National Audit Projects Research Articles

A study on the key drivers of national construction project audit risk and evolvement mechanism

PurposeChina has recently introduced a new audit law that aims to increase the scope of audit supervision and raise the standards for preventing risks in auditing national public projects. This paper presents a systematic research study on the causes of audit risks in national public projects and discusses the process by which these causes contribute to the emergence of such risks. Furthermore, the paper investigates the core risk sources in various types of national construction project audit. This paper aims to provide theoretical support for auditors of national construction projects in risk avoidance when conducting audits.Design/methodology/approachIn this study, the authors carefully selected five national public audit projects from China and performed a comprehensive analysis of 85 relevant audit documentation. The textual analysis was conducted using Nvivo12 software, and the grounded theory approach was adopted for generalization purposes.FindingsBased on the research results, the findings suggest that there are five key causes contributing to the audit risk of national construction projects: professional competence, risk awareness, management capacity, level of attention and deliberate fraud. The most critical factor identified is management capability, with 59.93% of the data supporting this view. This conclusion was based on an analysis of state-owned enterprises, administrative organs and public institutions. Building upon this, a framework titled “the mechanism of audit risk factors with management capability as the core” was constructed.Originality/valueThis paper employs qualitative analysis methods to examine national construction projects in China, contributing new literature to the theoretical study of audit risk management. The article also provides practical recommendations for auditors on how to mitigate audit risks and improve the quality of audit services in national project governance.

Patient characteristics, anaesthetic workload and techniques in the UK: an analysis from the 7th National Audit Project (NAP7) activity survey.

Detailed contemporary knowledge of the characteristics of the surgical population, national anaesthetic workload, anaesthetic techniques and behaviours are essential to monitor productivity, inform policy and direct research themes. Every 3-4 years, the Royal College of Anaesthetists, as part of its National Audit Projects (NAP), performs a snapshot activity survey in all UK hospitals delivering anaesthesia, collecting patient-level encounter data from all cases under the care of an anaesthetist. During November 2021, as part of NAP7, anaesthetists recorded details of all cases undertaken over 4 days at their site through an online survey capturing anonymous patient characteristics and anaesthetic details. Of 416 hospital sites invited to participate, 352 (85%) completed the activity survey. From these, 24,177 reports were returned, of which 24,172 (99%) were included in the final dataset. The work patterns by day of the week, time of day and surgical specialty were similar to previous NAP activity surveys. However, in non-obstetric patients, between NAP5 (2013) and NAP7 (2021) activity surveys, the estimated median age of patients increased by 2.3 years from median (IQR) of 50.5 (28.4-69.1) to 52.8 (32.1-69.2) years. The median (IQR) BMI increased from 24.9 (21.5-29.5) to 26.7 (22.3-31.7) kg.m-2 . The proportion of patients who scored as ASA physical status 1 decreased from 37% in NAP5 to 24% in NAP7. The use of total intravenous anaesthesia increased from 8% of general anaesthesia cases to 26% between NAP5 and NAP7. Some changes may reflect the impact of the COVID-19 pandemic on the anaesthetic population, though patients with confirmed COVID-19 accounted for only 149 (1%) cases. These data show a rising burden of age, obesity and comorbidity in patients requiring anaesthesia care, likely to impact UK peri-operative services significantly.

UK National Reports: Lessons for Obstetric Anaesthesia

The Confidential Enquiries into Maternal Deaths is a national programme investigating maternal deaths in the UK and Ireland and has been running since 1957. Since the inception of the report, there has been a fall in overall maternal deaths, with rates in the UK having fallen from 90 per 100,000 women giving birth in the 1950s to around 10 per 100,000 today. The National Audit Projects are a programme of investigations that study an important subject within anaesthesia, which occurs with a low incidence and is likely to have been incompletely studied previously. There have been five completed National Audit Projects to date, with the latter three providing valuable insights into the serious complications of central neuraxial blockade, airway management and accidental awareness under general anaesthesia. Recommendations from the Confidential Enquiries into Maternal Deaths and the National Audit Projects have led to substantial changes in practice and improved patient safety and outcomes in obstetric anaesthesia in the UK.

The United Kingdom National Audit Projects: a narrative review

The Royal College of Anaesthetists’ National Audit Project (NAP) programme has been running in its current form since 2006. Since NAP3 was commissioned the NAPs have examined rare but important complications of anaesthesia and related sub-specialties. The topics covered include major complications of central neuraxial block (NAP3), major complications of airway management in hospitals (NAP4) and accidental awareness during general anaesthesia (NAP5). NAP6 is currently studying severe perioperative anaphylaxis. The NAPs have shed new light on the major complications of anaesthesia, providing both quantitative (frequencies, prevalence, incidence, risk factors) and qualitative (themes, patient stories, human factors) knowledge that has led to new learning, recommendations and changes in practice. This article describes the background, nature and processes of the NAPs.

The Academic Surgical Collaborative: Launching a new trainee research collaborative

The first trainee research collaborative (TRC) in medicine began in 1986, when General Practitioners orchestrated a research project for regional trainees [1]. Whilst there has been a proliferation of research collaboratives across the UK, and an increase in the proportion of publications written by collaborative groups [2], TRCs have only become more widespread relatively recently. Multicentre surgical research projects led by trainees [3,4] have firmly cemented the resurgence of the TRC and its role within the surgical profession [5]. The National Research Collaborative website is dominated by the surgical disciplines and at present twenty-nine out of the thirty-seven collaboratives listed are surgically themed [6]. Surgical TRCs are an opportunity for trainees at all levels of experience to develop their research involvement [7]. Junior trainees are supported as their exposure to research and audit increases [8] by more senior colleagues who are able to offer advice and experience. As trainees mature, TRCs can help to identify research questions, assist networking, offer academic support and mentoring, provide motivation to finish work [8] and improve access to funding [9]. TRCs are an educational tool, promote future collaboration, and increase the exposure of trainees at all levels to research and audit [1]. Finally, TRCs allow trainees to learn basic research methodology, to assist in the co-ordination of multi-centre studies, and to recruit willing collaborators from other centres who may otherwise be inaccessible [7]. Bhangu identifies that surgical trainees are highly suited to the delivery of collaborative work; they are regularly in contact with each other, are motivated and desire evidence of involvement in research [10]. However, now we find medical students are leading national audit projects (STARSurg) [10], giving them an early taste of collaborative research. International level, trainee led surgical collaborative projects have also begun to establish [10], with GlobalSurg announcing it had completed patient recruitment for its first endeavour in January 2015 [11]. This short paper describes the establishment of the Academic Surgical Collaborative (ASC); a new TRC. We describe the ASC's positioning within TRCs and its guiding philosophies.

Peri‐operative care of the elderly 2014

Increasing numbers of elderly patients are undergoing an increasing variety of surgical procedures. There is an age-related decline in physiological reserve, which may be compounded by illness, cognitive decline, frailty and polypharmacy. Compared with younger surgical patients, the elderly are at relatively higher risk of mortality and morbidity after elective and (especially) emergency surgery. Multidisciplinary care improves outcomes for elderly surgical patients. Protocol-driven integrated pathways guide care effectively, but must be individualised to suit each patient. The AAGBI strongly supports an expanded role for senior geriatricians in coordinating peri-operative care for the elderly, with input from senior anaesthetists (consultants/associate specialists) and surgeons. The aims of peri-operative care are to treat elderly patients in a timely, dignified manner, and to optimise rehabilitation by avoiding postoperative complications. Effective peri-operative care improves the likelihood of very elderly surgical patients returning to their same pre-morbid place of residence, and maintains the continuity of their community care when in hospital. Postoperative delirium is common, but underdiagnosed, in elderly surgical patients, and delays rehabilitation. Multimodal intervention strategies are recommended for preventing postoperative delirium. Peri-operative pain is common, but underappreciated, in elderly surgical patients, particularly if they are cognitively impaired. Anaesthetists should administer opioid-sparing analgesia where possible, and follow published guidance on the management of pain in older people. Elderly patients should be assumed to have the mental capacity to make decisions about their treatment. Good communication is essential to this process. If they clearly lack that capacity, proxy information should be sought to determine what treatment, if any, is in the patient's best interests. Anaesthetists must not ration surgical or critical care on the basis of age, but must be involved in discussions about the utility of surgery and/or resuscitation. The evidence base informing peri-operative care for the elderly remains poor. Anaesthetists are strongly encouraged to become involved in national audit projects and outcomes research specifically involving elderly surgical patients.

The incidence of intra-operative awareness in the UK: under the rate or under the radar?

The incidence of intra-operative awareness in the UK: under the rate or under the radar?

The importance of audit to monitor applications of procedures and improve primary angioplasty results

Although clinical trials have demonstrated that primary percutaneous coronary intervention (PPCI) provides better outcomes than thrombolysis for STEMI, it cannot be assumed that similar results can be obtained in day-to-day practice. To determine whether standards are being met, continuous audit of PPCI programmes is necessary, with appropriate feedback to participating centres and operators. Both the MINAP and BCIS national audit projects allow central electronic collection of data on consecutive patients presenting to every hospital involved in the acute management of these patients. Regular programmed feedback is provided to centres performing primary PCI that attempts to take account of statistical variation and differences in case mix between units by making use of funnel plots, statistical process control graphs and risk adjustment models. This reporting of "process" and "outcome" data, both confidentially and within the public domain, has been used to drive up clinical performance and has been associated with steady improvements and reduced inequalities of care.

Surgical Audit and the Evaluation of Surgery

Audit is a process used by clinicians to improve patient care. This process involves the investigation of clinical practice and institutional systems and comparing against given or accepted standards. The traditional model used in audit is illustrated in Figure 1. There are a number of types of audit that take place within an institution, including: • morbidity and mortality meetings • local/regional audit • national or international comparative audit. The structure, process and outcomes of health care can all be subjected to the audit process (Figure 2). Audit is a fundamental part of modern surgical practice in the UK. From consultant to trainee, involvement in audit is not only desirable, but is increasingly becoming compulsory. Experience of audit is an essential criterion in most (if not all) specialist registrar shortlisting procedures, and both the Royal College of Surgeons and the Royal College of Physicians in the UK recommend sufficient time is dedicated on a weekly basis for the purpose of audit. An approach to modern surgical audit has been described in a pervious article (Thomas K, Emberton M, Surgery 2000; 18(10): 250–2). In this contribution, we discuss the problems in applying this traditional model in local surgical audit and describe ways in which local audit can be improved by applying the high standards adopted by national comparative audit projects. This article should be read in conjunction with (and be considered a replacement for) the previous contribution.

A computer software package to facilitate clinical audit of outpatient paediatric dentistry

This paper reports the development and function of a computer program for clinical audit of outpatients in hospital paediatric dentistry in the United Kingdom. The project was one of several national audit projects supported by the Faculty of Dental Surgery, Royal College of Surgeons of England, and funded by the Department of Health. The software is designed to record data utilizing a nationally-agreed minimum set of codes for dental diagnosis, treatment and medical complications, together with patient demographic details pertaining to source of referral, age and sex of patient, and area of residence. A significant component of the software is a flexible report generator which allows data to be analysed using any combination of the above criteria. Audit of activity in hospital dentistry is desirable to enable comparisons to be made between groups of patients and treatments related to diagnosis. This provides the information necessary to enable improvements in clinical practice whilst also assisting the development of both local and national clinical guidelines. Use of this software package will enable such comparisons to be made not only within one hospital but also between different hospital and regions in the United Kingdom.