Manual Audit Research Articles

Promoting audit transparency in higher education through an internal academic quality audit application

This study aims to design and develop a web-based application for Internal Quality Audit at Universitas Ibnu Sina, replacing the conventional audit process which is currently in use. The previous manual audit process resulted in inefficiencies and increased the risk of errors. Key challenges identified include limitations in human resources, time, and funding, as well as the low effectiveness of the audit process. In order to address these issues, the proposed information system facilitates the distribution of online checklists and document uploads, thereby expediting the verification and reporting audit results. This research adopts the System Development Life Cycle (SDLC) approach in its development, utilizing methods that include use case diagrams, activity diagrams, sequence diagrams, and database design. These methods enhance interaction and workflow within the audit team. Testing results indicate that the system functions to the expected specifications. Furthermore, this study demonstrates that implementing a web-based system can accelerate reporting, improve the structure and documentation of audits, and support efforts to enhance academic quality at the university. Implementing this system is expected to increase efficiency and accuracy in the academic quality audit process at Universitas Ibnu Sina.

High-level feature-guided attention optimized neural network for neonatal lateral ventricular dilatation prediction.

Periventricular-intraventricular hemorrhage can lead to posthemorrhagic ventricular dilatation or even posthemorrhagic hydrocephalus if not detected promptly. Sequential cranial ultrasound scans are typically used for their diagnoses. Nonetheless, manual image audit has numerous disadvantages. This study aimed to develop a predictive model utilizing modified inception (MI) and high-level feature-guided attention (HFA) modules for predicting neonatal lateral ventricular dilation via ultrasound images. The MI modules reduced input data sizes and dimensions, while the HFA modules effectively delved into semantic information through supervision from high-level feature images to low-level feature images. The process facilitated the accurate identification of dilated lateral ventricles. A total of 710 neonates, corresponding to 1420 lateral ventricles, were recruited in this study. Each lateral ventricle was captured in two images, one on the parasagittal plane and the other on the coronal plane. The combination of anterior horn width, ventricular index, thalamo-occipital distance, and ventricular height served as the gold standard. A lateral ventricle would be considered dilatated if any of these four indices exceeded its upper reference value. These lateral ventricles were randomly split into training and testing sets at a 7:3 ratio. We evaluated the validity of our proposed approach and its competitors across the coronal plane, parasagittal plane, and overall performance. We also determined the impact of subjects' baseline characteristics on the overall performance of the proposed approach. Additionally, ablation analyses were conducted to ensure the efficacy of the proposed approach. Our proposed approach achieved the largest Youden index (0.65, 95% CI: 0.58-0.72), DOR (27.11, 95% CI: 15.89-46.26), area under curves (AUC) of receiver operating characteristic curve (ROC) (0.84, 95% CI: 0.80-0.88), and AUC of precision-recall curve (PRC) (0.81, 95% CI: 0.74-0.86) in the overall performance assessment and ablation analyses. Moreover, it boasted the biggest Cramer's V values on the coronal (Cramer's V=0.488, p<0.001) and parasagittal (Cramer's V=0.713, p<0.001) planes individually. Factors such as left side, male sex, singleton birth, and vaginal delivery were positively correlated with higher performance regarding the proposed algorithm, except for the gestational age. This work provides a novel attention optimized algorithm for rapid and accurate ventricular dilatation predictions. It surpasses the traditional algorithms in terms of validity whether concerning the coronal plane, parasagittal plane, or overall performance. The overall performance of algorithms will be influenced by the baseline characteristics of populations.

Impact of Updating Surgical Instrumentation Preference Cards on Operating Room Operations

Hospital systems across the United States have implemented quality improvement initiatives designed to mitigate unnecessary waste and decrease healthcare costs that are frequently passed on to patients. One key source of waste is excess sterile instrumentation in surgical operating rooms. This quality improvement project identified waste by auditing and updating surgical instrumentation preference cards (SIPCs) for the three most common procedures at a multi-center academic health system. Unnecessary items were recorded and savings calculated using 2022 supplier price data. Forty-nine procedures were audited, resulting in changes to 111 unique SIPCs. Although this process produced significant savings for the health system, it was limited to fewer than 10% of the total cases performed. Total savings were observed at $337,007 with savings of $56,254 for open instrumentation. A manual audit of all SIPCs across the institution and regular updates has the potential to decrease instrumentation waste and annual expenditures by approximately $4 million.

Enhancing Reliability in Automated Pavement Condition Data with a Data Quality Check Approach for Highway Agencies

Automated methods have been widely used by highway agencies to collect pavement condition data. However, there are still accuracy and precision issues associated with the reliability of the existing automated data collection methods. Therefore, this research aims to develop data quality check procedures to improve the reliability of automated pavement condition data for highway agencies. The study comprises three main components: identification of data quality check indexes; establishment of data quality thresholds; and implementation of data quality check procedures. Annual pavement rating data collected by a vendor using automated technologies and manual audit data from an independent third party were utilized to develop thresholds and test the procedures. Three districts, including two urban and one rural districts in Texas, were selected for the data quality check implementation. The results indicate that the proposed procedures, along with defined indexes and thresholds, efficiently identify pavements with data quality issues at both the section level and the county level. By pinpointing problematic areas, highway agencies can allocate resources for quick quality checks, enhancing the accuracy and precision of automated pavement condition data. The study can help highway agencies enhance the accuracy and precision of automated pavement condition data, ultimately leading to improvements in their pavement conditions.

The Utility of Dot Phrases and SmartPhrases in Improving Physician Documentation of Interpreter Use.

Patients with limited English proficiency (LEP) experience significant healthcare disparities. Clinicians are responsible for using and documenting their use of certified interpreters for patient encounters when appropriate. However, the data on interpreter use documentation in the emergency department (ED) is limited and variable. We sought to assess the effects of dot phrase and SmartPhrase implementation in an adult ED on the rates of documentation of interpreter use. We conducted an anonymous survey asking emergency clinicians to self-report documentation of interpreter use. We also retrospectively reviewed documentation of interpreter- services use in ED charts at three time points: 1)pre-intervention baseline; 2)post-implementation of a clinician-driven dot phrase shortcut; and 3)post-implementation of a SmartPhrase. Most emergency clinicians reported using an interpreter "almost always" or "often." Our manual audit revealed that at baseline, interpreter use was documented in 35% of the initial clinician note, 4% of reassessments, and 0% of procedure notes; 52% of discharge instructions were written in the patients' preferred languages. After implementation of the dot phrase and SmartPhrase, respectively, rates of interpreter-use documentation improved to 43% and 97% of initial clinician notes, 9% and 6% of reassessments, and 5% and 35% of procedure notes, with 62% and 64% of discharge instructions written in the patients' preferred languages. There was a discrepancy between reported rates of interpreter use and interpreter-use documentation rates. The latter increased with the implementation of a clinician-driven dot phrase and then a SmartPhrase built into the notes. Ensuring accurate documentation of interpreter use is an impactful step in language equity for LEP patients.

Verification and Application Evaluation of Intelligent Audit Rules for The UN9000 Urine Analysis System

Objective: To apply and verify the application of intelligent audit rules for urine analysis by Cui et al. Method: A total of 1139 urine samples of hospitalized patients in Tai’an Central Hospital from September 2021 to November 2021 were randomly selected, and all samples were manually microscopic examined after the detection of the UN9000 urine analysis line. The intelligent audit rules (including the microscopic review rules and manual verification rules) were validated based on the manual microscopic examination and manual audit, and the rules were adjusted to apply to our laboratory. The laboratory turnaround time (TAT) before and after the application of intelligent audit rules was compared. Result: The microscopic review rate of intelligent rules was 25.63% (292/1139), the true positive rate, false positive rate, true negative rate, and false negative rate were 27.66% (315/1139), 6.49% (74/1139), 62.34% (710/1139) and 3.51% (40/1139), respectively. The approval consistency rate of manual verification rules was 84.92% (727/856), the approval inconsistency rate was 0% (0/856), the interception consistency rate was 12.61% (108/856), and the interception inconsistency rate was 0% (0/856). Conclusion: The intelligence audit rules for urine analysis by Cui et al. have good clinical applicability in our laboratory.

IMPLEMENTASI ALGORITMA DECISION TREE DALAM OPTIMASI PENILAIAN KINERJA OPERASIONAL

Companies nowadays derive significant benefits from adopting digital systems in their operations. Politeknik LP3I Jakarta, for example, an educational institution, has implemented digitalization to optimize operational performance assessments by auditors. Manual audit assessments consume significant time and effort. Applying intelligent algorithms, such as Decision Tree, has become key to enhancing efficiency and accuracy in decision-making during assessments. The objective of this research is to evaluate the effectiveness of operational performance assessments by identifying and addressing these issues, implementing the Decision Tree algorithm. Decision Tree, which has evolved through a series of algorithms like C5.0, is the appropriate choice as it can make decisions based on specific conditions from the input data. The Decision Tree method and C5.0 Algorithm will help in rapidly and accurately calculating assessments based on criteria. This implementation can minimize manual audit activities, save time, and improve the accuracy of operational performance evaluations. The outcome of this research is higher efficiency in the operational performance assessment process, allowing auditors to focus on strategic aspects and in-depth analysis. Thus, Politeknik LP3I Jakarta and similar institutions can experience positive impacts from technology integration in their operational management, supporting progress and enhancing the quality of educational services.

What care do people with dementia receive at the end of life? Lessons from a retrospective clinical audit of deaths in hospital and other settings

BackgroundThe need for better end-of-life care for people with dementia has been acknowledged. Existing literature suggests that people dying with dementia have less access to palliative care, yet little is known about the care provided to people with dementia at the end of life. This study aimed to establish evidence related to end-of-life care for people dying with dementia in hospital compared to other settings.MethodsA retrospective clinical audit of people who had a diagnosis of dementia and had accessed services within a local health district, who died between 2015 and 2019, was conducted. A total of 705 people were identified, and a subset of 299 people randomly selected for manual audit. Chi-square p-values were used to compare the place of death, and a t-test or non-parametric test was used to assess the significance of the difference, as appropriate. Measures of functional decline within one month of death were assessed using mixed effects logistic regression models.ResultsThe characteristics of people differed by place of death, with people who died in hospital more likely to be living at home and to not have a spouse. Less than 1 in 5 people had advance care directives or plans. Many were still being actively treated at the time of death: almost half of people who died in hospital had an investigation in their final 72 hours, less than half of people were coded as receiving palliative care at death, and more than 2 in 3 people did not get access to specialist palliative care. Declining function was associated with the terminal phase.ConclusionThis study provides novel insights for those providing end-of-life care for people with dementia. Healthcare professionals and policy makers should consider how demographic characteristics relate to the places people with dementia receive end-of-life care. The care provided to people with dementia in the last year of their life highlights the need for more support to prepare advance care documentation and timely consideration for palliative care. Changes in markers of nutritional status and function in people with advanced dementia may help with identification of terminal phases.

Validation of adult asthma case definitions for primary care sentinel surveillance.

Most asthma diagnoses and patient care take place in primary care settings. Electronic medical records (EMRs) offer an opportunity to utilize technology to improve asthma diagnosis and care. The purpose of this study was to create and validate separate case definitions for suspected and confirmed asthma in primary care EMRs, to enable surveillance, benchmarking, and quality improvement in primary care settings. The objective of this study was to develop a case definition for suspected and confirmed asthma for use in a primary care sentinel surveillance system. A single chart abstractor conducted a manual audit of 776 randomly selected patient charts from an academic primary care practice EMR in Kingston, Ontario. Following the single chart abstractor classification, a consensus on chart classification as "not asthma", "suspected asthma", or "confirmed asthma" was achieved between the abstractor, a family physician, and a respirologist using Canadian Thoracic Society (CTS) criteria. Case definition algorithms based on billing codes, clinical data elements and medications were applied to the site's Canadian Primary Care Sentinel Surveillance Network (CPCSSN) data for the same charts and compared to abstractor classifications to determine each algorithm's measurement properties. The prevalence of suspected and confirmed asthma were 7.3% (n = 54) and 2.4% (n = 18), respectively. None of the proposed case definitions could differentiate between suspected and confirmed asthma. One algorithm consisting of billing, clinical, and medication elements had the highest Youden's Index for either suspected or confirmed asthma. The algorithm had a sensitivity of 81%, a specificity of 96%, positive predictive value of 71%, negative predictive value of 98%, and a Youden's Index of 0.77 for combined suspected or confirmed asthma cases. An EMR case definition for suspected or confirmed adult asthma has been validated for use in CPCSSN. Implementation of this case definition will enable the development of a surveillance electronic tool (eTool) for adult asthma that can foster quality improvement.

Every Tube Counts: reducing extra tubes drawn in the emergency department

A common practice exists in hospitals where extra tubes of blood are collected for possible add-on testing, this practice contributes to wastage of consumables. Baseline estimates from a 5-month local...

Audit in surgical histopathology at Wadia hospitals - Study of pre-analytical, analytical, and post-analytical phase

Objectives: This audit of surgical histopathology aims to verify conformance to required processes, assess their implementation, and define the targets of quality control with appropriate changes in the existing system by evaluating pre-analytical, analytical, and post-analytical phases of histopathology. Material and Methods: This study was an observational retrospective study done over a year, from March 15, 2022 to February 28, 2023. Small biopsies, large organ resections, and second opinion samples like paraffin blocks or slides received in the surgical histopathology department were categorized as I, II and III respectively. Samples were also segregated as per the department it was received from, namely, gastroenterology, neurology, pulmonology, nephrology, orthopedics, gynepathology, and others. Manual audit was done as a pre-analytical phase including adequacy of clinical information and grossing adequacy, analytical phase to study the turn around time (TAT) and tissue section quality, and the post-analytical phase in the form of report verification, approval and dispatch, and amendment if any, were studied. Results: During this audit period, 1752 surgical histopathology samples were received of which 80% were small biopsies (category I), 19.6% were large organ resection samples (category II) and 0.4% samples were received for second opinion (category III). General pediatrics (n = 798) and Gynepathology (n = 569) were the main departments from which the samples were received. Incomplete request forms, errors in sample fixation, wrong payment/barcode were some of the pre-analytical errors. Training of staff on one to one basis was done. In the analytical phase errors such as nicks, folds or air bubbles in the mounted sample were seen. Histotechnical staff were retrained to reduce errors. In the post analytical phase, the turnaround time was achieved as per the hospital quality process indicator, feedback from cases on second opinion was received only in 25% of samples. Conclusions: In this surgical histopathology audit of 1752 samples, quality indicators were achieved as per external quality assurance system (EQAS). Remedial actions were carried out to prevent errors.

PENGGUNAAN APLIKASI E- AUDIT DALAM SISTEM INFORMASI MANAJEMEN INSPEKTORAT POLRI

This research investigates the utilization of e-audit applications in the management information system of the Indonesian National Police Inspectorate. The Inspectorate plays a crucial role in upholding the integrity and efficiency of the Republic of Indonesia Police. However, the manual audit process faces challenges in terms of accuracy, efficiency, and standardization. Therefore, the utilization of e-audit applications is seen as a potential solution to enhance the effectiveness and efficiency of the audit system.This study employs a mixed-methods approach that combines literature review, observation, interviews, and surveys. The literature review provides an understanding of the utilization of e-audit applications and management information systems in the context of the Inspectorate. Observations and interviews were conducted to observe the existing audit processes and gain direct insights from auditors and Inspectorate staff. Surveys were utilized to collect data on users' perceptions and experiences with e-audit applications. The findings indicate that the utilization of e-audit applications can enhance the efficiency, accuracy, and consistency of the audit process. E-audit applications enable process automation, accurate data collection, quick analysis, and efficient report generation. However, the implementation of e-audit applications also faces challenges such as the need for deep understanding, staff competence development, and adequate information technology infrastructure. This research contributes to understanding the role and benefits of utilizing e-audit applications in the management information system of the Inspectorate. Recommendations are provided to strengthen awareness and understanding, enhance staff competence, and overcome information technology infrastructure constraints. It is expected that the utilization of e-audit applications can improve the overall quality of internal supervision and transparency within the Indonesian National Police.

The International Society for Biological and Environmental Repositories Presents Abstracts from Its Annual Meeting

The International Society for Biological and Environmental Repositories Presents Abstracts from Its Annual Meeting

Implementation of a knowledge-based decision support system for treatment plan auditing through automation.

Independent auditing is a necessary component of a comprehensive quality assurance (QA) program and can also be utilized for continuous quality improvement (QI) in various radiotherapy processes. Two senior physicists at our institution have been performing a time intensive manual audit of cross-campus treatment plans annually, with the aim of further standardizing our planning procedures, updating policies and guidelines, and providing training opportunities of all staff members. A knowledge-based automated anomaly-detection algorithm to provide decision support and strengthen our manual retrospective plan auditing process was developed. This standardized and improved the efficiency of the assessment of our external beam radiotherapy (EBRT) treatment planning across all eight campuses of our institution. A total of 843 external beam radiotherapy plans for 721 lung patients from January 2020 to March 2021 were automatically acquired from our clinical treatment planning and management systems. From each plan, 44 parameters were automatically extracted and pre-processed. A knowledge-based anomaly detection algorithm, namely, "isolation forest" (iForest), was then applied to the plan dataset. An anomaly score was determined for each plan using recursive partitioning mechanism. Top 20 plans ranked with the highest anomaly scores for each treatment technique (2D/3D/IMRT/VMAT/SBRT) including auto-populated parameters were used to guide the manual auditing process and validated by two plan auditors. The two auditors verified that 75.6% plans with the highest iForest anomaly scores have similar concerning qualities that may lead to actionable recommendations for our planning procedures and staff training materials. The time to audit a chart was approximately 20.8 min on average when done manually and 14.0 min when done with the iForest guidance. Approximately 6.8 min were saved per chart with the iForest method. For our typical internal audit review of 250 charts annually, the total time savings are approximately 30hr per year. iForest effectively detects anomalous plans and strengthens our cross-campus manual plan auditing procedure by adding decision support and further improve standardization. Due to the use of automation, this method was efficient and will be used to establish a standard plan auditing procedure, which could occur more frequently.

Using cognitive load theory to evaluate and improve preparatory materials and study time for the flipped classroom

BackgroundPreclinical medical education is content-dense and time-constrained. Flipped classroom approaches promote durable learning, but challenges with unsatisfactory student preparation and high workload remain. Cognitive load theory defines instructional design as “efficient” if learners can master the presented concepts without cognitive overload. We created a PReparatory Evaluation Process (PREP) to systematically assess and measure improvement in the cognitive-load efficiency of preparatory materials and impact on study time (time-efficiency).MethodsWe conducted this study in a flipped, multidisciplinary course for ~ 170 first year students at Harvard Medical School using a naturalistic post-test design. For each flipped session (n = 97), we assessed cognitive load and preparatory study time by administering a 3-item PREP survey embedded within a short subject-matter quiz students completed before class. Over three years (2017–2019), we evaluated cognitive load- and time- based efficiency to guide iterative revisions of the materials by content experts. The ability of PREP to detect changes to the instructional design (sensitivity) was validated through a manual audit of the materials.ResultsThe average survey response rate was ≥ 94%. Content expertise was not required to interpret PREP data. Initially students did not necessarily allocate the most study time to the most difficult content. Over time, the iterative changes in instructional design increased the cognitive load- and time-based efficiency of preparatory materials with large effect sizes (p < .01). Furthermore, this increased the overall alignment of cognitive load with study time: students allocated more time to difficult content away from more familiar, less difficult content without increasing workload overall.ConclusionsCognitive load and time constraints are important parameters to consider when designing curricula. The PREP process is learner-centered, grounded in educational theory, and works independently of content knowledge. It can provide rich and actionable insights into instructional design of flipped classes not captured by traditional satisfaction-based evaluations.

Use of quality improvement methodology to improve care of women with hypertensive disease in pregnancy and haemorrhage in Yemen (low-income, high-insecurity setting)

This safety improvement project used quality improvement methods in a Comprehensive Emergency Obstetric and Newborn Care facility in Yemen, managed by an international humanitarian non-governmental organisation. It is responsible for...

Intent-Driven Secure System Design: Methodology and Implementation

Given the typical complexity of networked systems in terms of number of components and their interconnections, manually designing their architecture is inherently difficult, and the design process requires expert knowledge and skills. If we also consider the security requirements that networked systems must meet, the task becomes even more demanding, since the manual audit and security mitigation of the architecture are time and labor intensive. This led to research on automated system design, including ways to cover the related security aspects.In this paper we present a methodology for secure system design that uses an intent-based representation of the network service requirements as input, which is annotated with security requirements, and applies the Design Space Exploration (DSE) approach to generate the system design. Security is handled via a MITRE ATT&CK-based security knowledge base, and a set of security check functions, so that the resulting system design meets not only the functional and quantitative requirements, but also the specified security requirements. We implemented this methodology as the secure system designer SecureWeaver by extending the functionality of an existing intent-based system designer that targeted IT/NW services, named Weaver. A case study of a typical corporate network scenario is used to illustrate the feasibility of the methodology in producing a system design that mitigates the associated security threats. The performance evaluation we conducted for this scenario demonstrates that the added security check overhead does not have a significant impact on the overall performance characteristics of the framework.

Managing Audit Information with The Atlas Application (Audit Tool and Linked Archive System) As an Effort to Improve Audit Quality

The purpose of this research is to explain the information system used in assisted the audit process, is an implementation of Audit Tool and Linked Archive System (ATLAS). This study will focuss to an automated auditing process using an information system in the form of the Audit Tool and Linked Archive System (ATLAS) application. This study used a qualitative method by analyzing results and data that have been collected through interview with the auditor regarding implementation of the Audit Tool and Linked Archive System (ATLAS) at one of the Public Accounting Farms in Malang. The results show that the use of the Audit Tool and Linked Archive System (ATLAS) developed by the Ministry of Finance through the Financial Professional Development Center (PPPK) in collaboration with Indonesian Public Accountants Association (IAPI) has advantages over the manual audit process. The audit process using Computer-Based Audit Technology (TABK) helps and facilitates auditors, especially in producing audit work papers and filing processes so that it improves audit quality.

The nexus between blockchain distributed ledger technology and financial crimes

Abstract: Purpose: The study sought to uncover the effect of blockchain digital ledger technology (BCDLT) on financial crimes. The study was driven by the need to promote blockchain technology in a bid to enhance financial sanity through elimination of financial delinquency. Research methodology: The study followed a quantitative paradigm using an explanatory research design. The study targeted financial executives, senior staff members at the Zimbabwe stock exchange, bankers and officials from the financial regulators. Data was collected using a structured questionnaire. Results: The study found out that of the four independent BCDLT antecedents, manual audit costs were insignificant, whereas the other three had strong positive associations with financial crime reduction. Limitations: The study targeted a specific group of financiers; hence the results may not be universal to other excluded categories Contribution: The study significantly guides policy formulation and laws in line with the adoption of the blockchain technology in the global financial system to guard against the possibility of new forms of financial crimes that could emanate from the use of technology. Keywords: 1. Blockchain digital ledger technology 2. Financial crime 3. Financial performance

Interaction design of financial insurance products under the Era of AIoT

Abstract This study aims to explore how the insurance business can combine artificial intelligence (AI), huge data technology and good design under the ecological background of AIoT to improve the efficiency of double-entry in the insurance business and improve the user experience. It is accomplished through observation, user interview and other methods to explore user needs and distress points, comprehensive use of image and video analysis, face recognition, behaviour detection and other AI technologies. aiCore intelligent dual-recording system is proposed, which integrated mobile terminal dual-recording application and backstage quality control system. The proposed system realised the design optimisation of the whole process of intelligent dual-recording scenario combining the three functions ‘front-end intelligent dual-recording, in-process real-time quality control and post-AI quality control.’ Using in-process detection, post-review and manual final audit, the aiCore intelligent dual-recording system has significantly improved the efficiency of dual-recording, quality inspection pass rate and user experience satisfaction.