Older patients with frailty and complex needs require patient-centered care. This may challenge non-geriatric staff lacking the expertise to care for these patients. Geriatric Task Force (GTF) is a Quality Improvement initiative developed to integrate geriatric principles into non-geriatric departments through interdisciplinary workplace-based learning, using Comprehensive Geriatric Assessment (CGA) as a cornerstone for the intervention. To evaluate the implementation of the GTF initiative in a vascular surgical department (VSD). The intervention utilized the Model of Improvement and followed premises for workplace-based learning to implement a structured four-phase model: preparation, analysis and planning, implementation, and evaluation during a one-year period. Staff received CGA principles training through e-learning and supervision. Identified focus areas included identification of frailty using Clinical Frailty Scale (CFS), registration of treatment plan for resuscitation and intensive care, and the use of early discharge checklists. Evaluation measures included frequency and quality of Standardized Field Input (SFI), medical record audits, surveys, and semi-structured interviews. CFS was integrated into daily routines in the ward. Registered treatment plan for resuscitation and intensive care was well implemented, with 83% of SFIs rated as high quality, whereas the preparation of discharge checklists achieved moderate adoption, 44% rating as high quality. Staff and management reported improved frailty recognition and advanced holistic care approach. The GTF initiative embedded geriatric principles into VSD, improving patient-centered care for older patients with frailty. While challenges remain, the intervention demonstrates potential for sustainable improvements in non-geriatric departments. Tailored approaches and strong collaboration are essential for successful implementation.

BackgroundThe quality of postoperative care is a critical determinant of patient safety in neurosurgery, particularly in low-resource settings. This study evaluated the quality of postoperative care in the neurosurgery department of Sylvanus Olympio University Hospital in Lomé, Togo.MethodsWe conducted a descriptive, cross-sectional study from October to December 2024, including patients who underwent neurosurgical procedures and received postoperative care in the neurosurgery ward. Data were collected using a structured checklist, medical record audits, and patient satisfaction surveys.ResultsA total of 51 patients were included (mean age: 37.1 ± 21.6 years; male-to-female ratio: 4.67). Traumatic brain injury accounted for 45% of surgical indications. Compliance with perioperative procedural standards was observed in 64.9% of cases, while only 13.7% of postoperative prescriptions adhered to standard protocols. Postoperative complications occurring during the inpatient hospital stay were observed in 13.7% of patients, and the mortality rate was 1.96%. Despite systemic shortcomings, 64.7% of patients reported overall satisfaction with their care.ConclusionSubstantial gaps remain in the application of standardized postoperative procedures, particularly in documentation and timing of care. Strengthening written protocols, enhancing staff training, and institutionalizing regular audits may improve neurosurgical outcomes in low-resource settings.

This study aims to analyze the role of the Medical Committee in improving the quality of health services at Dr. Pirngadi Hospital, Medan City. The Medical Committee plays an important role in maintaining the professionalism of medical personnel and ensuring quality medical services through medical audits, continuing education, scientific meetings, and mentoring new medical personnel. Using a qualitative descriptive method with an in-depth interview approach to informants consisting of medical staff, doctors, patients, and nurses. This study shows that the role of the Medical Committee at Dr. Pirngadi Hospital has been carried out well, especially in medical audits, although there are obstacles in implementing follow-up audit results due to limited time and facilities. The role of the Medical Committee in organizing scientific meetings and continuing education is still limited and not made a routine program, while the mentoring process (proctoring) for new medical personnel has not been well structured. Through this study, it is clear that although the Medical Committee has played a role in improving the quality of services through medical audits, there is still room for improvement, especially in terms of continuing education and proctoring new medical personnel.

Purpose Active implementation efforts are needed to reduce evidence-practice gaps in post-stroke aphasia services. One potential solution is a comprehensive toolkit incorporating evidence-based implementation tools, led by trained Change Champions. We explored the feasibility, acceptability, and potential effectiveness of a prototype toolkit to improve speech-language pathologists’ practice. Method Mixed-methods, pre-post, feasibility study within one Australian health service (n = 12 speech-language pathologists). Two Change Champions completed training then selected tools to support provision of written aphasia-friendly information for 3 months. Outcome measures included: a) Pre-post medical record audits, b) pre-post behavioural-determinants surveys, and c) post-study clinician focus groups. Data were analysed using descriptive statistics and non-parametric tests for quantitative data and content analysis for qualitative data, then integrated using a convergent interactive approach. Result Clinicians perceived the toolkit was feasible and acceptable, and highlighted the benefit of Change Champions and resources in facilitating change. Post-implementation written aphasia-friendly information provision increased by 60% (p = 0.005) and most (12/14) targeted barriers improved, suggesting the toolkit with Change Champion support had the potential to improve practice. Conclusion The champion-led implementation toolkit prototype was feasible and acceptable, improving guideline-recommended aphasia care. Result support further development of a theory-informed, tailorable implementation toolkit to improve aphasia services.

Background: Tuberculosis (TB) is a contagious disease caused by mycobacterium tuberculosis bacteria, mostly affecting lungs. It is one of the main causes of death worldwide and nearly 100% of transmission, by which 230,000 children died and 1million suffering, according to recent data of World Health Organization (WHO). Multidrug resistant (MDR) TB became a threat to health security specially in developing countries. The antibiotics used in pediatrics need to have medical audit to ensure rational use because children are at three times higher risk level to have medication error and it is crucial for medical practioners and researchers to pay attention on growing rates of antibiotic resistance.Method: Purposive observational cross-sectional study. Date and place: 01-04-2016 to 29-04-2019, Hyderabad and Jamshoro. Children of ˂16 years of age were reviewed prospectively after their clinical examination (including growth valuation), routine blood tests, chest X-ray (CXR), and two sputum samples sent for Mycobacterial tuberculosis culture and drug-susceptibility testing (DST). Result: Of 649 patients, 183 patients were male (28%) and 466 were females (72%). Age group, most prone to TB was adolescent with 87% and least affected age was neonates and infants with 0%. Majority of patients belonged to rural areas with 67%. Most prescribed combination of antibiotic was pyrazinamide+ kanamycin+ levofloxacin+ ethionamide+ cycloserine + para-aminsalicylic acid with percentage of 41.6 but many antibiotics were changed during regimen. Line of therapy was followed in 639 patients (98.5%). Most common replacement therapy was pyrazinamide+ ethambutol+ amikacin+ levofloxacin+ ethionamide+ cycloserine with 25.4% out of total replacements with p-value ˂0.01. All prescribed antibiotics were with correct dose according to guidelines. Conclusion: Ratio of MDR-TB in pediatrics is very high and preventative medicines are extremely crucial but implementation of prophylactic measures for these cases is quite low.

This study analyses the interrelationship between alleged medical malpractice, patient safety, and legal accountability through a case study of a suspected malpractice incident during a cesarean section at Bekasi Regional Public Hospital (RSUD Bekasi) in 2025. Using a juridical-normative approach combined with empirical case analysis, the research applies Donabedian’s quality of care framework and examines Indonesian legal instruments, particularly Law No. 17 of 2023 on Healthcare. Data were collected from statutory provisions, court archives, national media reports, and scholarly literature, and analysed qualitatively through normative interpretation and triangulation of legal norms, theory, and factual findings. The results indicate three key deficiencies: (1) limited implementation of standard operating procedures and informed consent; (2) weak institutional oversight and patient safety culture; and (3) slow, costly, and opaque dispute resolution mechanisms that hinder access to justice. Comparative analysis with international practices shows that Indonesia’s legal governance remains fragmented, with insufficient integration between healthcare regulation and professional accountability. The study concludes that comprehensive reform is required to strengthen patient protection through clear regulatory mechanisms, independent medical audits, and the development of a no-fault compensation system that ensures both patient rights and medical professionalism.

Dynamics and Trends Around Clinical Events in the Postanesthesia Patient Within the First Twenty-four Hours: A Quality Improvement Project.

Improving Antibiotic Administration Time in At-Risk Pediatric Populations: A Quality Improvement Project.

General Background: Hospitals provide comprehensive health services and require complete medical record documentation to ensure quality care and accreditation. Specific Background: Incomplete medical records reduce the reliability of health data and hinder administrative and insurance processes. Knowledge Gap: Limited studies have analyzed the completeness of inpatient medical records for specific diseases in Indonesian hospitals. Aims: This study aims to analyze the completeness of medical record audits for patients with Diabetes Mellitus, Gastroenteritis, and Pneumonia at Bhayangkara Pusdik Shabara Porong Hospital. Results: Quantitative analysis of 76 inpatient records (34 Diabetes Mellitus, 25 Gastroenteritis, and 17 Pneumonia) from October 2021–October 2022 revealed that the completeness of social data review was 23.7%, record evidence 30.3%, record validity 67.1%, and recording procedure 56.6%. Novelty: The study provides a disease-specific evaluation of medical record completeness using standardized criteria. Implications: Findings highlight the need for continuous audits to improve documentation accuracy, ensure compliance with accreditation standards, and support hospital administration. Highlights: Medical record audits revealed low completeness in social data and record evidence. Record validity was relatively higher but still below standard requirements. Continuous audits are essential for accreditation and service quality improvement. Keywords: Hospital, Medical Record Audit, Diabetes Mellitus, Gastroenteritis, Pneumonia

The completeness of inpatient medical records plays a vital role in ensuring the quality of healthcare services and compliance with hospital accreditation standards. This study aims to design an inpatient medical record audit application that addresses existing inefficiencies in manual audit processes at RSUD Prof. Dr. Margono Soekarjo Purwokerto. The research was conducted using the System Development Life Cycle (SDLC) with a waterfall model approach, consisting of needs analysis, system design, coding, and testing. Data collection involved observation and interviews with inpatient coding staff, which revealed several issues in the current Google Spreadsheet-based audit system, including inflexible checklists, high risk of data loss, poor synchronization, and duplicate entries. The proposed web-based application offers functional features such as multi-user login, patient data upload, dynamic checklists, open and close audit forms, and graphical audit reports. Non-functional requirements emphasize security, accessibility, simplicity, and responsiveness. User requirements focus on ease of navigation, printable reports, and support for daily work routines. The system was implemented using JavaScript and tested through black-box testing, which confirmed all functionalities performed as expected. User satisfaction was evaluated through a questionnaire distributed in the medical records department with 13 respondents, 1 department head and 12 coders, the results showed an overall satisfaction level of 92.59%. This application improves audit efficiency, reduces input errors, and supports hospital efforts to meet accreditation indicators. The findings suggest that a well-designed information system can significantly enhance the management and monitoring of medical record completeness.

The effectiveness of pembrolizumab maintenance with or without pemetrexed after induction treatment for advanced non-squamous Non-Small-Cell Lung cancer.

Background: Clinical Quality Registries (CQRs) capture clinical practice data to monitor the performance of health services against agreed standards of care. Ensuring data timeliness, completeness and reliability are challenges for CQRs, as data are prospectively collected and time sensitive. The Australian Stroke Clinical Registry (AuSCR) commenced in 2009 and includes 67 hospitals voluntarily collecting data on patients with acute stroke (at December 2024). Objective: To describe the methods used to ensure data quality in a national CQR, using the AuSCR as a case study. Method: Methods from the AuSCR were described against The Australian Framework for CQRs (2024), focusing on three operating principles for data quality: "Data collection," "Data elements" and "Ensuring data quality." Results: The AuSCR meets these principles through: (1) an online data platform to import data from primary sources and perform logic checks; (2) provision of comprehensive training, a data dictionary and user manuals for contributors; (3) medical record audits; (4) bi-annual hospital data quality reports and near real-time dashboards including data discrepancies; (5) cross-referencing data against government admissions data. Our processes extend to patient-reported follow-up data collected within 90-180 days of admission. Conclusion: Managing health information in a national CQR involves multiple methods to ensure data quality and minimise clinician data entry time. The AuSCR is an exemplar program to guide the field. Implications for health information management practice: CQRs are rapidly adopting streamlined processes to collect, manage and validate data to maximise the quality of health information for clinical practice improvement.

Environmental assessment and modification is an effective fall prevention intervention for high-risk older people, which has not yet been adopted in routine occupational therapy practice. A pilot pre-post quantitative implementation study was carried out in a regional hospital and health service, within a community-based occupational therapy service, in Queensland between 2019 and 2022, involving 279 occupational therapy medical chart audits of people aged ≥65 at high risk of falls, clinical practice observations of 9 participating occupational therapists, and 32 staff questionnaires. Occupational therapists were included as co-researchers, but there was no health consumer or community involvement in the study. Baseline fall rates were higher than anticipated, with 71% of clients sustaining ≥1 fall in the year preceding intervention and 52% sustaining ≥2 falls. Sixty per cent of people with ≥3 of the 5 identified fall risk factors died during the study period. Implementation outcomes included penetration, fidelity, acceptability, and sustainability. Penetration A fall prevention environmental assessment was provided when indicated in 80% of cases during and immediately after implementation. This increased to 97% 2 years after implementation. Fidelity When intervention was indicated, the occupational therapists delivered a high-intensity fall prevention environmental intervention, as per protocol, in 100% of cases. Acceptability Staff surveys revealed a marginal, non-statistically significant, increase in staff knowledge, attitude, confidence, and experience in fall prevention between the baseline and follow-up periods. Sustainability Medical chart audits revealed that implementation was sustained for 30 months and beyond post implementation. This project demonstrated that environmental assessment and modification was delivered per protocol, embedded in clinical practice, and sustained after implementation. Occupational therapists' precision, in determining who should receive the intervention, increased over time. The results of this pilot will inform the design of a national implementation study, which commencedin 2025. Checking an older person's home for fall risks can help lower their chances of falling by about 38%, especially if they are more likely to fall. People may be at higher risk because of how they do certain tasks, the tasks themselves, hazards in the environment, health issues, or a mix of these things. An occupational therapist does the assessment by watching the older person do daily tasks, like getting dressed or doing chores. This helps to find out what might cause a fall. The therapist then talks with the person about which activities they feel are most risky, asks for their ideas on how to stay safe, and helps them to make a plan. The therapist also checks in later to help put the plan into action. In this study, we trained therapists to do this kind of fall check. We looked at whether occupational therapists followed the training, if the right people were offered the assessment, and if it was still used after the project ended. We found that therapists did the assessments as they were trained to and with the people who needed them most. The therapists also kept doing the assessments after the project was over. This likely helped reduce falls.

In 2017, the PREDICT (Paediatric Research in Emergency Departments International Collaborative) network conducted a cluster randomised controlled trial (cRCT) at 26 Australian and New Zealand hospitals to improve bronchiolitis care. Findings demonstrated that targeted interventions significantly improved adherence with five evidence-based low-value bronchiolitis practices (no chest radiography, salbutamol, glucocorticoids, antibiotics and epinephrine) in the first 24 hours of hospitalisation (adjusted risk difference, 14.1%; 95% CI: 6.5% to 21.7%; p<0.001). During the intervention year (2017), intervention hospital (n=13) compliance was 85.1% (95% CI: 82.6% to 89.7%). This study aimed to determine if improvements in bronchiolitis management were sustained at intervention hospitals 2 years post-trial completion. International, multicentre follow-up study of hospitals in Australia and New Zealand that participated in a cRCT of de-implementation of low-value bronchiolitis practices, 1 year (2018) and 2 years (2019) post-trial completion, obtained retrospectively from medical audits. Sustainability was defined a priori as no more than a <7% decrease to any level of improvement in adherence for all five low-value practices (composite outcome) from the cRCT intervention year. Of the 26 hospitals, 11 intervention and 10 control hospitals agreed to participate in the follow-up study. Data were collected on 3299 infants with bronchiolitis 1 year (intervention and control hospitals) and 1689 infants 2 years post-trial (intervention hospitals). Adherence with no use of the five low-value practices 2 years post-trial completion was 80.9% (adjusted predicted adherence, 80.8%, 95% CI: 77.4% to 84.2%; estimated risk difference from cRCT outcome -3.9%, 95% CI: -8.6% to 0.8%) at intervention hospitals, fulfilling the a priori definition of sustainability. Targeted interventions, delivered over one bronchiolitis season, resulted in sustained improvements in bronchiolitis management in infants 2 years later. This follow-up study provides evidence for sustainability in de-implementing low-value care in bronchiolitis management. Australian and New Zealand Clinical Trials Registry No: ACTRN12621001287820.

Unveiling Bias in Distilled Artificial Intelligence Models: Ethical and Clinical Impacts on Decision-Making and Medical Auditing

Postoperative care pathways for patients following coronary artery bypass grafting surgery: An observational study.

There is a demand for regulations stating that every health service must organize a hospital management information system and be able to manage and develop SIMRS such as electronic medical records. In its implementation, there are problems in inputting SIMRS. The purpose of this Residency Activity is to find out the problems in the implementation of SIMRS at Pekanbaru Medical Center Hospital, then find the root of the problem and make a plan of action from the problem. The method of Residency activities is qualitative with observation and in-depth interviews. The results of the residency show that the priority problem in SIMRS implementation is the absence of evaluation activities in SIMRS implementation. The researcher provides a plan of action recommendation for evaluating SIMRS implementation, for example by using satisfaction surveys, conducting internal electronic medical record audits, forming a SIMRS Implementation Special Assessment Team, and developing SIMRS so that evaluating SIMRS implementation becomes easier. Keywords: Evaluation, Implementation, SIMRS

This study evaluates how well the Quality and Cost Control Team (TKMKB) can improve referral quality by reviewing and medically auditing Non-Specialist Referral Rasio (RRNS) indicators with the First Level Health Facility (FKTP). The quantitative descriptive approach compares RRNS data with Time, Age, Complication, and Comorbidity (TACC). It evaluates the appropriateness of TACC criterion selections before and after implementing the medical audit and RRNS indicator review with TACC at FKTP in Bantaeng Regency. The FKTPs that were sampled were those that met RRNS indicators at Ulugalung Health Center, Kota Health Center, and Pabentengang Health Center in Bantaeng Regency, had KBK compensation, and achieved 100% KBK for six consecutive months. The study results show that non-specialist referrals (RNS) with TACC were lower than those with RRNS TACC before the review and medical audit intervention. In Bantaeng District, 92.05% of referrals were Specialist Referrals, while 7.95% were Non-Specialist Referrals (0.92% RNS without TACC and 7.03% RNS with TACC). Additionally, following the TKMKB intervention, TACC criteria for Time were also reduced, suggesting an increase in the quality of referrals, particularly in selecting TACC criteria at FKTP in compliance with current norms and guidelines. Thus, the Branch Quality and Cost Control Team's contribution to enhancing referral quality via the medical audit and assessment of RRNS indicators with TACC at FKTP is deemed successful.

The purpose of this study was to determine if a satellite sexually transmitted infection (STI) testing clinic increased STI/blood-borne virus testing and detection in a correctional setting in Australia. A cohort study of males incarcerated in a correctional centre in Queensland, who voluntarily attended a satellite STI testing clinic over six months. Data were collected on purpose designed data collection sheets. A retrospective medical chart audit was conducted from three-months before commencement of the clinic until the end of the clinic period. Attendance rates for three-months following the clinic's completion were also considered. Attendance rates, treatment rates, time to treatment, follow-up rates, reinfection rates and client satisfaction were analysed using descriptive statistics, including program sustainability. Success of the STI clinic was evidenced by an increase in attendance rates from 32/242 (13.2%) to 242/242 (100%), pre-intervention to the intervention, respectively. Treatment rates increased from 10/242 (4.1%) to 41/242 (16.9%) pre-intervention to intervention, respectively, and an increase in time to treatment from 43.11 (Std. Dev 36.77) mean days pre-intervention to 54.62 (Std. Dev 42.06) mean days during the intervention. Follow-up rates also increased from 5/242 (2.1%) pre-intervention to 24/242 (9.9%) during the intervention. Of the 242 participants, 52 received a positive STI/diagnosis with 44 being diagnosed with hepatitis C. Satisfaction was high with a mean score of 9.7 out of 10 (Std. Dev 0.685). Attendance rates showed no significant difference three-months pre- (n = 32) to post-intervention (n = 35), however, support for the intervention has continued. Future practice should incorporate satellite STI testing clinics as weekly practice. To the best of the authors' knowledge, this is the first study to consider satellite STI testing within the corrections environment in Australia. The study uniquely showcased how the satellite STI clinic achieved increased STI testing attendance rates, treatment rates, follow-up rates and high satisfaction rates.

Healthcare institutions are under increasing pressure to deliver high-quality, patient-centered care while reducing their environmental footprint. Integrating quality and environmental management systems (ISO 9001 and ISO 14001) into a unified integrated management system (IMS) offers a potential pathway to meet these dual imperatives. This study investigates the effects of IMS implementation in three European hospitals through a comparative qualitative analysis of institutional reports, audit documentation, and performance indicators. The methodology combines a literature-informed conceptual framework with a multi-case analysis guided by four domains: environmental impact, care quality, process efficiency, and stakeholder engagement. The data were collected from institutional documentation over a six-year period (three years before and after IMS implementation), covering key indicators such as energy and water consumption, medical waste recycling, audit compliance, and patient satisfaction. The findings show that IMS adoption was associated with a 20–28% improvement in resource efficiency, increased recycling rates, and consistent gains in compliance and satisfaction metrics. These results were supported by strategic leadership, cross-functional training, and digital monitoring tools. The study concludes that IMS enhances institutional performance and sustainability while aligning healthcare operations with broader governance and policy goals. Further research is recommended to explore the long-term impacts and generalize the findings across healthcare systems.