Audit Data Collection Research Articles

Research on Auditing Supply Chain Finance Business of State-owned Enterprises Based on Deep Learning

Abstract Due to the complexity and tediousness of the current audit process, the development of audit intelligence has become a general trend. In order to improve the audit quality, the study establishes an intelligent financial audit model based on audit opinion for the supply chain finance business of state-owned enterprises after analyzing the application of the audit function of deep learning, for which an audit prediction model based on the Gray Wolf Optimization Algorithm (GWO-Optimization) and the fusion of Long and Short Term Memory Network (LSTMN) is proposed. The supplier of a state-owned enterprise is selected as the research object, and the GWO-LSTM model is trained and tested by constructing the audit opinion prediction index system and data collection, comparing it with the BP neural network and support vector machine model, and combining it with the gray prediction model for predicting the audit opinion of the samples, in order to improve the model’s practical application ability. The GWO-LSTM model performs better in predicting audit opinions than the comparison models, as evidenced by the results. Its prediction and training accuracies are above 80%, and the accuracies of RMSE, MAE, and R² are finally stabilized at 0.1, 0.1, and 0.948, and the combined accuracy of prediction in practical application reaches 90%. The model in this paper can scientifically predict the audit opinion, thus improving the efficiency of the audit data analysis for the supply chain finance business of state-owned enterprises.

Clinical audit: principles and practice

Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the review of change. Aspects of the structure, process and outcome of care are selected and systematically evaluated against explicit and specific criteria. Where indicated, changes are implemented at an individual, team or service level and further monitoring is used to confirm the improvement in healthcare delivery. It is one of the six pillars of clinical governance. Clinical audit involves evaluating three key areas of healthcare delivery: structure, process and outcomes. Clinical audit became mandatory for all clinicians in the United Kingdome in 1990 as a contractual obligation, and it has fuelled evidence-based medicine. The five stages of audit are identification of an audit topic, setting standards, data collection, data analysis, and implementation of changes if necessary. Closing the audit cycle by re-auditing to reassess if implemented changes have had led to improvements. Audit could be indicated for quality assurance against local or national guidelines or because of recent adverse events or patient complaints. It should be specific, measurable, achievable, realistic (or relevant), and time bound. If no guidelines available, adoption of self-constructed standards will be necessary. Once completed, it should be shared with all stakeholders, including clinicians and management. Implementation of changes is essential, although it can be difficult. It needs a buy in and enthusiasm of all. Audit is now an important part of modern clinical practice. It drives improvement and effectiveness culture, and it is a duty we owe to our patients.

OGBN P39 Feasibility and Safety of Laparoscopic Anti-Reflux Surgery at a District General Hospital: Matching National Standards and Improving Patient Quality of Life

Abstract Background Gastro-oesophageal Reflux Disease (GORD) affects a substantial proportion of adults in the UK, with surgery offering superior short-to-medium term benefits compared to medical management alone. However, there is significant variation in surgical practice nationwide. This study aimed to assess the feasibility and safety of laparoscopic anti-reflux surgery (LARS) at a District General Hospital (DGH) by aligning outcomes with the national standards set by AUGIS (Association of Upper Gastrointestinal Surgeons). Methods Prospective data from patients who underwent LARS between May 2022 and May 2023 were collected and recorded locally as well as on the National Hiatal Surgery Register (NHSR). Pre-operative symptoms and investigations, intraoperative findings, post-operative short and medium-term outcomes, and patient-reported outcome measures (PROMs) were analyzed. Quality of life (QoL) questionnaires, administered by the NHSR, were collected at 6 months to 1 year post-surgery. AUGIS standards, including a minimum of 5 procedures per year by 2 surgeons, conversion rate below 5%, 30-day return to theatre below 5%, and 30-day readmission rate below 10%, were utilized for comparison. Results In one year, two surgeons performed 41 LARS procedures: 31 Nissen, 4 Toupet, and 2 Dor wraps, with 2 redo surgeries. Minor complications occurred in 3 patients, requiring no intervention. One surgery was converted to open due to bleeding, and hiatal repair performed. Wrap migration led to re-do after 10 months. The 30-day return to theatre rate was 0%, readmission rate 2% (n=1, unremarkable CT scan). One patient discharged as a day case, average stay 4 days. Out of 23 eligible patients, 15 completed post-op questionnaires, showing significant QoL improvement. Additionally, 55% no longer needed anti-reflux meds at 6-month follow-up. Conclusions We significantly increased the number of LARS procedures performed while meeting the national standards set by AUGIS and we observed a significant improvement in our patients' quality of life following surgery. Experienced laparoscopic Upper GI surgeons can safely and effectively offer anti-reflux surgery in a DGH setting. Our commitment to prospective data collection for audit and research purposes has been a major strength. Future objectives include further consolidation of our work and expanding the range of procedures, such as magnetic sphincter augmentation (LINX), to improve day-case rates.

P32 Assessing outpatient parenteral antimicrobial therapy (OPAT) referrals to determine number of bed days saved in secondary care

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is a safe and effective service to manage infections in patients.1 OPAT allows medical admission avoidance for stable patients and allows for early discharge for patients with ongoing IV antimicrobial therapy needs. OPAT therefore allows the optimization of hospital bed management and relieve pressures on the NHS.2 The primary aim of this audit is to determine the number of bed days saved in secondary care through early discharge and admission avoidance by the OPAT service which is completed by Cornwall Foundation Trust’s Acute Care at Home (ACAH) Team. This study did not require ethics approval. Objectives (i) To quantify the total number of bed days saved by referral to OPAT; (ii) to determine the total number of days of each IV antibiotic received by patients under the OPAT service and (iii) to compare treatment course lengths for infections being managed by the OPAT service against nationally reported data. Standards 100% of patients must be receiving IV antibiotics with an indication whilst under OPAT. 100% of patients must have an IV antibiotic dose, frequency and administration method documented. 100% of patients must have an acceptance date by the OPAT team. Methods Patients were identified from daily handover documents from the ACAH team for the period of 1 February to 28 February 2023. Data collection was obtained using the clinical recording and electronic health recording system, RiO and Maxims, and the electronic prescribing and medicine administration (EPMA) system. The number of bed days saved is calculated from the acceptance date to OPAT to the discharge date from OPAT for each patient. Results A total of 70 patients were captured during initial data gathering, of which 41 patients met the inclusion criteria for the audit. Of these 41 patients meeting the audit criteria, 21 (51.2%) patients were referred from primary care and 20 (48.9%) patients were referred from RCHT. The total sum of bed days saved was 343 days, and the total sum of OPAT treatment days was 302 days. The most prescribed antibiotic was Ceftriaxone, with 27 patients (%) receiving this antibiotic; other antibiotics included the following: Tazocin (n = 5), ertapenem (n = 5), flucloxacillin (n = 2), gentamicin (n = 1), meropenem (n = 1) and teicoplanin (n = 1). The recorded indications were recorded, and when compared with the average treatment duration for each infection type against the NORS 2015–2020 data,3 the average treatment days in this audit were within range. Conclusions These results demonstrate that the OPAT service utilized by RCHT has a significant impact on bed utilization, through reducing hospital admissions and facilitating early discharge. Course lengths are in keeping with the national reported average indicating that patients are receiving comparable course lengths to other OPAT providers; further work to compare these course lengths against national best practice would be useful. There are limitations to the results, as the number of bed days saved was capped to the end of the audit data collection period. Recommendation to improve would be to re-audit with a longer data collection time frame.

Strength in numbers: Utilization of an innovative electronic audit to enhance the completion of central line maintenance audits

Healthcare systems use auditing processes to monitor compliance with evidence-based practices. The auditing process for a bundle targeting central line-associated bloodstream infectionprevention at a large children's hospital was suboptimal. The purpose of this project was to implement a revised audit and feedback data collection process. The specific aims of the project were to evaluate(1) the number of completed audits and, (2) central line maintenance bundle compliance rates before and after implementing a new process. An innovative, electronic audit process was developed to allow data entry in real-time as central line-associated bloodstream infection prevention champions conducted audits. Data were fed into a robust electronic dashboard, allowing units to readily visualize their performance. Data was analyzed over a 52-month period (26 months pre- and post-implementation). The number of central line maintenance bundle audits significantly increased post-implementation from an average of 36 to 64 per month, P=.001. Central line maintenance bundle compliance scores also increased from an average compliance score of 76.3% to 89.3%, P=.001. Special cause variation was also noted in the statistical process control charts. This project demonstrated the effectiveness of using an electronic process to capture audit data to assist with quality improvement efforts. Other institutions may consider implementing a similar electronic audit process to capture infection prevention compliance data.

Quality of stillbirth and neonatal death audit in Malawi: A descriptive observational study

WHO developed a guideline for implementing stillbirth and neonatal death audits at healthcare facilities in 2016. Like many other poor resource countries, stillbirths and neonatal deaths rates remain high in Malawi despite implementation of audit. This paper assesses the quality of facility-based stillbirth and neonatal death audit implementation in Malawian hospitals and provides recommendations for improvement. In accordance with the WHO audit guidelines, we applied mixed methods to determine the quality of audit implementation in seven hospitals in Malawi. We reviewed hospital surveillance data; audit document forms and action plans. We sought staff perceptions and opinions through a questionnaire and interviews and observed audit meetings. Quantitative data was analysed using IBM SPSS 26.0 and presented using frequencies and proportions. Qualitative data were analysed using predefined themes in a survey guide. The frequency of audits and number of stillbirth and neonatal deaths audited varied significantly between hospitals. No hospital had national audit guidelines. Deficiencies included limited information on neonatal death audit data collection and reporting tools, incomplete documentation, lack of senior staff commitment and a blame or shame atmosphere. Audit meetings often did not start with review of ward statistics, previous minutes and follow-up as to whether previous recommendations had been implemented. Challenges in analysing audit information and recommending solutions resulted in lowquality action plans. No objective evidence was found that audit recommendations were implemented. Assessed according to WHO guidelines, audits were of low quality resulting in challenges in identifying and addressing factors contributing to mortality. We recommend regular audit implementation, with completion of audit cycles for audit to contribute to mortality reduction.

The National Audit of Primary Biliary Cholangitis (PBC) in the United Kingdom: Defining the Audit Dataset and Data Collection System.

Primary biliary cholangitis (PBC) is a debilitating chronic liver disease that progresses to cirrhosis with attendant complications in a substantial proportion of patients. It is a major cause of liver-related morbidity and mortality in the United Kingdom (UK). The British Society of Gastroenterology (BSG) published guidelines on PBC management, which included key audit standards. Therefore, we propose the first UK-wide audit of the management of PBC, sanctioned by the BSG and the British Association for Study of the Liver (BASL), to benchmark NHS trusts and health boards against these audit standards as a guide to targeted improvement in the delivery of PBC-related health care.

Effectiveness of quality clinical active audit in improving healthcare of a multispecialty hospital in a developing country.

Clinical audits enable a more responsible and patient-centric healthcare paradigm by comparing patient care processes to self-defined standard norms. The current study is a descriptive prospective observational analysis performed on data extracted from in-patient active audit files from a multispecialty hospital based in Delhi NCR, India. The files were reviewed to find out if the current documentation technique adhered to the accreditation board's audit guidelines. A random sample of 325 files among all inpatient medical records from the selected wards of the hospital was analyzed in accordance with standard protocols. The information gathered was primary in nature with 15-20 files being audited from different wards daily based on fulfillment of National Accreditation Board of Hospitals (NABH) criterion. Active audit data collection was lacking in many criteria like desired outcomes (25.2%) and others. Educating clinical staff about the necessity of accurate form recording and hospital-wide consistency of medical record keeping, providing summary of admission and discharge is vital. Utmost care should have been taken to ensure that hospital medical records are maintained in a systemic and scientific manner. There is an acute need for proper documentation to improve the quality. Active audits of this nature should be made regular to improve the standard of care over time.

Enterprise Blockchain Network Audit Mode and Application

In recent years, the continuous development of blockchain has not only spawned many emerging industries, but also changed the development mode of many original industries, but also had a certain impact on the audit work. This paper attempts to collide the unique characteristics of blockchain with the traditional online audit work. Based on the existing online audit mode of Zhiyuan technology company, this paper puts forward the idea of building a new blockchain online audit platform, which is based on four modules: blockchain technical support module, auditee basic data module, blockchain audit application service module and audit access module, Complete the four steps of audit information operation process: data collection, data preprocessing, collection of audit data and formation of audit report. Finally, it puts forward optimization suggestions for the existing blockchain online audit mode, such as improving the audit early warning mechanism, establishing a comprehensive and high-quality blockchain online audit talent training system, and improving relevant systems and laws, in order to provide reference for subsequent development and application.

Research on Audit Data Analysis and Decision Tree Algorithm for Benefit Distribution of Enterprise Financing Alliance

When traditional methods analyze the audit data of enterprise financing alliance, there are some problems, such as long algorithm modeling time and low accuracy of interest distribution algorithm of enterprise financing alliance. Therefore, this paper proposes an analysis method of interest distribution of enterprise audit data financing alliance based on the decision tree algorithm. The audit data collection process of enterprise financing alliance is given, and the continuous attributes of audit data are discretized by the C4.5 algorithm. We perform enterprise financing alliance audit data analysis, remove inconsistencies from audit data through data cleaning, and finally realize enterprise financing alliance audit data analysis based on the improved C4.5 algorithm. The experimental results show that this method can shorten the modeling time and improve the accuracy of interest distribution algorithm of enterprise financing alliance. We achieved an average accuracy of 84.7% with the C4.5 algorithm while 84.35% with NBTree.

Hidden labour: the skilful work of clinical audit data collection and its implications for secondary use of data via integrated health IT

BackgroundSecondary use of data via integrated health information technology is fundamental to many healthcare policies and processes worldwide. However, repurposing data can be problematic and little research has been undertaken into the everyday practicalities of inter-system data sharing that helps explain why this is so, especially within (as opposed to between) organisations. In response, this article reports one of the most detailed empirical examinations undertaken to date of the work involved in repurposing healthcare data for National Clinical Audits.MethodsFifty-four semi-structured, qualitative interviews were carried out with staff in five English National Health Service hospitals about their audit work, including 20 staff involved substantively with audit data collection. In addition, ethnographic observations took place on wards, in ‘back offices’ and meetings (102 h). Findings were analysed thematically and synthesised in narratives.ResultsAlthough data were available within hospital applications for secondary use in some audit fields, which could, in theory, have been auto-populated, in practice staff regularly negotiated multiple, unintegrated systems to generate audit records. This work was complex and skilful, and involved cross-checking and double data entry, often using paper forms, to assure data quality and inform quality improvements.ConclusionsIf technology is to facilitate the secondary use of healthcare data, the skilled but largely hidden labour of those who collect and recontextualise those data must be recognised. Their detailed understandings of what it takes to produce high quality data in specific contexts should inform the further development of integrated systems within organisations.

International evaluation of the Microscale Audit of Pedestrian Streetscapes (MAPS) Global instrument: comparative assessment between local and remote online observers

ObjectivesThe use of online imagery by non-local observers to conduct remote, centralized collection of streetscape audit data in international studies has the potential to enhance efficiency of collection and comparability of such data for research on built environments and health. The objectives of the study were to measure (1) the consistency in responses between local in-field observers and non-local remote online observers and (2) the reliability between in-country online observers and non-local remote online observers using the Microscale Audit of Pedestrian Streetscapes Global tool to characterize pedestrian-related features along streets in five countries.MethodsConsistency and inter-rater reliability were analyzed between local and non-local observers on a pooled database of 200 routes in five study regions (Melbourne, Australia; Ghent, Belgium; Curitiba, Brazil; Hong Kong, China; and Valencia, Spain) for microscale environmental feature subscales and item-level variables using the intraclass correlation coefficient (ICC).ResultsA local in-field versus remote online comparison had an ICC of 0.75 (95 % CI: 0.68–0.80) for the grand total score. An ICC of 0.91 (95 % CI: 0.88–0.93) was found for the local online versus remote online comparison. Positive subscales yielded stronger results in comparison to negative subscales, except for the similarly poor-performing positive aesthetics/social characteristics.ConclusionsThis study demonstrated remote audits of microscale built environments using online imagery had good reliability with local in-field audits and excellent reliability with local online audits. Results generally supported remote online environmental audits as comparable to local online audits. This identification of low-cost and efficient data acquisition methods is important for expanding research on microscale built environments and physical activity globally.

Clinical Audit cycle of Mental Health Act (MHA) documentation for patients on section 3 staying 90 days and over in adult wards at Roseberry park hospital

AimsTo complete the audit cycle on compliance of MHA documentation (including MCA1 form at admission and 3 months, T2 form, SOAD request and T3 form authorization) on patients on section 3 staying 90 days and over in adult wards at Roseberry park hospitalMethodIn the initial audit, we collected data from all inpatients on section 3 staying 90 days and over, in Adult acute and rehab wards on Roseberry park hospital between the time period 28/10/19–04/11/19. Using a designated audit data collection tool, information was gathered from each patient's electronic record pertaining to the standards. The same method was used in re-audit where data were collected from all inpatients on section 3 staying 90 days and over in Adult acute wards on Roseberry park hospital between the time period 04/11/20–11/11/20. To note, the rehab ward at Roseberry park hospital was closed in Feb 2020. The data were analysed by the project lead.ResultIn the initial audit, 16 patients records were identified as meeting criteria,out of these 7 (44%) patients were on acute wards and 9 (56%) at rehab ward. Where as in re-audit 5 patients records were identified as meeting criteria and all were on acute wards. Days in Hospital - Ranged from 120 days to 664 days, average being 295 days and median of 186 days in the initial audit compared to121 days to 290 days, average being 170 days and median of 150 days in the reaudit. Percentage of patients records with documented capacity assessment at admission and 3 months were same at 80% and 60% respectively in both audits.T2 form was completed in all consenting patients in both audits. SOAD request sent was recorded in only 1 (25%) patient in the reaudit, which was lower than the initial audit, where in SOAD request was sent in 7 (78%) patients but recorded in 5 (56%) of them. For patients lacking capacity, T3 form was documented only in 4 (45%) patients but T3 form authorisation was discussed with patient and evidenced in case notes in only 1(11%) case in the initial audit, where as in reaudit T3 form was not documented or discussed for any patient.ConclusionThere needs to be improvement in MHA documentation for detained patients.

An audit of people admitted to hospital with diabetes and coronavirus (SARS-CoV-2): data collection methods. The Association of British Clinical Diabetologists (ABCD) Nationwide Audit

We describe the rationale, aims and objectives and the methodology of data collection for the ABCD nationwide audit of individuals admitted to hospital with coronavirus (SARS-CoV-2; COVID-19) and diabetes. The audit was inspired and undertaken by the urgent need to understand the clinical course of COVID-19 in patients with diabetes admitted to hospital in the UK during the pandemic. We wished to understand the clinical behaviour of diabetes per se, post hospital admission and the factors with may be associated with admission to the Intensive Care Unit (ICU) and death due to COVID-19. This was a clinically-led audit. We used existing infrastructure and expertise to collect data using an electronic tool specifically designed and piloted by the steering group members. The clinical variables were chosen to fulfil the main aim of this audit as stated above, and factors influencing the clinical course of COVID-19 in individuals with both type 1 and type 2 diabetes at the time of admission to hospital and during the whole length of stay, until discharge or death from COVID-19. The data collected so far represent a large, multicentre audit with more than 3,500 admissions during the pandemic. We plan to continue collecting additional data and publish ongoing reports of interest to diabetes clinicians with the aim of enhancing knowledge and understanding and thereby improving clinical care of, and outcomes for, people with diabetes who are admitted to hospital with COVID-19 in the UK.

Utilization of the iOS Shortcuts App to Generate a Surgical Logbook Tool: Feasibility Study.

BackgroundSurgical audit is an essential aspect of modern reflective surgical practice and is key to improving surgical outcomes. The surgical logbook is an important method of data collection for both personal and unit audits; however, current electronic data collection tools, especially mobile apps, lack the minimum recommended data fields.ObjectiveThis feasibility study details the creation of a free, effective surgical logbook tool with the iOS Shortcuts app and investigates the time investment required to maintain a surgical logbook with this tool. In addition, we investigate the potential utility of the Shortcuts app in creating medical data collection tools.MethodsUsing the iOS Shortcuts app, we created a shortcut “Operation Note,” which collects surgical logbook data by using the minimum and extended audit data sets recommended by the Royal Australasian College of Surgeons. We practically assessed the feasibility of the tool, assessing the time requirement for entry, accuracy, and completeness of the entered data.ResultsThe shortcut collected accurate and useful data for a surgical audit. Data entry took on average 65 seconds per case for the minimum data set, and 135 seconds per case for the extended data set, with a mean difference of 68 seconds (P<.001; 95% CI 61.6-77.7).ConclusionsThis feasibility study demonstrates the utility of the iOS Shortcuts app in the creation of a surgical logbook and the time-consuming nature of data collection for surgical audit. Our iOS Operation Note shortcut is a free, rapid, and customizable alternative to currently available logbook apps and offers surgical trainees and consultants a method for recording surgical operations, complications, and demographic data.

Assessing the Feasibility of Retrospective and Prospective Clinical Audit in Farm Animal Veterinary Practice.

As a quality improvement tool, clinical audit has been extensively described in the medical literature. There is scant literature on the use of clinical audit in the farm animal veterinary setting. This study describes the process and feasibility of prospective and retrospective data collection for farm animal clinical audit performed at three different farm animal practices in the United Kingdom. Retrospective clinical audit was difficult in all three practices due to barriers in establishing diagnosis and patient identity from clinical records. Prospective data collection proved feasible but depended on adequate case accrual and practitioner engagement. The decision to conduct clinical audit retrospectively or prospectively will depend on the topic to audit, the availability of data and the wishes of the team members involved. Further work is required looking at the use of clinical coding and alternatives to using practice management software to improve retrospective data availability for clinical audit.

Development of a national stroke audit in Ireland: scoping review protocol.

Introduction Recent advances in stroke management and care have resulted in improved survival and outcomes. However, providing equitable access to acute care, rehabilitation and longer-term stroke care is challenging. Recent Irish evidence indicates variation in stroke outcomes across hospitals, and a need for continuous audit of stroke care to support quality improvement. The aim of this project is to develop a core minimum dataset for use in the new Irish National Audit of Stroke (INAS), which aims to improve the standard of stroke care in Ireland. This paper outlines the protocol for conducting a scoping review of international practice and guidelines in auditing acute and non-acute stroke care. Objective Identify data items that are currently collected by stroke audits internationally, and identify audit guidelines that exist for recommending inclusion of content in stroke audit datasets. Methods and analysis This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR). We will search the following databases: Medline Ovid; Embase; CINAHL EBSCOHost. Grey literature will also be searched for relevant materials, as will relevant websites. Study selection and review will be carried out independently by two researchers, with discrepancies resolved by a third. Data charting and synthesis will involve sub-dividing relevant sources of evidence, and synthesising data into three categories: i) acute stroke care; ii) non-acute stroke care; and iii) audit data collection procedures and resourcing. Data will be charted using a standardised form specific to each category. Consultation with knowledge users will be conducted at all stages of the scoping review. Discussion This scoping review will contribute to a larger project aimed at developing an internationally benchmarked stroke audit tool that will be used prospectively to collect data on all stroke admissions in Ireland, encompassing both acute and non-acute data items.

Opportunities to enhance ward audit: a multi-site qualitative study

BackgroundHospitals in many countries are encouraged to develop audits to assess and improve the quality of care. Ward audit is a specific form of audit and feedback that is commonly used but little studied. The aim of this study is to describe the content and application of hospital ward audit in order to identify potential enhancements to such audits.MethodsMultiple qualitative methods were used to study a diversity sample of four English National Health Service organisations over a 16-month period. We undertook semi-structured interviews (n = 32), documentary analysis (n = 44) and 25 h of observations of healthcare workers involved in the design and implementation of ward audit. Data were analysed using framework analysis. Findings were presented iteratively to stakeholders who used them to develop a description of the content and delivery of ward audit.ResultsWard audit consisted of seven stages: impetus; method; preparation of staff; assessing practice; analysis; feedback; and decide on action to improve. Two key stages were the monthly assessment of practice using case note data extraction, and the resulting feedback to clinical staff, ward managers, matrons and directors of nursing. At three organisations, the case note data were extracted by staff and there was evidence that this resulted in misrepresentation of the clinical performance audited. The misrepresentation appeared to be associated with the anticipation of punitive feedback from directors of nursing and matrons, as well as time pressures and a lack clarity about the method of audit data collection. Punitive feedback was reported to occur if no data were collected, if data demonstrated poor performance or if performance did not improve.ConclusionsOrganisations invest considerable clinical resources in ward audit, but such audits may have unintended, potentially negative, consequences due to the impacts from punitive feedback. We discuss potential enhancements to ward audit (e.g. providing feedback recipients with suggested actions for improvement) and discuss implications for theory. There is a need to reduce the use of punitive feedback.

A snapshot of chronic obstructive pulmonary disease management in general practice in Ireland

Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability. Its diagnosis, classification and management are complex. There is a paucity of data on the standard of COPD management in Irish general practice. We studied whether COPD diagnosis and management was in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. We investigated if patients who were smokers had received smoking cessation advice. We examined whether influenza and pneumococcal vaccination had been given. Ten general practices affiliated with the Irish Mid-West Specialist Training Programme in General Practice (GP) were searched, to determine which patients had a diagnosis of COPD. A data-collection audit tool was developed using GOLD 2019 guidelines. Results were tabulated in SPSS. Descriptive statistics were used. Of 482 patients studied, 91.7% were eligible for free GP care. In 49.4%, the diagnosis of COPD had been made appropriately. In 56.2%, there was no evidence that the stage of COPD had been formally assessed. Of the patients studied, 33.2% were deemed to be receiving appropriate therapy. Smoking status was documented in 99.6% of cases studied and 59.9% were ex-smokers, while 25.9% were current smokers. Appropriate smoking cessation advice had been offered to 71% of eligible patients. Influenza vaccine had been given to 66.2% in the previous 12 months. A total of 53.9% had ever received pneumococcal vaccination. This study provides a comprehensive snapshot of care in Irish general practice for patients with COPD prior to introduction of the Chronic Disease Management programme (CDM).

Automated data extraction and report analysis in computer-aided radiology audit: practice implications from post-mortem paediatric imaging

To determine local departmental adherence to the paediatric post-mortem magnetic resonance imaging (MRI) protocols, using a customised automated computational approach. A retrospective review of 460 whole-body post-mortem MRI examinations performed at Great Ormond Street Hospital for Children over a 5.5-year period was assessed for adherence to a full or abbreviated imaging sequence protocol. A simple computer program was developed to batch process DICOM (digital imaging and communications in medicine) files, extracting imaging sequence details, followed by natural language processing (NLP) of authorised reports to automate information extraction of diagnostic image quality. The program was able to extract study parameters from the entire dataset (approximately 80 GB of data) in a few hours, and retrieve information on diagnostic image quality using NLP with an overall diagnostic accuracy for data extraction of 96.7% (445/460, 95% confidence interval [CI]: 94.7-98%). The full imaging protocol was adhered to in 305/460 (66.3%) cases, and an abbreviated protocol in 140/460 (30.4%) cases. Overall, 423/460 (91.9%) of studies were of diagnostic quality. These included 298/305 (97.7%) of the full protocol, 111/140 (79.3%) of the abbreviated protocol. In only five cases were the examinations non-diagnostic for all body systems, all of whom weighed <100 g (24.7-72 g) and imaged using the abbreviated protocol. The present study demonstrated a successful application of an automated approach for data collection for audit and quality assessment purposes using paediatric post-mortem imaging as a specific example. Re-audit of these data following change implementation will be straightforward now that the automated workflow is clearly established.