Clinical audit in hospital

1993 ◽  
Vol 101 ◽  
pp. 115-121
Author(s):  
D. A. Heath
Keyword(s):  
Computer Technology ◽  
Clinical Audit ◽  
Clinical Care ◽  
General Medicine ◽  
Case Note ◽  
Medical Audit ◽  
Specific Topic ◽  
Main Effect ◽  
Limited Support ◽  
Clinical Records

SynopsisAudit within general medicine originated from a review of patient clinical records. The main effect of such activities was to lead to an improvement of documentation and a realisation that audit could be performed amicably. Once case note reviews had been established it was usually necessary to progress to specific topic review. Such audits required more input of doctors' time, and to be performed properly needed the support of committed audit staff and limited support from computer technology.The primary aim of medical audit is to improve clinical care. Although an important component it is not the primary purpose of audit to save money.

The Effects of Questionnaire Length and Behavioral Consequences on Careless Responding

2020 ◽  
Vol 36 (2) ◽  
pp. 410-420 ◽  
Author(s):  
Anthony M. Gibson ◽  
Nathan A. Bowling
Keyword(s):  
Self Report ◽  
Randomized Experiments ◽  
High Quality ◽  
Buffering Effect ◽  
Careless Responding ◽  
Main Effect ◽  
Limited Support ◽  
Report Data ◽  
Self Report Data ◽  
Consistent Support

Abstract. The current paper reports the results of two randomized experiments designed to test the effects of questionnaire length on careless responding (CR). Both experiments also examined whether the presence of a behavioral consequence (i.e., a reward or a punishment) designed to encourage careful responding buffers the effects of questionnaire length on CR. Collectively, our two studies found (a) some support for the main effect of questionnaire length, (b) consistent support for the main effect of the consequence manipulations, and (c) very limited support for the buffering effect of the consequence manipulations. Because the advancement of many subfields of psychology rests on the availability of high-quality self-report data, further research should examine the causes and prevention of CR.

Distrust of Employers, Collectivism, and Union Efficacy

2013 ◽  
Vol 4 (4) ◽  
pp. 13-26 ◽  
Author(s):  
Jack Fiorito ◽  
Daniel G. Gallagher
Keyword(s):  
Knowledge Work ◽  
Effect Sizes ◽  
Medium Effect ◽  
Future Research ◽  
Discussion Section ◽  
Worker Attitudes ◽  
Moderator Effects ◽  
Main Effect ◽  
Limited Support ◽  
Survey Results

This study examines relations between indicators of knowledge work and worker attitudes toward employers, collective action, and union efficacy. Previous writing on these relations are used to develop hypotheses. Data are drawn from the 2009 Young Workers Survey. Results fail to show any statistically significant main effect relations between knowledge work indicators and the worker attitudes examined, despite a sample size sufficient to detect at least medium effect sizes. Further, there is very limited support for moderator effects. A discussion section discusses limitations, implications, and issues for future research.

scholarly journals Variation in clinical care associated with weekend admission and discharge in psychiatric in-patient units: retrospective case-note review

BJPsych Open ◽  
2020 ◽  
Vol 6 (5) ◽  
Author(s):  
Ryan Williams ◽  
Lorna Farquharson ◽  
Ellen Rhodes ◽  
Mary Dang ◽  
Natasha Lindsay ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Psychiatric Hospital ◽  
Depressive Disorders ◽  
Clinical Care ◽  
Case Note ◽  
Weekend Effect ◽  
Standards Of Care ◽  
Retrospective Case ◽  
Case Note Review

Background Questions have been raised regarding differences in the standards of care that patients receive when they are admitted to or discharged from in-patient units at weekends. Aims To compare the quality of care received by patients with anxiety and depressive disorders who were admitted to or discharged from psychiatric hospital at weekends with those admitted or discharged during the ‘working week’. Method Retrospective case-note review of 3795 admissions to in-patient psychiatric wards in England. Quality of care received by people with depressive or anxiety disorders was compared using multivariable regression analyses. Results In total, 795 (20.9%) patients were admitted at weekends and 157 (4.8%) were discharged at weekends. There were minimal differences in quality of care between those admitted at weekends and those admitted during the week. Patients discharged at weekends were less likely to be given sufficient notification (48 h) in advance of being discharged (OR = 0.55, 95% CI 0.39–0.78), to have a crisis plan in place (OR = 0.65, 95% CI 0.46–0.92) or to be given medication to take home (OR = 0.45, 95% CI 0.30–0.66). They were also less likely to have been assessed using a validated outcome measure (OR = 0.70, 95% CI 0.50–0.97). Conclusions There is no evidence of a ‘weekend effect’ for patients admitted to psychiatric hospital at weekends, but the quality of care offered to those who were discharged at weekends was relatively poor, highlighting the need for improvement in this area.

Antibiotic consumption and healthcare associated infection in a third level Italian hospital

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F Gori ◽  
N Vonci ◽  
A Tinturini ◽  
C Basagni ◽  
G Messina ◽  
...  
Keyword(s):  
Infection Control ◽  
Teaching Hospital ◽  
General Medicine ◽  
Venous Catheter ◽  
Antibiotic Consumption ◽  
Healthcare Associated Infection ◽  
Peripheral Venous Catheter ◽  
Control And Prevention ◽  
Medical Wards ◽  
Clinical Records

Abstract Background The extended length of stay (LoS) is one of the main causes of hospital infections (HAI), followed by an increase in antibiotics consumption. The final step is the development of multiresistant microorganisms, with a consequent increase in costs for the national healthcare system. Aim of this study is to evaluate the prevalence of HAI and to analyze ATB consumption in a teaching hospital Methods Between 17-21 June 2019 the infection control team collected the clinical records of 425 patients to perform a point of prevalence analysis (PPA). Eligible patients were hospitalized in surgical and medical wards of the teaching Hospital (615 beds) in Siena, Italy. For each patients according to guidelines of European Centers for Disease Control and Prevention (ECDC 4.2) we searched for evidence of HAI and for all indication of ATB consumption. Data were processed using Stata12 Results Overall 425 patients have been analyzed (48.24% female), mean age was 60.88 (SD 26.11) years, mean LoS 8.37 (min 1 max 86) days. Patients were admitted mostly in General Medicine wards (48.94%); 34% underwent surgery. 63.8% of patients had Peripheral Venous Catheter, 20% Central Venous Catheter and 31.06% Urinary Catheter. Twenty-nine HAI were discovered (PPA 6.82%); the higher prevalence (19.23%) was in Intensive Care Unit. LoS (OR:1.07;IC95%1.04-1.1) and devices (OR:2.17;IC95%1.39-3.37) were the two variables that significantly influenced the infection risk. Forty-six percent of all patients received ATB, the most used were third generation Cephalosporines (26,18%), followed by Penicillines (24,73%). The main use was to treat community infections (62.12%), followed by medical prophylaxis (30.81%) Conclusions PPA of HAI was 6.82%, comparable to 2017 national PPA (6.5%); prolonged LoS is probably the main cause of this result. Our analysis showed that ATB consumption was quite high, in agreement with the Italian prevalence (44.9%), but the percentage of medical prophylaxis was still high. Key messages The way to achieve the health care infection control is still long, the length of the hospitalization could be a field to be improved. High consumption of antibiotics for prophylaxis is still the main point to fight in the battle against the multiresistant microorganisms.

Improving monitoring for metabolic syndrome using audit

2011 ◽  
Vol 28 (3) ◽  
pp. i-iv ◽  
Author(s):  
Alan Murtagh ◽  
Radu Petrovici ◽  
Wendy Wong ◽  
Curtis Obadan ◽  
Olufemi Solanke ◽  
...  
Keyword(s):  
Systematic Review ◽  
Professional Competence ◽  
Clinical Audit ◽  
Clinical Care ◽  
Improve Patient Care ◽  
Medical Council ◽  
Medical Practitioners ◽  
Quality Improvement Process ◽  
Improve Patient ◽  
Explicit Criteria

Audit has been defined as “a quality improvement process that seeks to improve patient care and outcome, through systematic review of care and comparison with explicit criteria, followed by the implementation of change”. As of May 2011, under the Medical Practitioners Act 2007, doctors are legally obliged to join in professional competence schemes, following requirements set by the Medical Council. These include the obligation for doctors to conduct one clinical audit per year. In Ireland and elsewhere, audit provides an opportunity for services to create an “environment in which clinical care will flourish”.

scholarly journals A surveillance study to determine the accuracy of mild traumatic brain injury diagnosis in an emergency department: protocol for a retrospective cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016222 ◽  
Author(s):  
Ilaria Pozzato ◽  
Ian D Cameron ◽  
Susanne Meares ◽  
Annette Kifley ◽  
Kim Van Vu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Ethical Issues ◽  
Clinical Care ◽  
Local Health ◽  
South Wales ◽  
Operational Criteria ◽  
Clinical Records

IntroductionPrevious literature confirms that a mild traumatic brain injury (mTBI) may result in long-term emotional impacts and, in vulnerable subgroups, cognitive deficits. The accurate diagnosis of mTBI and its written documentation is an important first step towards providing appropriate and timely clinical care. Surveillance studies involving emergency department (ED) and hospital-based data need to be prioritised as these provide incident mTBI estimates. This project will advance existing research findings by estimating the occurrence of mTBI among those attending an ED and quantifying the accuracy of mTBI diagnoses recorded by ED staff through a comprehensive audit of ED records.Methods and analysisRetrospective chart reviews (between June 2015 and June 2016) of electronic clinical records from an ED in Sydney (New South Wales, Australia) will be conducted. The study population will include persons aged 18–65 years who attended the ED with any clinical features potentially indicative of mTBI. The WHO operational criteria for the clinical identification of mTBI cases is the presence of: (1) a Glasgow Coma Scale (GCS) of 13–15 after 30 min postinjury or on presentation to hospital; (2) one or more of the following: post-traumatic amnesia (PTA) of less than 24 hours’ duration, confusion or disorientation, a witnessed loss of consciousness for ≤30 min and/or a positive CT brain scan. We estimate that 30 000 ED attendances will be screened and that a sample size of 500 cases with mTBI will be identified during this 1-year period, which will provide reliable estimates of mTBI occurrence in the ED setting.Ethics and disseminationThe study was approved by the Northern Sydney Local Health District Ethics Committee. The committee deemed this study as low risk in terms of ethical issues. The written papers from this study will be submitted for publication in quality peer-reviewed medical and health journals. Study findings will be disseminated via presentations at national/international conferences and peer-reviewed journals.

scholarly journals Cohort profile: Prematurity Immunology in Mothers living with HIV and their infants Study (PIMS)

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e047133
Author(s):  
Thokozile R Malaba ◽  
Landon Myer ◽  
Clive Gray ◽  
Marie-Louise Newell
Keyword(s):  
Immune Responses ◽  
Birth Outcomes ◽  
Mononuclear Cells ◽  
Clinical Care ◽  
Blood Pressure Measurement ◽  
Hiv Care ◽  
Adverse Birth Outcomes ◽  
Clinical Records ◽  
Living With Hiv ◽  
The Relationship

PurposePrematurity Immunology in Mothers living with HIV and their infants Study (PIMS) is a prospective cohort study in South Africa investigating the association between antiretroviral therapy (ART) use, preterm delivery (PTD) and small-for-gestational age (SGA) live births. PIMS main hypotheses are that ART initiation in pregnancy and ART-induced hypertension are associated with PTD and SGA respectively and that reconstitution of cellular immune responses in women on ART from before pregnancy results in increases in PTD of GA infants.ParticipantsPregnant women (n=3972) aged ≥18 years regardless of HIV status recruited from 2015 to 2016 into the overall PIMS cohort (2517 HIV-negative, 1455 living with HIV). A nested cohort contained 551 women living with HIV who were ≤24 weeks’ GA on ultrasound: 261 initiated ART before pregnancy, 290 initiated during the pregnancy.Findings to dateWomen in the overall cohort were followed antenatally through to delivery using routine clinical records; further women in the nested cohort were actively followed up until 12 months post partum, with data collected on maternal health (HIV care and ART use, clinical care and intercurrent clinical history). Other procedures conducted on the nested cohort included physical examinations (anthropometry, blood pressure measurement), assessment of fetal growth (ultrasound), maternal and infant phlebotomy for storage of plasma, RNA and peripheral blood mononuclear cells, collection of delivery specimens (placenta and cord blood) and infant 12-month developmental assessment. Preliminary findings have contributed to our understanding of risk factors for adverse birth outcomes, and the relationship between pregnancy immunology, HIV/ART and adverse birth outcomes.Future plansUsing specimens collected from study participants living with HIV throughout pregnancy and first year of life, the PIMS provides a valuable platform for answering a variety of research questions focused on temporal changes of immunology markers in women whose immune status is altered by HIV infection, and how ART initiated during the pregnancy affects immune responses. The relationship between these immunological changes with adverse birth outcomes as well as possible longer-term impact of exposure to ART in fetal and early life will be explored. Additionally, further active and passive follow-up of mothers and their infants is planned at school-going age and beyond to chart growth, morbidity and development, as well as changes in family circumstances.

scholarly journals 679. Mass-Scale Post-Hurricane Sheltering of Evacuees From Hurricane Harvey: Infectious Disease Surveillance and Prevention: Dallas County, Texas, 2017

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S245-S245
Author(s):  
Wendy Chung ◽  
Kyoo Shim ◽  
James Blackwell ◽  
Joel Henderson ◽  
Meredith Stocks ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infection Control ◽  
Disease Surveillance ◽  
Communicable Disease ◽  
Clinical Care ◽  
Mass Scale ◽  
Medical Clinic ◽  
Infectious Disease Surveillance ◽  
Clinical Records ◽  
Clinic Visits

Abstract Background The record rainfall following Hurricane Harvey’s landfall along the Texas coast on August 25, 2017 caused prolonged, widespread flooding, which devastated Houston and areas along the southern Gulf Coast. With shelters in Houston at capacity, residents from adjacent affected regions were evacuated elsewhere, and Dallas received over 3,800 evacuees at a single convention center shelter. Approaches to infectious disease surveillance and prevention in this mega-shelter setting were assessed and refined during the response. Methods Teams of epidemiologists and medical students reviewed all clinical records daily from the on-site, 24/7 walk-in medical clinic, which was staffed by local volunteer physicians. Demographic data, chief complaints, and diagnosis for each patient visit were reviewed, and daily aggregate summaries of visits for potential communicable disease symptoms were compiled. An additional infection control team consisting of health department staff and volunteer hospital infection preventionists implemented aggressive infection prevention measures in the shelter and clinic. Results Of the evacuees registered at this mass-scale shelter, 92% were from counties outside of Houston and 36% were 18 years of age or younger. During the shelter’s 23 days of operation, the shelter medical clinic received a cumulative volume of 2,654 clinic visits from 1,560 evacuees. The most common reasons for clinic visits included: need for medication refills (27.2%); respiratory symptoms (18.8%); and skin-related complaints (8.6%). Isolated cases of scabies, lice, norovirus, and influenza were confirmed, with no outbreak transmission of communicable diseases reported in the shelter. Conclusion The need for acute-care medical services and resources at a central shelter location was highlighted by the high proportion (40%) of evacuees seeking care at least once at the shelter medical clinic. The 24/7 accessibility of this on-site medical clinic to evacuees additionally provided a reliable mechanism for daily syndromic surveillance for potential outbreaks of infectious disease in a large shelter. Given the challenges of mass-sheltering and provision of clinical care in non-residential structures, dedicated staffing with infection control expertise was critical in this shelter setting. Disclosures All authors: No reported disclosures.

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