letters and as a consequence identify any areas of delay between patients' discharge and the letter being mailed. By serially monitoring both individual consultant and specialty performance, the system can provide valuable information on the discharge letter process to Purchaser and Provider alike. A copy of the audit system together with details of audit design and methodology is available to interested clinicians, managers and audit facilitators.

Communication↗
PubMed2004

A costed profile audit of the surgical management of female stress incontinence.

BACKGROUND AND AIMS: To conduct a profile audit of three surgical treatments for urinary stress incontinence through the application of an episode costing process. METHODS: Four stage methodology: (1) construction or a profile of care for each of the surgical approaches (setting the standard); 2) calculation of a theoretical profile cost; (3) calculation of the observed costs from real patient episodes; (4) comparison of observed costs with profile costs, (comparing present practice with established standard). RESULTS: Profiles of care were constructed and compared with 39 actual in-patient episodes. Tension free vaginal tape (TVT Gynecare) is the cheapest modality of treatment in terms of both the expected profile cost and also observed (real patient) cost. Colposuspension is the most expensive form of treatment with real costs significantly greater than the expected profile. Clinical issues such as length of stay, duration of surgery, patient selection and complication rates were revealed through the exception reporting process. Length of stay is the main determinant of overall cost. CONCLUSION: It is possible to construct a costed and auditable standard of care for a surgical procedure. This standard can be compared with real patient costs calculated using the same methodology. Exception reporting based on differences between expected and real costs can be used to facilitate the audit of clinical practice. The technique is limited, however, by the need to collect accurate and detailed activity data.

Collagen↗
PubMed1994

Clinical audit and organizational audit in palliative care.

Palliative medicine has a history of critical appraisal dating back to the start of the hospice movement during the 1970s. Methods and audit tools are available and have been tested, especially for clinical audit. Practical approaches such as the Support Team Assessment Schedule, the Edmonton Symptom Assessment System and topic audits are particularly recommended. Developments in clinical audit could lead to clinical algorithms or protocols to assist patient management. Organizational audit is less well developed, and the scientific basis of choosing the standards is questioned. However, only with the piloting of organizational audits will their true value emerge. There are, however, constraints of time and resources: audit should be cost effective and in the future will need management and evaluation.

Cost-Benefit Analysis↗
PubMed1997

An audit of the assessment and management of adults admitted to Christchurch Hospital with community acquired pneumonia.

AIMS: To audit the management of adult patients admitted with community acquired pneumonia including the standards of clinical assessment, use of modified British Thoracic Society prognostic criteria and antibiotic therapy. METHODS: A prospective, 16 week, study of consecutive patients admitted to Christchurch Hospital with community acquired pneumonia. RESULTS: Ninety-six patients met the inclusion criteria. The median age was 70 years. A pathogen was identified in 28 (26%) patients. Forty two patients fulfilled the modified British Thoracic Society criteria for severe disease and all 9 deaths occurred in that subgroup. The management guidelines were followed without exception in only 15% of cases. Documentation of the prognostic criteria was often incomplete and therefore only 33% of those patients with severe disease were correctly identified. Seventy one percent of those with severe disease were treated with only one antibiotic and there was significant delay in administering the first dose in 44% of cases. A follow up chest radiograph was performed in 43 (51%) of those discharged. CONCLUSIONS: There was poor compliance with the management guidelines. There was a lack of awareness of the severity criteria leading to inadequate treatment in many cases. Further educational initiatives are indicated.

Adult↗
PubMed2006

An audit of corneal abrasion management following the introduction of local guidelines in an accident and emergency department.

BACKGROUND AND OBJECTIVES: Corneal abrasions are a common presentation to accident and emergency (A&E) departments. Patients can be treated and discharged by A&E staff without the need for an ophthalmologist's attention; complicated cases, however, should be recognised and referred. Inexperience and limited training in ophthalmology may lead to suboptimal patient care and inappropriate use of ophthalmology outpatient clinics. Issues of poor documentation may also arise. The purpose of this audit was to assess the effect of guidelines on the management of corneal abrasion by A&E staff. METHODS: A retrospective case note audit was performed to assess current management of corneal abrasions. Guidelines for management of corneal abrasions were formulated following a literature search and collaboration between A&E and ophthalmology staff. A prospective case note audit was undertaken to assess management after introduction of the guidelines. RESULTS: A total of 51 cases were audited before the introduction of the guidelines and 57 cases after. Following the introduction of the guidelines documentation of visual acuity increased to 93% and specific enquiry into contact lens wear rose from 35.3% to 71.9%. A&E staff stopped giving out local anaesthetic eye drops. The follow up profile also improved; appropriate patient discharges increased by 40% whereas inappropriate referrals to eye clinic dropped by 75%. More patients were given abrasion advice (a 101% increase). CONCLUSIONS: A&E staff members are capable of managing corneal abrasions if they are given guidance and some training. This audit identified shortcomings in current management and showed that guidelines can significantly improve clinical practice.

Anesthetics↗
PubMed2005

Human error risk management methodology for safety audit of a large railway organisation.

This paper considers the application of the human error risk management for engineering systems (HERMES) methodology for safety assessment studies. The application concerns the recurrent safety audits (RSA) of a large organisation in the domain of railway transportation systems. The objective of the study was the identification of the most relevant areas of intervention for improving safety and reliability of the service. The methodology has been applied to the whole organisation and its working processes. Specific attention was paid to train drivers. A number of critical indicators of safety and recurrent safety audit matrices were identified, which enabled the assessment of the safety level of the organisation and the generation of safety recommendations. The application of HERMES to this case study shows that the methodology is applicable in practice and can give valuable and significant results.

Efficiency, Organizational↗
PubMedDate not supplied

Building the airplane in flight: an auditing approach to quality management system development.

In June of 2000, Maine DEP (in company with the other five New England states) found itself under EPA pressure to develop and document a quality management system by the end of the calendar year. In the frenzy that followed, the Department decided to use a private sector model for system development that called for a prospectively-focused QM plan that would be implemented through formal auditing. That is, instead of trying in advance to identify all the deficits in departmental quality management, and then assigning individuals and task groups to create structures to fill the gaps, Maine's QMP specifies the future desired system in broad terms. ME-DEP then uses its own cadre of trained auditors to assess current practice against the "condition expected" in the QMP, knowing that in many cases basic quality management practices will need to be developed. This approach assists program managers, particularly (but not exclusively) in areas sensitive to environmental data standards, in creating systems and practices that are rooted in reality, and that are perceived to add value to the Department's core work instead of just additional paperwork. Audit reports create a continuous feedback loop assuring that written procedures document actual operations. Finally, the results of auditing identify areas in which the QM system (and its plan) should be elaborated or refined, which leads to an iterative process by which quality approaches are infused in all areas of DEP operations. In the twelve months following EPA-Region I's initial approval of Maine's QMP, a total of seven audits were completed at various program levels, including two focused on critical QMP elements: Documents and Records; and Computer Hardware/Software. This paper will briefly describe the background and implementation of this approach; identify some of the factors which led to success; and describe, using selected examples, some of the early outcomes of the program.

Cooperative Behavior↗
PubMed1997

Conservative management of abdominal injuries: audit of criteria for discharge.

This prospective study was conducted to audit the discharge criteria of patients admitted for the conservative management of abdominal trauma. A total of 184 patients who were admitted to Groote Schuur Hospital (GSH) with penetrating or blunt abdominal injuries and who were conservatively managed according to the GSH protocol were assessed. The study concluded that patients with abdominal trauma who do not require emergency laparotomy can be safely discharged after a period of conservative management provided they are pain-free, hungry and passing flatus.

Abdominal Injuries↗
PubMedDate not supplied

Accounts receivable reports: underutilized mining tools.

There is gold to be found in accounts receivable reports for those willing to mine the data. The key is to know how to interpret the information buried within the numbers and use it to recover monies owed. This article identifies seven reports that should be staples in every organization committed to improving its overall collection performance. Also included are tips on understanding reports and implementing changes.

Accounts Payable and Receivable↗
PubMed2002

Evaluation of the management of optic neuritis: audit on the neurological and ophthalmological practice in the north west of England.

The management of acute optic neuritis by neurologists and ophthalmologists in the north west of England was assessed in the light of the Optic Neuritis Treatment Trial (ONTT) recommendations. A questionnaire on a fictitious case of typical unilateral optic neuritis was mailed to all consultant ophthalmologists and neurologists working in the North West and Merseyside Health Authorities. They were then asked to comment on management of the case. Fifty two out of 86 ophthalmologists and 20 out of 28 neurologists replied. The overall response rate was 63%. Sixty five per cent of neurologists and 46% of ophthalmologists would investigate a typical case of acute optic neuritis further. Forty six per cent of neurologists and 36% of ophthalmologists were likely to arrange MRI of the brain or orbit. Significantly more neurologists (55%) than ophthalmologists (9%) chose to treat with intravenous methylprednisolone (p<0.005). Significantly more ophthalmologists (64%) than neurologists (32%) chose not to give steroids (p<0.025). Oral prednisolone alone was rarely selected for treatment. Respondents were more likely to discuss multiple sclerosis with the referring doctor than with the patient. Only 32% of ophthalmologists and 20% of neurologists would clearly mention the possibility of improvement to the patient. Clear differences in practice between ophthalmologists and neurologists remain. A consensus on practice guidelines on the issues raised might be useful.

Acute Disease↗