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PubMed1992

Managers and medical audit.

A study of the role of the manager in medical audit showed that few people had a clear idea of the manager's role; indeed there was little recognition that managers might have a significant role. The picture today, however, is changing. Deborah Harman and Geraldine Martin, who carried out the study, describe progress.

Administrative Personnel↗
PubMed1999

Breast cancer: outcome audit of axillary management in 1991.

AIMS: To audit the outcome of axillary treatment of patients diagnosed with invasive breast cancer in 1991, with particular reference to the incidence of regional recurrence and lymphoedema after limited axillary dissection. METHODS: A review of records of patients identified prospectively. RESULTS: Two per cent regional recurrence and 5.7% lymphoedema incidence at 5 years. CONCLUSIONS: There is no indication from these results that axillary treatment, for our patient population, should be more aggressive.

Adult↗
PubMed1995

An audit on hospital management of bronchial asthma.

Medical audit is a new concept in developing countries like Pakistan. We carried out this retrospective study on bronchial asthma. The purpose was to see if care given to patient with asthma meets the accepted international standard or not. During this audit several deficiencies were found. Documentation in notes about signs indicating severity of asthma was very poor. Peak flow recording in the notes was also very deficient. There was no documentation in notes whether inhalers technique of the patients has been checked or not. This audit shows that care given to asthma patients is far from satisfactory and we clearly need to improve in order to reach the accepted international standards.

Adolescent↗
PubMed2000

The British Association of Dermatologists audit of atopic eczema management in secondary care. Phase 2: audit of service process.

An audit of atopic eczema management, conducted on behalf of the British Association of Dermatologists, examined service structure (phase 1), process (phase 2) and outcome (phase 3). In phase 2, an on-site case-note audit was conducted in 19 hospital dermatology departments randomly selected from the original sample of 187 centres across the U.K. In total, 630 sets of notes were examined for completeness of: (i) information given to general practitioners (GPs) in clinic letters and (ii) facts relevant to the management of atopic eczema recorded in the patients' notes. In general, the information given to GPs in the clinic letters was good, with the recording of diagnosis, treatment and follow-up approaching the 100% working standard. Factual information such as site and severity of eczema (83% and 74%), and presence or absence of asthma (53%) were better recorded than quality of life issues such as sleep loss secondary to itching (21%) and effect on school, work or social life (6%). On average, only 51% of all audit measures were recorded across all centres, with slight variation between centres (41-61%). The centre with the best recording had a purpose-designed data sheet for doctors to complete when seeing new patients with atopic eczema. Such data sheets may help improve case-note recording. Similar data sheets for patients to complete may be more time-efficient.

Adolescent↗
PubMed1996

Clinical audit: integrating the management of quality.

The recent implementation of clinical audit by the Department of Health seeks to both integrate existing professional audit activities, and to integrate the resulting multi-professional audit more closely with other quality-assurance activities developed by corporate management and purchasers. This paper, which is based on studies of medical and clinical audit undertaken over the past 3 years, examines the potential for integration in the light of, first, the history and characteristics of the different forms of quality assurance initiative and, second, a comparison of their different properties. In many ways clinical audit appears to stand between domination by both professional and managerial influences, which may enhance its potential for integrating different approaches. If, however, clinical audit is to succeed it is suggested that it requires a strong managerial infrastructure; with clearly delineated responsibilities related to the different modes of quality assurance.

Contract Services↗
PubMed1991

Design of legal audits for utilization management.

Liability for managed care risks, the enactment of detailed state regulation of utilization management and the process requirements of accreditation agencies and managed care customers all create the need for new approaches to legal auditing. Concepts from industrial quality management theory can be used to define process elements that serve the legal adequacy of the utilization management process. The information systems that record information gathered and judgments made by reviewers and generate basic notices of certification can be designed so as to produce data relevant to compliance and liability management. These key process elements then can be analyzed statistically to develop plans for preventive counseling.

Contract Services↗
PubMed1999

The lack of integration of clinical audit and the maintenance of medical dominance within British hospital trusts.

Concerns have been expressed repeatedly about the effectiveness of clinical audit. Some have argued that this is limited by the lack of integration within day-to-day practice and with other NHS policy initiatives. We aimed to explore what mechanisms were being used to develop annual clinical audit programmes within NHS Trusts, and to describe the influence of other initiatives on this; to understand how such influences are exerted; and to understand the role of key players, in order to inform future programme development. Semi-structured face-to-face interviews were performed with Chairs of Clinical Audit Committees, Clinical Audit Managers and Co-ordinators (N = 15) in the former Yorkshire Region of the NHS in England. Concerns about the development, planning and integration of clinical audit focused upon an almost exclusive medical dominance and upon how audit leadership could be delivered within the context of hospital management structures. The lack of an overall plan for the development of clinical audit in most sites was seen as enabling the doctors' agenda to dominate. Purchasing authorities were recognized as being important, but often with limited influence. Other influences on the audit agenda, such as research and development (R&D) and clinical risk management, were rarely well co-ordinated. These findings concur with previous studies in identifying a wide range of constraints on the progress of audit. Several of these constraints operate within the internal environment, for example the doctors' agenda, and concerns about management involvement. Such constraints require resolution in order to facilitate the integration of audit with other initiatives and to achieve the goals of audit effectively. Clinical effectiveness and clinical governance may offer a means of facilitating this integration.

Health Policy↗
PubMed1996

Communication audits and the management of change: a case study from an NHS unit of management.

This article explores the importance of high quality communication between managers and staff for the effective management of change within the National Health Service (NHS). In particular, a methodology termed communication audit is outlined. Such audits enable managers to gather accurate information about communication practices within organizations and allows them to assess the nature, quantity and quality of internal communications. This, in turn, facilitates the identification and resolution of potential problems and helps to provide a clearly focused agenda for action and change. A case study is offered which illustrates how such an audit was applied to a Unit of Management within the NHS. The implications for managers throughout the organization are then considered.

Attitude of Health Personnel↗
PubMed2004

An audit on the management of female victims of sexual assault attending a genitourinary medicine clinic.

The victims of sexual assault may attend GUM clinic without any referral from any other agency. The management of these cases need special care. We audited the management of females who were known to us as victims of sexual assault. In 15 months, 68 females attended our clinic. All were screened for sexually transmitted infections (STI). Emergency contraception was offered to only 38.4% at risk cases, and formal counselling support was offered to only 25% cases. Further care is necessary to improve counselling support and offering emergency contraception to the victims of sexual assault.

Adolescent↗
PubMed2006

An audit of the management of melanoma patients at Glasgow Royal Infirmary 1998-2003.

BACKGROUND: Melanoma is an important cause of morbidity and mortality. Recently published Scottish Intercollegiate Guideline Network (SIGN) guidelines outline standard management for melanoma patients in Scotland. METHODS: We audited the management of consecutive patients diagnosed with melanoma in Glasgow Royal Infirmary (1998-2003), using the SIGN guidelines as a gold standard. RESULTS: Of 102 patients, 41% were male and 59% were female. The mean ages of men and women were 58 and 50 years respectively. Fifty five per cent of all patients had a superficial spreading melanoma, and the median Breslow thickness was 0.64 mm. The most commonly affected site was the head and neck (29%). Most patients (87%) were referred by their general practitioner, but only 30% were marked as urgent by the referrer, and accordingly the median time to first appointment varied between 20 days (1998) and 52 days (2001). The most frequently noted suspicious feature was irregular pigmentation. The median time to biopsy was 6 days. Seventy-one per cent of patients had an excision biopsy, and of those who did not, most (71%) had lesions on the head and neck. There was poor recording of surgical margins (13%) and histological margins were used to determine the need for re-excision. The SIGN guidelines for re-excision and sentinel lymph node biopsy were closely followed. CONCLUSION: The SIGN guidelines for melanoma have been adhered to in our department, although time to first appointment exceeded national recommendations.

Adult↗
PubMed1996

Auditing hypertension control and management: a position paper.

The categorical term "auditing" hypertension control is chosen on purpose, to emphasize the responsibility of health politicians for assessing the quality and effects of interventions in populations. Auditing of hypertension is needed for reasons of Efficacy, Economics and Ethics. An analysis of efficacy should test whether the local strategies of hypertension control are sufficiently adapted to the needs and characteristics of a given population. Economic analyses should consider hypertension control in the perspective of resources and priorities. The ethical imperative requires an assessment and follow-up of the effects of health measures on the population, by the same token as evaluation of treatment results is obligatory in clinical medicine. The WHO/WHL Hypertension Management Audit Project was an attempt to analyze the repercussions of hypertension control programs on selected population. Five approaches were taken: (i) assessment of the epidemiological situation; (ii) clinical analysis on a sample of patients; (iii) assessment of patient satisfaction and of (iv) physicians' knowledge and attitudes; and (v) drug utilization studies. The results showed (a) a mixture of under- and overdiagnosis of hypertension in populations; (b) undertreatment of various degrees; (c) mixed patient satisfaction; (d) partial compliance of physicians' concepts and attitudes with standards promulgated by WHO and ISH; and, (e) great differences (at the time of the study) between drug utilization patterns in different countries.

Humans↗
PubMedDate not supplied

An audit of the management of malaria in a Tanzanian district hospital.

An audit of the management of falciparum malaria was carried out over a 12 month period in a north-west Tanzanian district hospital; 1494 patients were studied, 75% being children under 5 years. Chloroquine was effective in 1128 cases (79%), 68 patients died, of whom 64 were aged under 5 years; 30 of them died fewer than 2 d after admission; 14 had received quinine chemotherapy. Management can be improved by better diagnosis of anaemia and hypoglycaemia, changing the dose of injectable chloroquine, earlier use of quinine, and enabling doctors to see very ill patients earlier.

Child↗
PubMed2003

Use of an integrated care pathway: a third round audit of the management of shoulder pain in neurological conditions.

OBJECTIVES: To complete a third round audit of management of shoulder pain using an integrated care pathway, to evaluate pro forma documentation and to determine outcome. SUBJECTS AND SETTING: Thirty-four patients with upper limb paresis admitted to a rehabilitation unit during a 22-month period had shoulder pain and were included in the integrated care pathway. METHODS: Retrospective review of pro forma documentation against pre-determined standards. RESULTS: Compared with the second round audit, performance against 5 out of 9 standards for initial assessment and documentation had improved, and ranged from 56% to 94%. Achievement of 9 further standards relating to continued management ranged from 44% to 97%. Variance was not always well recorded. Shoulder pain resolved or improved in 18/34 (53%) of patients. CONCLUSION: Introducing the pro forma improved standards of documentation and demonstrated a positive outcome in over half the patients. Some problems with developing and maintaining integrated care pathways in the context of rehabilitation are discussed.

Adult↗