Comparative Audit Research Articles

Efficacy of vertebral fracture assessments in detecting osteoporotic fractures: a comparative audit of local and ISCD criteria

Efficacy of vertebral fracture assessments in detecting osteoporotic fractures: a comparative audit of local and ISCD criteria

Transfusion sample mislabelling and wrong blood in tube in the UK: Insights from the national comparative audits of blood transfusion in 2012 and 2022.

Samples for transfusion rejected due to mislabelling can lead to harm when a patient has to be re-bled or has a transfusion or procedure delayed. Electronic labelling systems which scan the patient's identification band and generate a label at their side aim to reduce mislabelling and misidentification leading to wrong blood in tube (WBIT) errors. The 2022 National Comparative audit of sample collection aimed to compare national rates of sample mislabelling and WBIT to the 2012 audit and to examine the impact of electronic systems. All UK hospitals were invited to provide data on rejected transfusion samples and WBIT incidents in 1 month (October 2022) and were asked if they had electronic labelling. Twenty-three thousand five hundred and eighty-four rejected samples were reported by 179 sites in 1 month. The rejection rate of 4.4% represents a 47% increase compared to 2012 (2.99%). There were 92 WBIT incidents, an incidence of 1 in 5882 samples-a 45% increase compared to 1 in 8547 in 2012. Twenty-three percent of sites can print a sample label at the patient's side, up by 224%. The six sites using only electronic sample labelling had a 46.9% lower rejection rate than sites using only hand-labelling but still reported WBIT. The increase in sample rejection and WBIT may reflect pressures facing clinical staff, zero tolerance policies and the two-sample rule. A human factors approach to understanding and tackling underlying reasons locally is recommended. Electronic systems are associated with fewer labelling errors, but careful implementation and training is needed to maximise their safety benefits.

The impact of sedation on the quality of initial skeletal surveys performed for suspected physical abuse in children: a comparative two-centre audit

The impact of sedation on the quality of initial skeletal surveys performed for suspected physical abuse in children is not known. To assess whether sedation influenced the number of, reason for and effective dose of repeat radiographs obtained as part of initial skeletal surveys, and their mean examination times. One hundred consecutive antemortem initial skeletal survey examinations performed for suspected physical abuse in children <2 years were retrieved from two tertiary paediatric hospitals: Centre 1, where sedation is not used for initial skeletal survey imaging; and Centre 2, where sedation is used routinely. In total, 4055 radiographic projections were performed, of which 93 (2.3%) were repeats. Comparing centres, there was a significant difference in the total number of repeats (P=0.001) and the number of repeats in children aged <12 months (P=0.008). Mean examination times were significantly shorter in unsedated children (P=0.005), even after outliers were excluded (P=0.002). There was no significant difference between the number of routine projections (P=0.587), incompletely imaged body parts (P=0.254), rotation/suboptimal positioning (P=0.527), repeats in children aged >12 months (P=0.089), routine projections in children aged <12 months (P=0.642) or >12 months (P=0.979) or the effective doses of repeats (P=0.286). There were fewer repeat projections in sedated children and those aged <12 months but examination times were significantly longer. There was no difference in the effective doses of repeated projections. The routine use of sedation is not supported when performing skeletal survey imaging if the primary considerations are reducing radiation dose and examination time.

A realist synthesis of multicentre comparative audit implementation: exploring what works and in which healthcare contexts

BackgroundMulticentre comparative clinical audits have the potential to improve patient care, allow benchmarking and inform resource allocation. However, implementing effective and sustainable large-scale audit can be difficult within busy and...

The Impact of Gender on In-Hospital Outcome after Elective Percutaneous Coronary Intervention: A Comparative Single Center Audit

The Impact of Gender on In-Hospital Outcome after Elective Percutaneous Coronary Intervention: A Comparative Single Center Audit

Men's satisfaction with female/unisex and male incontinence pads: a comparative clinical audit.

Urinary incontinence is a common and impactful condition. Despite the availability of incontinence pads specifically designed for the male form, many men use pads designed to fit the female anatomy. This clinical audit-based study compares female/unisex and male incontinence pads in male community patients with urinary incontinence. A survey was used to collect Likert-scale data on overall satisfaction and satisfaction with specific aspects of female/unisex and male incontinence pads, as well as with their health and wellbeing and situation and attitudes before and after intervention. Qualitative data were collected on positive features of, reasons for dissatisfaction with and suggested changes to each pad. Among 18 participants, and in all but one domain, satisfaction scores were higher for male pads overall, with the greatest increases in score (1-5) for physical coverage of genital area (1.5), ability to hold urine without leaks (1.4) and level of comfort when wet (1.3). Using a male pad had a positive impact on participants' sense of health and wellbeing. Positive qualitative feedback focused on comfort, ease of use and reliability, as well as the anatomical fit of the male pad. Sex-specific fit is an important factor in the acceptability of an incontinence pad for men with urinary incontinence. Wearing pads specifically designed for the male anatomy provides men with a greater sense of comfort and confidence.

Men's satisfaction with female/unisex and male incontinence pads: a comparative clinical audit.

Urinary incontinence is a common and impactful condition. Despite the availability of incontinence pads specifically designed for the male form, many men use pads designed to fit the female anatomy. This clinical audit-based study compares female/unisex and male incontinence pads in male community patients with urinary incontinence. A survey was used to collect Likert-scale data on overall satisfaction and satisfaction with specific aspects of female/unisex and male incontinence pads, as well as with their health and wellbeing and situation and attitudes before and after intervention. Qualitative data were collected on positive features of, reasons for dissatisfaction with and suggested changes to each pad. Among 18 participants, and in all but one domain, satisfaction scores were higher for male pads overall, with the greatest increases in score (1-5) for physical coverage of genital area (1.5), ability to hold urine without leaks (1.4) and level of comfort when wet (1.3). Using a male pad had a positive impact on participants' sense of health and wellbeing. Positive qualitative feedback focused on comfort, ease of use and reliability, as well as the anatomical fit of the male pad. Sex-specific fit is an important factor in the acceptability of an incontinence pad for men with urinary incontinence. Wearing pads specifically designed for the male anatomy provides men with a greater sense of comfort and confidence.

Validation of the APACHE IV Score for ICU Mortality Prediction in Dr. Sardjito Hospital During the Pandemic Era

Introduction: ICU service quality must continuously improve to provide better patient service. One of these improvement efforts is the use of a risk prediction system to predict mortality rates in the ICU by utilizing risk factors. This system helps healthcare services perform evaluations and comparative audits of intensive services, which can also aid with more targeted planning. APACHE IV is considered to have good validity. However, its predictive capabilities may change over time due to various factors, such as the pandemic, where changes in the case mix may affect its predictive abilities. Therefore, this research tests the validity of APACHE IV on the Indonesian population through Dr. Sardjito Hospital patients. The findings can be utilized for future use and risk stratification, and ICU quality benchmarking. Objectives: This study aims to assess the validity of the APACHE IV score in ICU Mortality prediction in Dr. Sardjito Hospital for medical patients, surgical patients, and patients with both cases during the pandemic. Materials and Method: This study used retrospective data from 336 patients at Dr. Sardjito Hospital Yogyakarta from the 1st of January 2020 to the 31st of December 2021. All data required for calculating the APACHE IV score was collected, and the patient’s observed ICU Mortality was used. The model’s predictive validity is measured by finding the discrimination and calibration of the APACHE IV score and comparing it to the observed ICU mortality. Validation was also conducted separately for medical and surgical cases. Results: APACHE IV shows good discrimination ability in all cases (AUC-ROC 95% CI: 0.819 [0.772-0.866]) but poor calibration (p = 0.023) for mortality prediction in the ICU. For medical cases, the discrimination ability is poor but still acceptable (AUC-ROC 95% CI: 0.698 [0.614-0.782]), and in surgical cases, the discrimination ability is good (AUC-ROC 95% CI: 0.848 [0.776-0.921]). Both cases showed good calibration (p: medical = 0.569, surgical = 0.579) in predicting mortality during the pandemic. Conclusion: APACHE IV showed good discrimination but poor calibration ability for predicting mortality for all ICU patients during the pandemic era. Mortality prediction for surgical cases showed good discrimination and calibration. However, medical cases showed poor discrimination but good calibration.

The Impact of Gender on In-Hospital Outcome after Elective Percutaneous Coronary Intervention: A Comparative Single Center Audit

Background: In the literatures, there is still argument regarding whether female gender is correlated with worse outcome following percutaneous coronary intervention (PCI). In recent years, using of PCI has steadily increased in Yemen. However, the impact of gender on the clinical outcome following PCI with 2nd generation drug-eluting stents is still unknown in Yemeni patients.

Promoting health and wellbeing at health precincts: a rapid review of four built environment audit tools for assessing health precincts

Abstract In Australia, ‘health precincts’ are increasingly touted as the new innovation hub. They perform important health care functions, and often incorporate vital research and innovation roles. As such, they do not only assist patients in recovery but also promote health and wellbeing to safeguard their patients, visitors and workers. Although their functions in disease care are unquestionable, less is known about whether and how health precincts promote health and wellbeing. Over the past decade, several audit tools have been developed to assess the degrees of, first, sustainability and, more recently, health promotion of individual buildings. No comparable audit tools, however, exist that can account for the role of health promotion of multi-building and multi-functional spaces like health precincts. This paper reports on a rapid review on the suitability of four existing built environment audit tools—the Health Facility Audit Tool, health impact assessments, the WELL Building Standard checklist, and the Built Environment Assessment Tool—for assessing the promotion of health in health precincts. Twenty-six papers published in English between 2010 and 2022 were included in this rapid review, many (n = 15) of which were critical assessment of one of the four tools. Our findings show a lack of application of such tools at the precinct scale, with many instead focusing on the city or metropolitan scale (n = 7) or individual office buildings (n = 5). For each audit tool, we report on the benefits and drawbacks highlighted. We conclude with suggestions on how these audit tools may be adapted for application at health precincts.

Different platforms, different plots? The Kremlin-controlled search engine Yandex as a resource for Russia’s informational influence in Belarus during the COVID-19 pandemic

Extant research demonstrated that the algorithms of the Kremlin-controlled search engine Yandex, compared to those of its US-based counterpart Google, frequently produce results that are biased toward the interests of Russia’s ruling elites. Prior research, however, audited Yandex’s algorithms largely within Russia. In contrast, this study is the first to assess the role of Yandex’s web search algorithms as a resource for Russia’s informational influence abroad. To do so, we conduct a comparative algorithm audit of Google and Yandex in Belarus, examining the visibility and narratives of COVID-19-related conspiracy theories in their search results. By manually analysing the content of 1320 search results collected in mid-April to mid-May 2020, we find that, compared with Google, (1) Yandex retrieves significantly more conspiratorial content (2) that close to exclusively suspects US plotters to be behind the pandemic, even though the virus spread from the Chinese city of Wuhan across the globe.

Evolution of parenteral nutrition practices in a comprehensive cancer center: Comparative audits

Malnutrition affects 20% to 70% of oncology patients depending on the patient's age, type and stage of cancer. Two audits were carried out in 2016 and 2019 to evaluate the practice of Parenteral Nutrition (PN). Records of adult medical inpatients who received PN between January 1, 2018 and April 30, 2019 were retrospectively analysed. Twenty criteria were defined. We conducted a statistical analysis to compare the two audit data. Between January 1, 2018 and April 30, 2019, 86 hospitalizations with a PN prescription were analysed. Of the 69 patients, 66% were female, the mean and median age was 60 years. These were most often medical oncology patients in palliative care. Gynecological and digestive tumors were the two main tumor localization. Bowel obstruction and palliative care management were the two main reasons for hospitalization. Nutritional assessment, amount of energy prescribed, monitoring, and duration of PN remain with poor results. Our study seems to show improvements in the relevance of PN indications, the prescription, and monitoring in patients due to the computerization of prescription and training of professionals. PN remains often prescribed in exclusive palliative situations. We need to continue our improvements, particularly for the initial clinical and biological assessment, and the monitoring. It requires a referral team to improve management of patients treated with PN.

Measuring the Performance of a Training Nurse Angiographer

Background/AimsIn considering whether the new role of nurse angiographer could be developed nationally, radiation exposure was focused on as a performance indicator to demonstrate if patients were positively or negatively impacted when compared to national benchmarks. Measuring this clinical performance indicator in the first 104 training cases would provide evidence to either adapt training to ensure improved clinical performance, or allow the role to be adopted in other hospitals.MethodsA quasi-experimental, retrospective, comparative audit was statistically analysed to compare a training nurse angiographer’s dose area product and screening time against the national X-ray diagnostic reference levels, to identify whether they could consistently perform coronary angiography safely within these parameters.ResultsThis audit provided reasonably robust evidence that appropriately experienced nurses can be trained in coronary angiography safely within the national diagnostic reference levels. This provides assurance that this new role does not negatively impact patients’ procedural outcomes and that existing measures in place provide satisfactory governance. This also indicates that robust background knowledge and pre-learnt motor skills are beneficial to any operator.ConclusionsAlthough this study contributes to research within this area, further research is needed to demonstrate the scope and benefits of this nursing role to a wider healthcare population.

Regional immediate deep inferior epigastric perforator (DIEP) flap for immediate breast reconstruction: A collaborative multidisciplinary comparative audit in the information transfer in local versus regional referrals

Introduction: DIEP autologous breast reconstruction is considered the “gold” standard - maintaining good oncological outcomes, cosmesis and patient satisfaction following mastectomy. Portsmouth Hospitals University NHS Trust(PHU) has had an increase in the regional referrals with ongoing local population demand. Our aim is to ensure excellent standards for both regional and local referrals and introduce a high quality of information transfer checklist for an accelerating regional service.

Preliminary outcome of use of parenterally administered tranexamic acid during primary total knee replacement.

Perioperative blood loss and the need for blood transfusion following total knee arthroplasty (TKA) has been a source of concern for many arthroplasty surgeons and patients over the years. Tranexamic acid (TXA) is increasingly being used by surgeons in limiting perioperative blood loss and the subsequent need for transfusion during TKA. This study aims to determine the efficacy of TXA in preventing perioperative blood loss, transfusion needs of patients that underwent TKA, complications, and its financial implications of its use in our institution. The study was a clinical comparative audit of perioperative blood loss and transfusion needs in primary TKA patients. The study population was divided into two groups of equal numbers (n = 40). Group A, who did not receive perioperative TXA, had TKA prior to the adoption of TXA in our institution, whereas group B, who received TXA, had TKA after TXA was adopted. The mean postoperative hemoglobin was 9.49 g/dl for group A and 10.15 g/dl for group B (P = 0.021). The mean postoperative blood drainage was 888.25 ml for group A and 821.67 ml for group B (P = 0.397). The number of patients transfused in group A was 17 (42.5%) against 7 (17.5%) in group B. The mean postoperative transfusion volume was 270 ml and 101.25 ml for group A and B, respectively (P = 0.014). The mean total transfusion volume was 450 ml and 277 ml in group A and B, respectively (P = 0.063). The use of TXA in TKA was shown to be beneficial in our study as it resulted in a statistically significant reduction in the postoperative transfusion volumes and higher postoperative hemoglobin levels.

Comparative Audit of Batam City Information System and COVID-19 National Website

The use of Information Technology for the information center on the COVID-19 web in Batam city and the COVID-19 web in Indonesia, must be supported by IT Governance which describes the most important factors in the use of IT. In addition, the development of the internet also supports the use of computers. The data on the two websites may still not be used as the main reference data due to differences in data from the national web version and Batam City, also because the data obtained are not aligned and do not intersect, it can cause errors in reporting the data that has been collected in such a way. In this study, an Information System Audit will be carried out with the process of collecting and also evaluating evidence about the accuracy of the available information to determine the level of suitability of the information with the audit standards that have been set and express the results of the examination, based on the information system audit standards. The results of the assessment of aspects of the security system, design, navigation, mobile friendly, speed, content quality and keywords of the two websites show that it is very worthy to say that it is very good.

Where the earth is flat and 9/11 is an inside job: A comparative algorithm audit of conspiratorial information in web search results

Web search engines are important online information intermediaries that are frequently used and highly trusted by the public despite multiple evidence of their outputs being subjected to inaccuracies and biases. One form of such inaccuracy, which so far received little scholarly attention, is the presence of conspiratorial information, namely pages promoting conspiracy theories. We address this gap by conducting a comparative algorithm audit to examine the distribution of conspiratorial information in search results across five search engines: Google, Bing, DuckDuckGo, Yahoo and Yandex. Using a virtual agent-based infrastructure, we systematically collect search outputs for six conspiracy theory-related queries (“flat earth”, “new world order”, “qanon”, “9/11”, “illuminati”, “george soros”) across three locations (two in the US and one in the UK) and two waves (March and May 2021). We find that all search engines except Google consistently displayed conspiracy-promoting results and returned links to conspiracy-dedicated websites, with variations across queries. Most conspiracy-promoting results came from social media and conspiracy-dedicated websites while conspiracy-debunking information was shared by scientific websites and legacy media. These observations are consistent across different locations and time periods highlighting the possibility that some engines systematically prioritize conspiracy-promoting content.

Interventions to optimise the outputs of national clinical audits to improve the quality of health care: a multi-method study including RCT

Background National clinical audit programmes aim to improve patient care by reviewing performance against explicit standards and directing action towards areas not meeting those standards. Their impact can be improved by (1) optimising feedback content and format, (2) strengthening audit cycles and (3) embedding randomised trials evaluating different ways of delivering feedback. Objectives The objectives were to (1) develop and evaluate the effects of modifications to feedback on recipient responses, (2) identify ways of strengthening feedback cycles for two national audits and (3) explore opportunities, costs and benefits of national audit participation in a programme of trials. Design An online fractional factorial screening experiment (objective 1) and qualitative interviews (objectives 2 and 3). Setting and participants Participants were clinicians and managers involved in five national clinical audits – the National Comparative Audit of Blood Transfusions, the Paediatric Intensive Care Audit Network, the Myocardial Ischaemia National Audit Project, the Trauma Audit &amp; Research Network and the National Diabetes Audit – (objective 1); and clinicians, members of the public and researchers (objectives 2 and 3). Interventions We selected and developed six online feedback modifications through three rounds of user testing. We randomised participants to one of 32 combinations of the following recommended specific actions: comparators reinforcing desired behaviour change; multimodal feedback; minimised extraneous cognitive load for feedback recipients; short, actionable messages followed by optional detail; and incorporating ‘the patient voice’ (objective 1). Main outcome measures The outcomes were intended actions, including enactment of audit standards (primary outcome), comprehension, user experience and engagement (objective 1). Results For objective 1, the primary analysis included 638 randomised participants, of whom 566 completed the outcome questionnaire. No modification independently increased intended enactment of audit standards. Minimised cognitive load improved comprehension (+0.1; p = 0.014) and plans to bring audit findings to colleagues’ attention (+0.13, on a –3 to +3 scale; p = 0.016). We observed important cumulative synergistic and antagonistic interactions between modifications, participant role and national audit. The analysis in objective 2 included 19 interviews assessing the Trauma Audit Research Network and the National Diabetes Audit. The identified ways of strengthening audit cycles included making performance data easier to understand and guiding action planning. The analysis in objective 3 identified four conditions for effective collaboration from 31 interviews: compromise – recognising capacity and constraints; logistics – enabling data sharing, audit quality and funding; leadership – engaging local stakeholders; and relationships – agreeing shared priorities and needs. The perceived benefits of collaboration outweighed the risks. Limitations The online experiment assessed intended enactment as a predictor of actual clinical behaviour. Interviews and surveys were subject to social desirability bias. Conclusions National audit impacts may be enhanced by strengthening all aspects of feedback cycles, particularly effective feedback, and considering how different ways of reinforcing feedback act together. Future work Embedded randomised trials evaluating different ways of delivering feedback within national clinical audits are acceptable and may offer efficient, evidence-based and cumulative improvements in outcomes. Trial registration This trial is registered as ISRCTN41584028. Funding details This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 15. See the NIHR Journals Library website for further project information.

The Impact of the COVID-19 Pandemic on Hepatobiliary and Pancreatic Surgical Services in Singapore: Retrospective Quantitative Study.

BackgroundAt the height of the COVID-19 pandemic, the hepatopancreatobiliary (HPB) unit had to reorganize its surgical case volume due to the rationing of health care resources. We report on a local audit evaluating the impact of COVID-19 on the HPB unit and the HPB surgical oncology practice.ObjectiveThe aim of this study was to review the impact of the COVID-19 pandemic on the HPB unit’s elective and emergency surgical cases. The secondary aims were to investigate the impact on the HPB surgical oncology operative case volume.MethodsWe performed a comparative audit of the HPB unit surgical case volume for January-June 2019 (baseline) and 2020 (COVID-19). Elective and emergency cases performed under general anesthesia were audited. Elective cases included hernia and gallbladder operations and liver and pancreatic resections. Emergency cases included cholecystectomies and laparotomies performed for general surgical indications. We excluded endoscopies and procedures done under local anesthesia. The retrospective data collected during the 2 time periods were compared. This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000040265).ResultsThe elective surgical case volume decreased by 41.8% (351 cases in 2019 compared to 204 cases in 2020) during the COVID-19 pandemic. The number of hernia operations decreased by 63.9% (155 in 2019 compared to 56 in 2020; P<.001) and cholecystectomies decreased by 40.1% (157 in 2019 compared to 94 in 2020; P=.83). The liver and pancreatic resection volume increased by 16.7% (30 cases in 2019 compared to 35 cases in 2020; P=.004) and 111.1% (9 cases in 2019 compared to 19 cases in 2020; P=.001), respectively. The emergency surgical workload decreased by 40.9% (193 cases in 2019 compared to 114 cases in 2020). The most significant reduction in the emergency workload was observed in March (41 to 23 cases, a 43.9% reduction; P=.94), April (35 to 8 cases, a 77.1% reduction; P=.01), and May (32 to 14 cases, a 56.3% reduction; P=.39); however, only April had a statistically significant reduction in workload (P=.01).ConclusionsThe reallocation of resources due to the COVID-19 pandemic did not adversely impact elective HPB oncology work. With prudent measures in place, essential surgical services can be maintained during a pandemic.Trial RegistrationChinese Clinical Trial Registry (ChiCTR2000040265); https://tinyurl.com/ms9kpr6x

A 3-year Comparative Audit of Thyroid Nodule Ultrasound and Cytology Using TIRADS and Bethesda Scoring Systems

A 3-year Comparative Audit of Thyroid Nodule Ultrasound and Cytology Using TIRADS and Bethesda Scoring Systems