Audit Phases Research Articles

Improvement of antibiotic use in sore throat, tonsillitis and acute otitis media in Palestine: a prospective full cycle audit

Antibiotics are commonly prescribed for upper respiratory tract infections (URTIs) which are generally caused by viral pathogens and do not require antibiotics under most circumstances. Adherence to the international guidelines regarding the necessity of prescribing antibiotics and the selection of antibiotics used for these illnesses have never been reviewed in West Bank. This study was a prospective full cycle audit and re-audit done in West Bank, Palestine. Audit and re-audit phases involved short interviews. The intervention phase included surveys, oral presentations, and development of mobile/web applications. p values of < 0.05 were considered significant. A total of 297 cases were reviewed during the audit and reaudit phases. These cases included tonsillitis (56.9%), sore throat (29.6%) and acute otitis media (13.5%). Improvements in the percentages of correct antibiotics prescriptions in the reaudit phase were noticed, including + 6.5% for correct direct antibiotics prescriptions, + 44.4% for correct backup antibiotics prescriptions, and + 63.4% for correct no antibiotics prescriptions. Improvements in the percentages of prescribing the correct choice of antibiotic (+ 41.4%) and frequency, dosage and duration (+ 13.3%) were also recorded. There was inadequate adherence to the international guidelines of antibiotic prescription for URTIs indicating a possible national problem. There is an evident trend toward using the second-line antibiotics for URTI. Improvements were observed in antibiotic prescribing patterns over a four months period. Therefore, our study's improvement strategies and approaches can be extended to other disease management systems and locations.

13 Risk Documentation in Consent Form of Open Inguinal Hernia Repair

Abstract Introduction Inguinal hernia repair is amongst the most commonly performed general surgical operations. The high case load of groin repair in our hospital has the potential to have high risk of medical legal complications. The importance of discussing these potential complications with patients, allowing them to make informed decisions about their care, and clearly documenting them during the consent process, is clear. Aim We aimed to assess the quality and consistency of consent forms for open inguinal hernia repairs with emphasis on the risks being documented. Objectives Measure the compliance of Trust consent forms with (RCS) and British Hernia Society (BHS) 2016 guidelines and European Hernia Society (EHS) International guidelines for Groin Hernia Management (2019). Method Retrospective consent form analysis was carried out for all (38) open inguinal hernia repairs done during July-September 2020. The documentation of 13 pre-determined risks, was analysed, some specific to open inguinal hernia repairs, others general surgical complications. Results A total of 38 Trust consent forms were audited. Infection (100%) and bleeding (95%) were the most commonly documented risks. The documentation of chronic infection/abscess formation (5%), numbness (60%), testicular atrophy (31%) and scarring (34%) all increased compared to the two previous audit phases, the latter two significantly so. Unfortunately, many of the risks audited (8/13) showed a decrease in compliance with documentation with only two of the examined risks meeting the standard or ‘partially’ meeting it. Notably, recurrence and damage to other structures documentation dropped by over 10% (17% drop and 31% drop, respectively).

Applying Deep Learning to Audit Procedures: An Illustrative Framework

SYNOPSIS This paper aims to promote the application of deep learning to audit procedures by illustrating how the capabilities of deep learning for text understanding, speech recognition, visual recognition, and structured data analysis fit into the audit environment. Based on these four capabilities, deep learning serves two major functions in supporting audit decision making: information identification and judgment support. The paper proposes a framework for applying these two deep learning functions to a variety of audit procedures in different audit phases. An audit data warehouse of historical data can be used to construct prediction models, providing suggested actions for various audit procedures. The data warehouse will be updated and enriched with new data instances through the application of deep learning and a human auditor's corrections. Finally, the paper discusses the challenges faced by the accounting profession, regulators, and educators when it comes to applying deep learning.

Understanding of Client’s Business in Audit Practice

One of the main requirements to audit tasks according to ISA is an understanding of the business entity’s nature. The process of business scrutiny is a lengthy and labor-consuming process because, apart from obtaining information from various sources, it involves its systematization and further analysis in order to make appropriate decisions.&#x0D; The role of business knowledge during the audit of a business entity is analyzed. A list of the essential issues which solution requires the necessary knowledge of the client’s business is given, the sources of obtaining the necessary information and factors that influence the auditor’s judgments at the phase of the task acceptance are considered. The specific nature of the audit activity requires the use of professional judgment at all audit phases, which necessitates heuristic methods of information analysis. The use of heuristic methods may contain a hidden threat – errors in the auditor’s judgment that can have significant effects for the auditor’s interim conclusions and the final judgment when forming the audit opinion regarding financial reporting. The article shows examples of errors in the auditor’s judgments that may arise at task acceptance and planning phases if the entity’s business is not fully understood. The issues which solutions require understanding of the business entity nature are grouped by phase of auditing on the basis of the author’s scrutiny and the existing audit practice.&#x0D; This study will provide a more thorough auditor’s approach to selecting resources for audit, obtaining high quality data about a business entity and its analysis; it will contribute in solutionsof theoretical and practical problems related with audit planning and performance, assessment of audit evidences, decision making to achieve the goal of audit: audit quality assurance.

The Methodological Renewal of the State Audit Office of Hungary in Light of the Protection of Public Funds

The change in international standards unfolding from 2007, the independence and transparency criteria applying to supreme audit institutions and the enhanced enforcement of objectivity and professionalism requirements called for the methodological renewal of the State Audit Office. Auditing guidelines and standards define the fundamental principles and norms adhered to by the SAO, which provide the basis for the quality of its audit work and reports. These principles and norms provide the framework that enables the auditors of supreme audit institutions (SAIs) to preserve their independence and the probity of their work. The effects of the renewal apply to and are felt in some form in all audit phases and organisational levels. By developing its new, quality-driven operations and by completing its methodological renewal, the State Audit Office has become a supreme audit institution which, as a professionally indispensable constitutional organisation enjoying the trust of Hungarian citizens, can support the operation of a well-managed state.

Auditing Challenging Fair Value Measurements: Evidence from the Field

ABSTRACT Concern about effective auditing of fair value measurements (FVMs) has risen in recent decades. Building on prior interview-based and experimental research, we provide an engagement-level analysis of challenging FVMs, using quantitative and qualitative data on audit phases from risk assessment to booking adjustments. Challenging FVMs have high estimation uncertainty, high subjectivity, significant/complex assumptions, and multiple valuation techniques. Estimation uncertainty is associated with higher inherent risk assessments, which are, in turn, predictive of client problems identified during the engagement. The use of a valuation specialist by auditors, associated with higher inherent risk and client specialist use, is a key decision: procedures performed by specialists have the highest yield in identifying problems. Auditor-client discussion of an adjustment increases with problem identification and auditors' expressions of residual concern about uncertainty post-testing. However, booked audit adjustments are infrequent; the only factors explaining income-decreasing adjustments are better evidential support and breadth of problems identified.

Feasibility of early discharge strategies for neutropenic fever: outcomes of a Victorian organisational readiness assessment and pilot

Although Australian consensus guidelines support the use of ambulatory care strategies for management of adult patients with low-risk neutropenic fever (NF), few centres have successfully implemented viable programmes. To study the feasibility of an early discharge programme for adult patients with low-risk NF and assess organisational factors likely to influence successful implementation across participating Victorian hospitals. Four hospitals participated in an organisational readiness assessment preceding selection of a pilot site for programme implementation. Prospective baseline auditing of current practice (i.e. inpatient care until resolution of NF) across three hospitals preceded programme implementation and evaluation. Barriers and facilitators to successful implementation were identified. One hundred and seventeen NF episodes were evaluated during audit phases. The frequency of low-risk NF presentations eligible for early discharge was low (less than two episodes per week). The programme reduced median (interquartile range) duration of parenteral antibiotics and length of stay for eligible patients (n = 11) from 4 (4, 5) days at baseline to 1 (1, 2) day during pilot (P = 0.02) and 4.5 (4, 5) days (baseline) to 2 (1, 3) days (pilot) (P = 0.02) respectively. The proportion of ineligible patients stepped down to oral antibiotics was improved from 38% (baseline) to 67% (pilot). No patients failed ambulatory care requiring readmission into hospital. The ambulatory care strategy for management of NF proposed by Australian consensus guidelines has been successfully piloted at a single Victorian centre. Organisational readiness tools can be used to identify potential barriers to the implementation of evidence based practices in patients with NF.

Evidence from Auditors about Auditing Fair Value Measurements

Concern about effective auditing of fair value measurements (FVMs) has risen in recent decades. Building on prior interview-based and experimental research, we provide an engagement-level analysis of challenging FVMs, using quantitative and qualitative data on audit phases from risk assessment to booking adjustments. Challenging FVMs have high estimation uncertainty, high subjectivity, significant/complex assumptions, and multiple valuation techniques. Estimation uncertainty is associated with higher inherent risk assessments, which are in turn predictive of client problems identified during the engagement. The use of a valuation specialist by auditors, associated with higher inherent risk and client specialist use, is a key decision: procedures performed by specialists have the highest yield in identifying problems. Auditor-client discussion of an adjustment increases with problem identification and auditors’ expressions of residual concern about uncertainty post-testing. However, booked audit adjustments are infrequent; the only factors explaining income-decreasing adjustments are better evidential support and breadth of problems identified.

Comparison of two fall risk assessment tools (FRATs) targeting falls prevention in sub-acute care

FRATs are designed to identify both persons at high risk of falls and to allow for cost-effective targeting of fall prevention strategies. This study compares two FRATs (BHS FRAT and TNH-STRATIFY) for accuracy of predicting falls and targeting of fall prevention strategies in a sub-acute hospital. Comparisons of retrospective audit data over two periods (use of the BHS-FRAT; post TNH-STRATIFY implementation) were used in the evaluation (n=362). Inter-rater reliability of the TNH-STRATIFY was evaluated from independent assessment by two nurses for 30 sub-acute patients and using intraclass correlation coefficient (ICC2,1). Event rate (ER) and standard measures of predictive accuracy were calculated for both FRATs. The proportions of patients with documented fall prevention strategies addressing identified fall risk factors were compared between audit phases. The TNH-STRATIFY had high inter-rater reliability (ICC2,1=0.96). The BHS-FRAT and TNH-STRATIFY demonstrated poor predictive accuracy using recommended high risk cut-off scores, with low specificityER (0.07 and 0.13 respectively) and very low Youden IndexER (0.04 and 0.07 respectively), although these measures improved using modified cut-off scores. Positive and negative predictive values were moderate for the BHS-FRAT (0.51, 0.64) and TNH-STRATIFY (0.52, 0.61). The falls rate and proportion of recurrent fallers did not change between audit phases. Implementation rates for prevention strategies for key risk factors were higher following implementation of the TNH-STRATIFY. The results indicated that the TNH-STRATIFY, combined with associated nursing care plan falls documentation, improved the targeting of prevention strategies for key risk factors such as cognitive impairment, incontinence and mobility impairment.

INTEGRATING ANALYTICAL PROCEDURES INTO THE CONTINUOUS AUDIT ENVIRONMENT

The objective of this article is to show how to embed analytical procedures (AP) into the continuous audit environment. The audit environment is discussed in terms of audit phases, where the role of APs is to obtain evidence for auditors. The article addresses different characteristics of AP techniques. Furthermore, the article compares four different AP techniques to form expectations for the monthly sales values. Two of these techniques are simple quantitative ones, such as the previous year’s value and the mean of the previous years’ values. The advanced quantitative techniques are regression analysis and an artificial neural network (ANN)-based model. In a comparison of the prediction results, the regression analysis and ANN model turn out to be equally good. The development of these kinds of tools is crucial to the continuous audit environment, especially when most data transmission between companies and their stakeholders are moved into the electronic form.

Psychological Characteristics Contributing to Expertise in Audit Judgment

Prior research has sought a better understanding of the relation between audit expertise and judgment of auditors. The motivation for this study is derived from the need to further understand psychological characteristics contributing to audit expertise. This paper adopts part of a framework derived from the decision‐making literature in psychology and applies it to auditing. Shanteau proposes that expert decision makers inherently possess 14 psychological characteristics. The importance of these characteristics is assessed using the perceptions of 55 practising auditors from three national accounting firms in Australia within and across four phases of the audit using a survey instrument. The results indicate that each of the 14 characteristics is important across all four phases of the audit in varying degrees. In addition, the degree of importance varies across characteristics and between audit phases. These findings indicate that psychological characteristics are associated with audit expertise to be applied and tested in future research.

An Analysis of Cross-Sectional Differences in Big and Non-Big Public Accounting Firms' Audit Programs

A significant body of prior research has shown that audits by the Big 5 (now Big 4) public accounting firms are quality differentiated relative to non-Big 5 audits. This result can be derived analytically by assuming that Big 5 and non-Big 5 firms face different loss functions for “audit failures” and is consistent with a variety of empirical evidence from studies of audit fees, auditor changes, and the stock price reaction to audited earnings. However, there is no existing evidence (of which we are aware) concerning the underlying production differences between Big 5 and non-Big 5 audits. As a result, existing empirical evidence cannot distinguish between the possibility that Big 5 audits are simply perceived to be different (e.g., by investors) or actually differ in how they are produced. Our research objective is to identify the production characteristics of audit engagements that may explain the differences in expected audit quality between Big 5 and non-Big 5 firms. In this archival study, we examine the total audit effort and the allocation of effort to four audit phases—planning, (control) risk assessment, substantive testing, and completion—for a cross-section sample of 113 audits of Dutch companies in 1998/99 by 14 public accounting firms. We find that, after controlling for client characteristics: (1) both types of auditors exert about the same amount of total audit effort; (2) Big 5 auditors allocate relatively more effort to planning and (control) risk assessment, and relatively less to substantive testing and completion; and (3) client size, use of the business-risk-based audit approach, and reliance on client internal controls affect audit hours differently for the two auditor types. We conclude that the Big 5 firms actually produce a higher audit quality level, and that this quality difference is related to how audit hours are deployed in a more contextual and less procedural audit approach.

Optimization of biometry for intraocular lens implantation using the Zeiss IOLMaster

To compare the accuracy of biometry using conventional A-scan ultrasonography and partial coherence interferometry, and to improve the accuracy of biometry by sequential audit of postoperative refractive error. The study was performed in three phases. In phase 1, 20 consecutive patients undergoing routine phacoemulsification underwent biometry using both A-scan ultrasonography and the Zeiss IOLMaster (ZIOLM). A single experienced optometrist refracted all patients 2 weeks after surgery. The errors between expected and achieved refraction were calculated and compared between the two methods. In phases 2 and 3, a further 22 and 20 patients, respectively, were recruited and only the ZIOLM was used for biometry. The manufacturer's suggested A-constant was refined and the error between expected and achieved refraction was calculated. In phase 1, the median unexpected error for the ZIOLM was +0.63 (interquartile range +0.368 to +1.015) and for A-scan biometry was - 0.24 (interquartile range - 1.335 to +0.802). In phase 1 65% of patients' postoperative refractions were found to be within 1.0 D of emmetropia using the ZIOLM (55% using A-scan biometry). Refinements to the A-constant improved this to 95% by phase 3. An error was identified in IOL power estimation with the ZIOLM, when using the manufacturer's recommended A-constant (recommended and previously optimized ultrasound A-constant 118.0; ZIOLM optimized A-constant 118.6). Serial modifications to the A-constant were successful in reducing the unexpected error to well within the tolerance limits of published international standards.

Determinants of the Mix of Audit Procedures: Key Factors that Cause Auditors to Change What They Do

Our research objective is to identify characteristics of clients and of audit engagements that are associated with changes in the mix of audit procedures performed by auditors. The conceptual basis for the research is simply that profit maximizing auditors should vary the nature of procedures performed and time spent in performing procedures as marginal benefits and/or costs change. However, prior research has found that audit programs generally tend to be quite rigid. In this archival study, we examine the determinants of the number of audit hours devoted to the performance of 34 common audit procedures over four audit phases - planning, risk assessment, substantive testing, and completion - for a cross-section sample of 113 audits of Dutch companies in 1998/99 by 14 public accounting firms, including a cluster of 56 audits performed by two of the (then) international Big 5 firms. We find that the length of auditor tenure with a client increases audit hours, while a high risk of management fraud weakly increases audit hours - but without changing the mix of procedures. A high level of client pressure on audit time and fees decreases audit hours, particularly in the areas of planning and risk assessment. Use of modern, strategic systems (business risk) based audit approaches, considerably changes the mix of procedures, but these approaches are applied quite differently by Big 5 vs. non-Big 5 firms. Likewise, the degree of auditor-reliance on clients' internal controls changes the mix of procedures, but the effects are quite different for Big 5 vs. non-Big 5 firms. The joint performance of management advisory services (MAS) for an audit client results in relatively less audit time in planning and risk assessment, but does not change total audit hours, suggesting that any benefits from 'knowledge spillovers' from MAS are retained by auditors, and hence may not be detectable in total hours or in audit fees. Finally, our results are consistent with the notion that the details of audit production by Big 5 firms are both more reasonable and predictable than audits by non-Big 5 firms. This can explain why Big 5 audits are more highly valued in the marketplace.

La auditoría de la información, componente clave de la gestión estratégica de la información

This article provides a general overview of the concept of information audit as a management tool, that allows an organisation to obtain a global diagnostic on the use of information and to identify critical information according to its strategic elements, functions and the roles developed by its staff together with their related knowledge and competencies. The article places the audit within internal control practices, providing a definition of terms and explaining its scope. Audit phases are described as well as the instrumental aspects; i. e., the techniques and methodologies used as well as the advantages. Special emphasis is given to the importance of incorporating the information audit as a standard for strategically managing information assets, information functions and information services within any type of organisation.

Identification of tasks for expert systems development in auditing

THE ACCOUNTING PROFESSION has shown significant interest in research and development of Decision Support Systems (DSS) and Knowledge-based Expert Systems (KES) in recent years. Reviews of the literature (Abdolmohammadi, 1987; Messier & Hansen, 1987, 1984; O'Leary & Watkins, 1989) indicate that such efforts have centered around complex audit tasks such as analytical review procedures, statistical sampling, auditing electronic data processing centers, going concern judgments, and evaluation of pertinent controls. This is based on some research indicating that expert systems are best suited to tackle unstructured audit tasks (Abdolmohammadi, 1987). Although much time and resources have been spent on efforts to develop expert systems in auditing, these efforts do not represent a systematic approach to identification of tasks for expert system development. Instead, these efforts have been based primarily on consideration of tasks one-at-a-time. This study uses a systematic model to identify viable audit tasks for KES development. The model represents a mechanism to identify audit tasks individually, and in relation with other tasks, within each of the main phases of the audit. The model has the following components: (l) compilation of a comprehensive inventory of audit tasks; (2) organization of audit tasks into audit phases, audit parts within each phase, and audit tasks within each part; and (3) Identification of viable tasks for KES development by very experienced auditors (partners and managers) from international accounting firms that

The Development of Government Expenditure Control: The Issue and Audit Phases

The Consolidated Revenue and Audit Act of 1931 is the statutory embodiment of the principles underlying the control which the Parliament of Canada exercises over the receipt and issue of moneys from the Consolidated Revenue Fund. It is the most recent of the legislative milestones which mark the evolution of systematic control from the plodding simplicity of the methods of 1855, when the first Audit Act was passed, to the mechanized organization of the present day.Legislative financial power had been firmly established in 1878 with the appointment of an Auditor General as an officer of Parliament, to regulate the issue of moneys from the treasury and to examine and report upon the public expenditures. With wide powers of inquiry and examination, the Auditor General possessed the means to learn if legislative directions were being obeyed. Control of the issue gave him the means to deal with the misapplication of appropriations by refusing to sanction further issue. This ever-present threat, hovering as the sword of Damocles over the heads of the spending departments, was ready at the word of the Auditor to cut off the flow of money from the treasury. For fifty-three years, legislative regulation of the issue served as a more or less effective restraint on executive disobedience to parliamentary directions.