Management peer review.
By implementing a management audit program, you can not only improve your clinic's operation, but also demonstrate a forward-thinking management style and strengthen your public image.
Accounting↗
SEARCH · Search PubMed
Results for “Management Audit”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
An audit of the management of patients with epilepsy in thirty general practices.
An audit of the management of epilepsy in 30 general practices is presented. A total of 377 patients from widely dispersed practices in the UK independently completed questionnaires which mirrored similar questionnaires answered by their doctors. A lack of detailed awareness by the doctor of how epilepsy was affecting the patient was detected. Many patients were found to have difficulty in communicating anxieties and problems associated with the disease to their general practitioner. Use of drug monotherapy and anticonvulsant blood level monitoring was sub-optimal. This multi-centre study supports previous single-centre reports of certain deficiencies in long-term management of epilepsy in general practice.
Activities of Daily Living↗
A prospective audit of asthma management following emergency asthma treatment at a teaching hospital.
OBJECTIVE: To audit the assessment and treatment of acute asthma and the subsequent application of the Australian Asthma Management Plan. DESIGN: Prospective audit of case notes with follow-up telephone questionnaire and clinical assessment at 8-12 weeks after discharge. SETTING: Tertiary-level teaching hospital. MAIN OUTCOME MEASURES: Comparison with published guidelines for acute and ongoing asthma management. RESULTS: Asthma severity was objectively assessed in the Primary and Emergency Care Department, with lung function performed in 95% of acute presentations. Clinical history and examination were documented completely in 28% of presentations. Corticosteroids were underused and there was inappropriate use of ipratropium bromide. At 8-12 weeks follow-up most patients were symptomatic with limited activity due to asthma (46%) and impaired lung function (66%). One-third of patients were undertreated. Asthma management skills were seriously inadequate: only 20% of patients were performing peak flow monitoring, and only 21% recalled receiving specific instructions for the management of future exacerbations. Inhaler technique was inadequate in one-third of patients and asthma knowledge was poor. These deficits were more frequent in patients not admitted to hospital. CONCLUSION: This audit identified suboptimal assessment and treatment of acute asthma, and deficits in the implementation of the Australian Asthma Management Plan following discharge. Patients in this audit were undertreated and not provided with the skills to manage future attacks of asthma.
Adolescent↗
Operational assessments: a must for gauging practice efficiency.
Explore the source record for details and available documents.
Efficiency, Organizational↗
The British Association of Dermatologists audit of atopic eczema management in secondary care. Phase 3: audit of service outcome.
Service outcome was examined by a preconsultation (part 1) and a 6-week postconsultation (part 2) patient questionnaire in 29 hospital dermatology departments randomly selected from an original sample of 187 centres across the U.K. The outcome measures were: quality of life as measured by the Dermatology Life Quality Index (DLQI) and Children's DLQI (CDLQI), improvement in sleep loss, improvement in worse aspect of skin disease and return to work or school. Three hundred and fifty-two questionnaires (115 adults, 237 children) were completed for part 1, and 235 (67%) replied to part 2. The mean DLQI at initial consultation was 12.5, dropping to 9.7 at 6 weeks (P = 0.001). The mean CDLQI at initial consultation was 10.5, dropping to 8.7 at 6 weeks (P < 0.001). Forty-nine per cent of adults and 44% of children had a > 25% relative improvement in score, which did not meet the 60% working standard. Forty-four per cent of adults and 47% of children had an improvement in sleep loss at 6 weeks, falling short of the 70% working standard. Sixty-one per cent of adults and 59% of children had an improvement in the worst aspect of their skin condition at 6 weeks, falling short of the 80% working standard. Of the 20 adults and eight children off work/school during part 1, 70% of adults and 87.5% of children had returned to work/school by 6 weeks. This met the 80% working standard for children but not for adults. On a national scale, only one of the eight working standards for service outcome was met, although most of the working standards were met by at least one of the 11 National Health Service administrative areas. This study presents the first national data on the outcomes of a representative sample of atopic eczema patients seen in secondary care. Small sample sizes, instruments which may be insensitive to change, as well as local factors such as case-mix, baseline severity and staff to patient ratios need to be taken into account when interpreting these results. Nevertheless, the results of this baseline audit suggest that the outcome of patients with atopic eczema following secondary care consultation may not be as good as some doctors believe. This suggests that an improvement in practice, a re-evaluation of the working standards, or both, is needed and should be examined in future audit cycles.
Adolescent↗
Audit of the management of patients with refractory epilepsy.
Achieving rational management for patients with refractory epilepsy can be difficult. We audited our management of 55 patients with refractory epilepsy by comparing two 3-month periods each 9 months apart. Despite attempts to rationalize antiepileptic drug therapy, a smaller proportion of patients were managed with monotherapy by the second analysis (16% vs 22%); however fewer patients were taking three or more AEDs (28% vs 43%). A substantial impact on seizure frequency was made in only six patients whilst 22 patients had a significant deterioration in seizure number (P = 0.005). Monitoring of AED levels was of little value with only six clinical decisions based on 305 AED levels performed at a cost of 2525 pounds. The newer AEDs accounted for a disproportionate expenditure (65% of the total AED cost in the second 3-month period) considering their lack of therapeutic impact. We confirm the need for audit in this patient group to ensure that pre-defined targets are met.
Adolescent↗
A collaborative audit of the management of hypertension in general practice.
We carried out an audit of the management of essential hypertension in general practice, against standards based on current guidelines. We examined the records of 882 hypertensive subjects (on medication) in whom hypertension had been diagnosed between January 1989 and December 1993, from 14 general practices in the Portsmouth and South East Hampshire Health Authority. The overall prevalence of hypertension was 3.5%. Pretreatment blood pressure had been measured on three or more occasions in 87% of patients. Pretreatment blood pressure was equal to or greater than 150/95 mmHg in 96% and 160/100 mmHg in 86.5% of patients. A thiazide diuretic was the initial drug of choice in 30% of patients, with beta-blockers being the most popular initial treatment. Ninety per cent of patients had had their blood pressure measured at least once during the preceding year. In 82.5% of patients, current blood pressure was less than 150/95 mmHg, while 44% achieved a current blood pressure less than 140/90 mmHg. We conclude that the prevalence of hypertension in this population was lower than expected, suggesting the need for improved screening. We also propose that the initial treatment choice should be a thiazide in the majority, which would result in significant cost saving. The blood pressure control was suboptimal compared to current guidelines.
Adrenergic beta-Antagonists↗
An audit of the management of uterine malignancy within the West Midlands. West Midlands Gynaecological Oncology Group.
OBJECTIVE: To audit the management of uterine malignancy. DESIGN: Retrospective casenote analysis. SETTING: Cancer units/centres within the West Midlands. SAMPLE: The last 100 cases managed by each hospital in 1997. RESULTS: Ninety-six cases of uterine malignancy from ten hospitals were analysed. Only six hospitals were able to provide a complete data set. Eighty-eight cases (92%) presented with abnormal, usually postmenopausal, vaginal bleeding. Over 90% of the cases were primary endometrial carcinomas. Of the 15 standards audited, 11 were met by at least one hospital. No hospital met all the standards, although every hospital was able to meet at least one. Standards concerned with initial referral and diagnostic intervals were universally failed. Outpatient diagnosis was made in only 30%. The availability of Rapid Access Clinics neither promoted outpatient diagnosis nor sped up diagnosis. Once the diagnosis had been made, surgery was usually performed within six weeks. CONCLUSIONS: This audit has provided valuable baseline data for future activity. Serious attention must be given to improvement in clinical cancer data collection. Referral pathways for women with suspected uterine cancer, and endometrial cancer in particular, need improvement. It is recommended that the current standards remain unaltered, and after the West Midlands Gynaecological Oncology Group had the opportunity to consider and implement the necessary changes, the audit be repeated.
Adult↗
Economic issues in managed care.
Economic issues abound in managed care. The advent of health insurance in the United States, which was created to ensure payment to hospitals, diminished an early emphasis on charity care. Escalating health care costs have ensued. Today, economic considerations dictate the need to control health care expenditures while guaranteeing responsible care. Managed care organizations can achieve both goals by establishing financial partnerships with physicians while instituting quality-control audits, management review teams, and home-care arrangements.
Health Care Reform↗
Management of chronic hepatitis C: clinical audit of biopsy based management algorithm.
OBJECTIVE: To assess the attendance, outcome, compliance with treatment, and response to interferon alfa in patients with chronic hepatitis C who attended during 1995 and were treated according to a biopsy based algorithm. DESIGN: Retrospective audit of all patients with chronic hepatitis C attending outpatient clinics over one year. SETTING: The liver unit at a London teaching hospital. SUBJECTS: 255 patients with chronic hepatitis C. MAIN OUTCOME MEASURES: Patient survival, attendance, and compliance with diagnostic and therapeutic regimens. Response to interferon alfa treatment, based on loss of viraemia three months after cessation of treatment. RESULTS: A large proportion of patients (39%) with newly diagnosed chronic hepatitis C infection do not want to undergo further investigation. Of those patients who do attend for further treatment, a large proportion with severe hepatic fibrosis (42%) do not want to undergo currently available treatment. The response rate to interferon (21%) in treated patients was similar to that previously reported in a trial setting. There was no significant difference in response rates in patients with or without severe fibrosis not amounting to cirrhosis. In patients with cirrhosis there was a high incidence of hepatocellular carcinoma (18%) over a follow up period of 20 months. CONCLUSION: Current strategies aimed at investigating and treating patients with chronic hepatitis C are not acceptable to a large proportion of patients. Many patients with cirrhosis related to hepatitis C infection develop hepatic neoplasms, and management strategies to deal with this problem are urgently required.
Adult↗
Improving the outcome of paediatric orthopaedic trauma: an audit of inpatient management in Southampton.
The patterns, management and outcome of non-fatal orthopaedic injury in childhood was audited over a 1 year period in Southampton. A computer-based audit (1 September 1993 to 31 August 1994) was conducted of all children aged under 15 years who were admitted to the orthopaedic unit after accidental injury. Management was audited by studying the primary conservative and operative treatment methods employed. Treatment outcome was evaluated in terms of need for secondary operative treatment, salvage internal fixation, length of hospital stay and unplanned readmission. In all, 398 children, representing 50/10,000 of the local paediatric population, were admitted with a traumatic injury. There was a significant (P < 0.001, Kolmogorov-Smirnov) seasonal variation in admission rate. There were 87.3% admissions required for fractures, 8.5% after soft tissue injury and 2.2% after joint injury. The following areas were identified where management and outcome could be improved: 1 A 12.1% readmission rate (47/346) in children with fractures owing to a 16% incidence of loss of position after closed reduction of distal radial, forearm shaft and distal humeral fractures. 2 In all, 24% of internal fixation procedures were performed as 'salvage' after failure of conservative treatment, entailing either reoperation during the initial admission or a further unplanned readmission. 3 A prolonged inpatient stay for patients with femoral fractures owing to a wide variation in treatment method. The outcome of non-fatal orthopaedic injury can be improved through the selective use of primary internal fixation of distal radial and humeral fractures and the close adherence to a management algorithm in femoral fractures. There may be a role for more specialised supervision of primary treatment of these particular fractures.
Adolescent↗
The involvement of pharmacists in professional and clinical audit in the UK: a review and assessment of their potential role.
This review addresses the uptake and implementation of the principles of audit by community, hospital and health authority pharmacists. The pressures to audit professional services are discussed, as are the barriers to cooperation among pharmacists and between pharmacists and prescribers in primary care. The development of standards of professional practice is then described taking into account the particular difficulty in developing standards for health care workers who are geographically separated from other members of the primary care team and are in commercial competition with each other. The review identifies audit of professional services in both community and hospital pharmacy and of clinical services in the latter. The role of pharmacists employed by health authorities to advise them and general practitioners on the optimum use of the drug budget is described and their potential role for involvement in audit is discussed. The particular advantages that pharmacists in hospital and health authorities have in developing the specific aspect of clinical audit related to medicines usage (drug utilization review) is then described. The potential for pharmacists to contribute to clinical and management audit is discussed.
Community Pharmacy Services↗
Audit on the management of epididymo-orchitis by the Department of Urology in Edinburgh.
Epididymo-orchitis among men younger than 35 years is mainly caused by chlamydial infection. National guidelines for the management of this condition have been published. The aim of this study was to audit the management of epididymo-orchitis in a major teaching hospital. To this end we performed a retrospective study of patients with epididymo-orchitis admitted to the Department of Urology in the Western General Hospital, Edinburgh between 1998 and 2003. Case-notes of 108 cases of epididymo-orchitis were reviewed. The diagnosis was established by ultrasound in 94% of cases. Patients were not tested routinely for chlamydial infection and the majority of men younger than 35 years were treated inappropriately with ciprofloxacin. The management of patients younger than 35 years was not in accordance with the recommendations of national guidelines. Chlamydia trachomatis is sexually transmissible and is not responsive to ciprofloxacin. As a result of this audit, each patient will be tested for chlamydial infection and men younger than 35 years will be treated with ofloxacin. Sexual partners of patients with chlamydial infection will be treated in the department of genitourinary medicine.
Adult↗
Audit of catheter management provided by District Nurses and Continence Advisors.
District Nurses and Continence Advisors were surveyed by post to audit their management of long-term indwelling catheters. They were asked to outline, anonymously, their management strategies in response to common specified catheter-related problems. The responses to each question were graded for the appropriateness of strategy from A (best) to E (worst) by previously formulated criteria. Completed questionnaires were returned from all 10 Welsh Continence Advisors and 73 of 139 (53%) District Nurses in South Glamorgan regularly involved in catheter care. A greater proportion of Continence Advisors' than District Nurses' responses were graded A or B in all problem areas specified. In patients with marked bacteriuria, 60% of Continence Advisors but only 11% of District Nurses would assess whether the patient was ill; 53% of District Nurses would treat with antibiotics without such assessment. Whereas most nurses investigating suprapubic pain would consider catheter blockage, only one-third would consider further history taking or examination, and only 1 District Nurse considered constipation or detrusor spasm. Although two-thirds of nurses sometimes used bladder washouts, few considered them effective and most were aware of the potential risks. Thus wide variations were found in the community nursing management of indwelling catheters and care may frequently be suboptimal. Appropriate management guidelines should be developed and disseminated.
Bacteriuria↗
Quantitative exposure assessment for confinement of maize biogenic systems.
The development of transgenic crops as production platforms for biogenic agents will largely depend on the success of efforts to confine the genes and their expressed proteins in field environments. We have used quantitative exposure assessment to evaluate how management practices affect materials escape due to outcrossing by pollen flow or grain loss during harvest operations. Specifically, we study the use of maize to produce biogenic agents within field-confined systems. Decision trees representing simplified schemes of fully conforming (designed to comply with current regulatory standards for field confined trials), partially conforming, and non-conforming management practices were developed. Exemplifying assumptions and published data for conformance and material fate probabilities were used in Monte Carlo simulations to forecast materials escape by pollen outcrossing and harvest operations from a 1 ha source field. Deterministic analyses showed fully conforming confinement management restricted materials loss to low levels (for this example, outcrossing produced <1 in 10(6) kernels in receptor fields). The corresponding high-end (90th percentile) probabilistic result was 16- and 4333-fold higher (relative to deterministic outcrossing = 1) for outcrossing and harvest loss, respectively. For partially conforming practice, high-end outcrossing ranged from 100- to >15000-fold over the base result in receptor fields, and harvest loss was >10000-fold over the base result. For non-conforming practice, high-end outcrossing produced >15000-fold greater kernels in receptor fields and high-end harvest loss was at least 19000-fold greater. Deterministic estimates of off-field loss by machine transfer are as much as 30000-fold higher for non-conforming operations relative to the base case of pollen outcrossing. Better knowledge of failure frequencies for confinement management practices, improved physical models of materials flows, refined analysis of confinement loss probabilities using quantitative tools, and decision analysis to improve and audit management system performance are all needed to extend understanding of confinement integrity beyond the exemplifying case used here.
Agriculture↗
Are doctors still failing to assess and treat asthma attacks? An audit of the management of acute attacks in a health district.
This audit aimed to observe the management of acute asthma by primary and secondary care within a Health District. Asthma attacks occurring during the first 6 weeks of 1996 to patients between the ages of 3 and 74 years in Canterbury and Thanet District were notified by general practitioners, out-of-hours co-operatives and hospitals. Data were obtained retrospectively from the patient records. A total of 378 episodes was registered: 342 (90%) to primary care. Of these 234 (76% of patients aged 6 years or over) had a peak flow recorded; 114 (30%) were given emergency bronchodilation: oxygen was not used in primary care; 204 (54%) were given systemic steroids; and 43 (11%) were referred for hospital care of whom 36 were admitted. Of the attacks, 212 (69% of the patients aged 6 years or over) could be classified by percentage predicted peak flow and management compared to the Guidelines published by the British Thoracic Society. Twenty-eight patients presented with 'life-threatening' asthma: 20 (71%) were given emergency bronchodilation; oxygen was used in only two; 24 (86%) were given systemic steroids; and six (21%) were referred for admission. In their confidential enquiry into the asthma deaths the British Thoracic Society identified a failure to appreciate the severity of the attack, resulting in inadequate emergency treatment and delay in referring to hospital. These data suggest that, 15 years later, these problems may still exist.
Acute Disease↗
Comparison of AIHA ISO 9001-based occupational health and safety management system guidance document with a manufacturer's occupational health and safety assessment instrument.
Numerous manufacturing and service organizations have integrated or are considering integration of their respective occupational health and safety management and audit systems into the International Organization for Standardization-based (ISO) audit-driven Quality Management Systems (ISO 9000) or Environmental Management Systems (ISO 14000) models. Companies considering one of these options will likely need to identify and evaluate several key factors before embarking on such efforts. The purpose of this article is to identify and address the key factors through a case study approach. Qualitative and quantitative comparisons of the key features of the American Industrial Hygiene Association ISO-9001 harmonized Occupational Health and Safety Management System with The Goodyear Tire & Rubber Co. management and audit system were conducted. The comparisons showed that the two management systems and their respective audit protocols, although structured differently, were not substantially statistically dissimilar in content. The authors recommend that future studies continue to evaluate the advantages and disadvantages of various audit protocols. Ideally, these studies would identify those audit outcome measures that can be reliably correlated with health and safety performance.
Environmental Monitoring↗
National audit of the management of injured patients in 20 Scottish hospitals.
The Scottish Trauma Audit Group was established in 1991 to observe and improve the management of seriously injured patients in four Scottish teaching hospitals. There are currently 25 hospitals contributing to the national database. This prospective audit monitors the management of approximately 98% of seriously injured patients in Scotland. This report presents an analysis of the management of 23479 patients who were admitted to hospital for at least three days or who died in hospital as a result of their injuries. The audit has specifically addressed the concerns raised by the working party of the Royal College of Surgeons in 1988 and the National Audit Office in 1992. National standards were agreed and implemented by STAG in 1997. STAG has demonstrated that 73.5% of seriously injured patients presented outwith 'normal' working hours when staffing and support services are at their lowest level. Seniority of accident and emergency doctor was associated with improved outcome in injured patients. An increase in the presence of consultants in accident and emergency medicine, anaesthetics and surgery has been demonstrated and a reduction in the mortality of seriously injured patients is evident. There was no evidence of a trimodal distribution of death as a result of injury. There has been a significant increase in the survival of seriously injured patients over the last six years from 65.3% to 75.6%. In terms of survival, the management of injured patients in Scotland is significantly better than that of the rest of the UK.
Hospital Mortality↗