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PubMed1994

War games: using MRP (material requirements planning) audits to pinpoint problems and keep the competitive edge.

In today's world, it is a challenge just to stay in business, let alone remain competitive in a specific industry. We will show you how to pinpoint MRP II problems and attack them through self-assessment audits. You will discover the secrets of breaking down barriers between Master Schedulers, Material Planners, Production Control Planners, and the Manufacturing Line. Self-assessment audits are one way to take care of your planning functions before outside auditors take care of them for you.

Aircraft↗
PubMed2000

ENVIRONMENTAL AUDITING: Environmental Auditing in Hospitals: First Results in a University Hospital.

/ While medical audit in infection control today is one important element in the quality assurance of health care, environmental auditing, approved in 1993 by the Council of the European Communities for the industrial sector, so far has not been used as a tool to control and reduce environmental pollution caused by medical care. The aim of this study was to investigate whether environmental auditing according to the European Eco-Management and Audit Scheme (EMAS) can be implemented in hospitals as a process of improvement in protection of the environment. In a prior publication the methodological issues and the organizational steps that had to be taken were described. An environmental review of the activities of the Freiburg University Hospital and an ecoanalysis of the input and output were performed. The results of this analysis, published in an environmental report, provide a fundamental data set for the consumption of energy, water, materials, and the burdens of major pollutants and waste. Regarding the organizational structure of the hospital, the first steps towards an integrating environmental management system as demanded by EMAS could be taken. Beside supporting advantages, e.g., improvement of environmental safety, public image and staff contentment, and potential economic benefits such as less cost to be paid for energy and water consumption, there are important restrictions of environmental auditing in hospitals. Examples are the lack of basic environmental data, staff motivation (especially of physicians), cooperation of the organizational substructures, and funds for prefinancing urgently needed improvements in ecology. Based on the study findings, a textbook on environmental auditing in hospitals, including checklists covering all important environmental objectives, has been published to support hospitals in their efforts to achieve an optimized and sustainable practice of providing health care.

Journal Article↗
PubMed1995

Promoting audit in primary care: roles and relationships of medical audit advisory groups and their managers.

OBJECTIVES: To investigate perceptions of family health service authorities and medical audit advisory groups of advisory groups' involvement in clinical audit and wider quality issues; communication with the authorities; and manager satisfaction. DESIGN: National postal questionnaire survey in 1994. SETTING: All family health services authority districts in England and Wales. SUBJECTS: Chief executives or other responsible authority officers and advisory group chairpersons in each district. MAIN MEASURES: Priorities of advisory group and authority for audit; involvement of advisory group in wider quality issues; communication of information to, and contacts with, the authority and its involvement in planning the future work of the advisory group; and authorities' satisfaction. RESULTS: Both groups' views about audit were similar and broadly consistent with current policy. Advisory group involvement in wider quality issues was extensive, and the majority of both groups thought this appropriate. Much of the information about their activities collected by advisory groups was not passed on to the authority. The most frequent contact between the two groups was the advisory group's annual report, but formal personal contact was the most valued. Most authority respondents thought their views had been recognised in the advisory group's planning of future work; only a small minority were not satisfied with their advisory groups. Dissatisfied respondents received less information from their advisory groups, had less contact with them, and thought they had less input into their plans. There was some evidence that advisory groups in the "dissatisfied districts" were less involved in clinical audit and with their authorities in wider quality issues. CONCLUSIONS: Most advisory groups are developing their activities in clinical audit and have expanded their scope of work. The quality and availability of information about progress with audit is a cause for concern to both groups.

England↗
PubMed2004

[New developments in the occupational safety and health management system].

The occupational safety and health management system(OSHMS)has been introduced into many companies and factories in Japan. However, there are certain factories that are considering the introduction of OSHMS, while other factories are not interested in it. In the factories which have introduced OSHMS, occupational health activities are still insufficient. Passage by which OSHMS was introduced into Japan and a basic way to advance OSHMS is described in this paper. In addition, for OSHMS to spread to many companies in the future, and to achieve good results, the themes and prospects which should be examined are described. The themes shown in this paper are as follows: risk assessment, revision of the law and regulation, system auditing, individual management of safety and health rules, evaluation of the low concentration exposure influence, appropriate job suitability system, training of the expert, the support organization, supporting small and medium-sized scale factories.

Forecasting↗
PubMed1991

Acute upper gastrointestinal haemorrhage in a district general hospital: audit of an agreed management policy.

All patients from an unselected population admitted with acute upper gastrointestinal (GI) haemorrhage to a District General Hospital (DGH) were studied prospectively over one year. Before the study period a management policy was agreed between physicians and surgeons. One-hundred-and-nine patients were admitted. Sixty-eight per cent were over 60 and 17% over 80 years of age. Sixty patients bled from peptic ulcers and seven patients rebled. Endoscopic stigmata (visible vessel, adherent clot, and oozing) were useful in identifying those at increased risk of rebleeding but not as an indication for surgery. Six patients underwent surgery for peptic ulceration with one postoperative death. There were four deaths among the other patient groups giving an overall mortality of 4.6%. This audit shows a low mortality after acute upper GI haemorrhage can be achieved even in an elderly population in a DGH without the establishment of a specialist unit but with an agreed policy of management.

Acute Disease↗
PubMed2002

An audit of the immunosuppressive management of ulcerative colitis. A retrospective chart review from a referral Day-Hospital of Gastro-enterology.

BACKGROUND: Ulcerative colitis is a chronic inflammatory disease of the colon thought to be caused by an abnormal T-cell response to lumenal antigens. In the last 10 years immunosuppressives have been proposed to treat its severe forms including cyclosporin and azathioprine. METHODS: An analysis of 72 patients treated for severe ulcerative colitis between 1991 and 2001 at our Day Hospital permitted an audit of the efficacy of this two-drug regime. RESULTS: Overall, the percentages of patients avoiding colectomy immediately, at 1 year, and on ending the study were 68, 47 and 36%, respectively. Thirty-five (81%) of the 43 colectomies, performed as a restorative procedure, clustered in the first year after disease presentation. The risk of colectomy was significantly reduced in the subset treated with azathioprine. Of the 25 long-term responder patients avoiding colectomy, to-date 16 (64%) had at least a relapse at the median time of 17.5 months; all but 1 episodes were managed on an out-patient basis. The types and frequencies of observed side-effects were within the known therapeutic profile of the two drugs. CONCLUSIONS: A two-drug regime of cyclosporin and azathioprine can avoid colectomy for 1 year in slightly less than 50% of a cohort of severe ulcerative colitis patients and permits an acceptable long-term response in slightly less than 40%. An accurate evaluation of this policy needs to be balanced with other options, including most recently refined techniques of colectomy.

Journal Article↗
PubMed1994

An audit and international comparison of asthma management in the emergency department.

AIMS: 1. To perform an audit of asthma management in the Christchurch Hospital emergency department during the period March 1987 to August 1988. 2. To compare management of asthma in Christchurch with other centres in New Zealand and the United Kingdom. 3. To compare markers of asthma severity on admission with other centres. METHODS: Details of all attendances by adults to the Christchurch Hospital emergency department with acute asthma during the above period were recorded on specially designed asthma treatment sheets. This data was compared with similar studies performed in Wellington (NZ) and Southampton and Leicester (UK). RESULTS: 759 cases were analysed. Most subjects were in the 15-25 year age group. 47% were taking inhaled corticosteroids at presentation. History taking was satisfactory according to guidelines operative at that time. Peak flow rate measurement at presentation was performed in 79% of cases, and in 67% of cases following treatment. Nebulised bronchodilators were given in 88% of cases and parenteral steroids given in 22%. 46% of cases were discharged home and of these 28% received a course of oral prednisone. All management decisions, except the decision to give oral steroids on discharge, showed a relationship to objective indices of asthma severity. CONCLUSION: Comparison with other centres shows that the treatment of acute asthma in Christchurch was of a similar standard. Severity of asthma on presentation, as measured by peak flow and pulse rates showed no difference between Christchurch and Southampton.

Acute Disease↗
PubMedDate not supplied

[Evaluation of the quality control system in blood transfusion service].

INTRODUCTION: Implementation of quality system improvement at the Blood Transfusion Institute Novi Sad, included adjustments in practice to the request of ISO 9001 standard. Quality improvement must be a permanent activity of the Institute. The audit is a management tool for monitoring the quality assurance system and is either a quality audit or a medical audit. A well planned, comprehensive quality audit covers each activity of the Blood Transfusion Institute. The procedures may be internal or external. INTERNAL AUDIT: Quality manager is responsible for annual internal quality audits. The purpose of internal audits is to check the efficiency of the quality system in terms of realization of quality policy, fulfullment of designed targets and implementation of quality system documents. An internal quality audit is performed in accordance with the procedure and audit findings are reported to the management in a form of internal quality report as a part of quality system review. The findings must be communicated to all persons responsible for the controlled area. Quality manager can initiate an internal quality audit whenever it is realized that problems about the quality system have occurred. Audits are conducted by the quality manager or an audit team. The accurate list of internal auditors is kept in the Institute archive. MEDICAL AUDIT: Medical audit carried out by a transfusion committee, evaluates the quality of blood transfusion for determining the degree of compliance with established local or national guidelines, in order to promote optimal transfusion practice. CONCLUSION: Audits are not only used for determining further quality management activities, but also make basis for creating and maintenance of excellent relations with product and service users. Considering all this, Blood Transfusion Institute exceeds the requirements of ISO 9000 standards series.

Blood Transfusion↗
PubMed2006

Treating claudication in 5 words (stop smoking and keep walking) is no longer enough: an audit of risk factor management in patients prescribed exercise therapy in New Zealand.

AIM: To assess the documentation and modification of vascular risk factors in patients with intermittent claudication enrolled in an exercise programme in Christchurch, New Zealand. PATIENTS/METHOD: A retrospective review of case notes of patients who presented to the vascular outpatient department with intermittent claudication and were given "Green Prescriptions" for an exercise programme was performed. Referral letters, clinic letters, vascular nurse notes, and handwritten hospital notes were searched for evidence of documentation of risk factors for atherosclerosis. Modification of these risk factors was also noted. Positive attempts at risk factor modification included starting or asking the GP to start a medication or asking the GP to assist with smoking cessation. RESULTS: Sixty patient notes were reviewed which included 81 referral letters (66 from GPs), 118 surgeon letters/clinic notes, and 43 vascular nurse assessments. Of the 60 patients referred, risk factor documentation (positive or negative) was antiplatelet therapy (40), hypertension (48), hyperlipidaemia (39), current tobacco use (40), diabetes mellitus (37), and coronary artery disease (38). Vascular surgeons saw 58 patients and documentation was antiplatelet therapy (42), hypertension (46), hyperlipidaemia (45), current tobacco use (48), diabetes mellitus (44), and coronary artery disease (29). Attempted modification of risk factors by vascular surgeons occurred in 12 patients for antiplatelet therapy, 11 patients for lipid lowering therapy, and 10 for current smokers. Forty-three vascular nurse assessments resulted in documentation of antiplatelet therapy (0), hypertension (42), hyperlipidaemia (42), current tobacco use (43), diabetes mellitus (42), and coronary artery disease (6). CONCLUSION: There is suboptimal communication of vascular risk factors by referrers to specialist vascular services. The recording and modification of risk factors for atherosclerosis in our unit compares favourably with other reported series, but improvement is needed. Furthermore, the role of clinicians with an interest in risk factor management, and patients' understanding of their vascular risk factors, needs clarification.

Adult↗
PubMed1995

Empowering staff through audit.

Describes the use of multidisciplinary project teams in audit planning, process and outcome. Discusses the motivation and need for reward in personal/professional settings and patient satisfaction surveys in the contractual arena into which they have been drawn.

Data Display↗
PubMed2005

Development of a cardiac technician led paediatric echocardiographic service--experience from a district general hospital in the United Kingdom.

OBJECTIVES: To report our experience in providing cardiac technician led paediatric echocardiography services in a district general hospital in the United Kingdom. METHODS: We have collected prospectively the numbers of referrals, and the proportion of abnormal echocardiograms, since inception of the service in 2000. In additional, for a period of 12 months, we have audited in detail the patterns of referral to the service, and outcomes, assessing the effect of the service on the outreach clinic run by a visiting paediatric cardiologist. RESULTS: Use of the system resulted in detection of a wide range of abnormalities, with our audit showing that the patients received appropriate management. The total referrals to the service increased 10 fold over the 4 year period of the study. The proportion of abnormal hearts detected by echocardiography, however, dropped from 90 per cent to 16 per cent over the same period. The numbers of patients seen in the outreach cardiology clinic remained unaltered. CONCLUSIONS: Having been proved to be an effective model for the triage of children with suspected congenital cardiac disease, adoption of a cardiac technician led echocardiographic service has seen a dramatic increase in the numbers of echocardiograms requested, without decreasing the workload of the visiting paediatric cardiologist.

Cardiology Service, Hospital↗
PubMed1995

An audit of the clinical management of urinary tract infection in childhood.

Urinary tract infection (UTI), is one of the commonest bacterial diseases in childhood, and may cause significant morbidity, inconvenience and anxiety for patients and their families and result in considerable consumption of resources. Although most clinicians would agree on the general principles of management, it is recognised that considerable variation exists in their application. The aim of this study was to assess the in-patient and out-patient management practice in infants and children with documented symptomatic UTI in several clinical areas in the Royal Hospital for Sick Children (RHSC) Glasgow. A total of 1,826 patient episodes were analysed, 1,592 of which were first referrals over a 29 month study period. The analysis highlighted a definite variation in a number of aspects of the management of UTI within the clinical services reviewed. In a significant number of in-patients, the diagnosis was made both in the absence of microbiological confirmation, and following the use of inappropriate urine specimens. An under-use of urine microscopy in the in-patient services was documented as well as an inappropriate use in out-patients, since the result in this latter group did not seem to influence the need for urine culture. Urinary tract imaging protocols varied widely between in-patient services and among in-patient and out-patient services with a continued over-reliance on urinary tract ultrasound and an under-use of more sensitive radio-isotopic techniques. These data reveal a continuing lack of uniformity in management practices in children with UTI and demonstrate the need for a wider application of practice guidelines.

Ambulatory Care↗
PubMed1994

A guide to evaluating managed care companies.

Managed care has gradually been replacing the traditional way in which doctors and patients interact. These changes are taking place at an increasing pace, which strongly suggests there will be a dramatic trend to managed care programs. It has become imperative to understand the business of medicine beyond the traditional "business manager" tasks of setting fees, analyzing tax consequences, and balancing the check book. Providers may be hard pressed to maintain the quality of care they feel comfortable giving as the regulations of managed care exert their pressures. A rational, systematic approach to evaluate managed care firms is presented in this article. Additional criteria will have to be added as new ideas for managed care evolve. Physicians and practices must make decisions concerning the level of their participation, depending on a variety of factors, some more sensible than others.

Contract Services↗
PubMed1992

Audit and research.

Explore the source record for details and available documents.

Management Audit↗