Pilot Audit Research Articles

Evaluating an integrated clinical pharmacy service model in an ambulatory cardiac clinic- a single centre study

Abstract Background Evidence suggests that multidisciplinary cardiology clinics improve patient outcomes. Currently, there is limited data on the type of pharmacist-led interventions occurring in cardiac ambulatory clinics in the Australian setting. Purpose The primary aim of this pilot audit is to examine the frequency and type of pharmacist-led interventions in the ambulatory clinics of this specialist hospital. The secondary aim is to assess factors associated with hospital readmissions within 30 days of Pharmacists' reviews. Methods A retrospective pilot audit was conducted for patients who attended an integrated multidisciplinary Heart Failure (HF) and Hypertension (HTN) clinic from April 2023 to February 2024. Patients’ demographics, Charlson comorbidity index (CCI), and the number and types of pharmacist interventions and readmission data 30 days post clinic review were recorded. Descriptive statistics were used to evaluate patient characteristics and logistic regression for hospital readmissions. Results A total of 398 patients were reviewed by pharmacists, with 300 (75%) from the HF clinics and 98 (25%) from the HTN clinics. Patients’ median age was 63± 14.8 years and median CCI was 4± 3.7. Pharmacists documented medication histories for all patients (100%) and provided 355 recommendations, of which 213 (60%) were actioned by the cardiologist. Pharmacists had a face-to-face consultation and provided education and counselling to 175 (44%) patients. The most common types of interventions were related to guideline-directed prescribing and deprescribing (68, 39%), followed by up-titration of current therapies (61, 35%). Pharmacists also provided education on medication adherence and lifestyle modifications (28, 16%) as well as optimizing medications related to other comorbidities (18, 10%). A total of 8 patients (2%) were re-admitted l within 30 days of clinic review from either heart failure exacerbation or hypertensive crisis. Patients who had a face-to-face consultation and education with a pharmacist were less likely to be readmitted within 30 days (P=0.048). However, none of the other predictors tested for readmission such as age (P= 0.572), gender (0.296), history of non-compliance (0.834), CCI (0.984) or a diagnosis of HF or HTN (0.473) were predictors for readmission within 30 days of clinic review. Conclusion Pharmacists play an integral role in the cardiac ambulatory setting by providing expert medication advice and patient education to optimize patients’ outcomes. This study demonstrates that the activities performed by pharmacists working in Australian cardiac clinics are consistent with other international ambulatory clinics. The study also identified opportunities to develop a similar service for other ambulatory clinics at this hospital such as lipid and atrial fibrillation clinics. Additionally, further research is required to assess long term benefit of pharmacist led interventions on cardiac patients.

Assessing the Frequency of Continuation of Beta Blocker Therapy Among Patients Admitted With Acute Decompensated Heart Failure—A Pilot Audit in a Multi-Centre Australian Hospital

Assessing the Frequency of Continuation of Beta Blocker Therapy Among Patients Admitted With Acute Decompensated Heart Failure—A Pilot Audit in a Multi-Centre Australian Hospital

Evaluating compliance with the care standard of proactively assessing bone health in patients with diabetes: a pilot audit of practice across Asia by the Asia Pacific Consortium on Osteoporosis (APCO)

SummaryThis pilot audit explored how bone health is assessed patients with diabetes in diverse centres across Asia. Only 343 of 1092 (31%) audited patients had a bone health assessment, 27% of whom were diagnosed with osteoporosis. Quality improvement strategies are needed to address gaps in patient care in this area.PurposeThe Asia Pacific Consortium on Osteoporosis (APCO) Framework outlines clinical standards for assessing and managing osteoporosis. A pilot audit evaluated adherence to clinical standard 4, which states that bone health should be assessed in patients with conditions associated with bone loss and/or increased fracture risk; this report summarises the audit findings in patients with diabetes. A secondary aim was to assess the practicality and real-world use of the APCO bone health audit tool kit.MethodsEight centres across Asia participated in the pilot audit, selecting diabetes as the target group. Participants reviewed their practice records for at least 20 consecutively treated patients with the target condition. Questions covered routine investigations, bone health assessment, osteoporosis diagnosis, and patient referral pathways. Data were summarised descriptively.ResultsThe participants represented public hospitals, university medical centres, and private clinics from India, Malaysia, Pakistan, Singapore, Taiwan, and Vietnam that see an estimated total of 95,000 patients with diabetes per year. Overall, only 343 of 1092 audited patients (31%) had a bone health assessment. Osteoporosis was subsequently diagnosed in 92 of 343 (27%) patients.ConclusionBone health was not assessed in most patients with diabetes. The results provide insight into current practices across diverse Asian centres and demonstrate the practical value of the audit tool kit. Participant feedback has been used to improve the tool kit. Results of this pilot audit are being used in the respective centres to inform quality improvement projects needed to overcome the gap in patient care.

Preoperative cross-matching in major elective surgical procedures in children: An audit of department’s transfusion practices

Abstract: AIMS: To determine the utilization of cross-matched packed red blood cell (PRBC) concentrate in children posted for major elective operative procedures. To evaluate the efficacy of a simple preoperative “screening criteria” for ordering preoperative cross-match. MATERIALS AND METHODS: Data were retrieved from online surgery scheduling system prospectively over a 4-month period (January–April 2022). The number of units cross-matched and those utilized were assessed. A screening criterion was devised in consultation with stakeholders for ordering blood. The utilization of PRBCs was reassessed after implementation of these criteria and reaudited (July–October 2022). A subset analysis of A1 (tunneled catheter placements) and A2 (core pediatric surgical procedures) groups was done to analyze blood utilization. RESULTS: Initial audit showed poor PRBC utilization with 46 units unused of the 54 cross-matched units, and most of these were from A1 group (3 of 29 units and 5 out of 25 units utilized in A1 and A2 groups, respectively). Reaudit after introducing cutoff criteria showed sharp decline (79.3%) in the number of cross-matched units and the number of units returned (84.6% decrease) in A1 group and the number of units returned unused dropped by 50% in the A2 group. There was visible reversal of indicators of utilization (cross-match to transfusion ratio dropped from 6.75 to 1.73 and TI increased from 0.163 to 0.613), indicating optimal utilization. CONCLUSION: This pilot audit clearly demonstrates the gap between requisition and utilization of cross-matched PRBCs. Formulating an effective screening criterion avoids unnecessary cross-matching and wastage of resources and maximizes utilization.

Cochlear implant referral patterns in the UK suggest a postcode lottery with inequitable access for older adults; results of a pilot audit in five Audiology sites

Objective To use a standardised reporting tool to identify potential eligible candidates for cochlear implant (CI) referral and quantify the proportion of adults who had a CI referral discussion after presenting with an audiogram within United Kingdom (UK) audiometric criteria. Design Retrospective multicentre 6-month audit of Audiology clinic databases. Study sample A total of 810 adults from five geographically diverse UK Audiology sites. Results Data were collected in late 2019 after UK CI audiometric candidacy criteria changed; one site collected only 3 months of data. The proportion of potential eligible adults (based only on audiometry) considered for CI referral was 64% (521 out of 810) and varied by site (from 50% to 83%). About 24% of patients (123 out of 521) declined CI referral; this also varied across sites (12–45%). The median age of patients where CI referral was not considered was 80 years – significantly higher than the group where CI referral was considered (73 years). Conclusions CI referral is dependent on where adults live, and how old they are. Older adults are significantly less likely to be considered for CI referral by Audiologists. Audiology clinics need more support to empower staff to talk to patients about CI referral.

Enhancing Psychological Wellbeing Practitioner (PWP) practice for depression and anxiety in the context of personality difficulties: a pilot audit of CPD workshop feedback

Abstract Psychological Wellbeing Practitioners (PWPs) are central to NHS Talking Therapies services for depression and anxiety (TTad; formerly ‘IAPT’). This workforce has been trained to deliver low-intensity treatments for mild to moderate depression and anxiety. In practice, PWPs routinely work with more complex clients, likely due to a combination of reasons. Over half of referrals experience concurrent personality difficulties, which are linked to poorer treatment outcomes, and PWPs describe feeling unskilled to work with these clients. This study aimed to develop and pilot a Continuing Professional Development workshop for PWPs about enhancing practice in the context of concurrent personality difficulties; and evaluate acceptability, feasibility and potential impacts on clinical skills and attitudes. This is an audit of routine feedback from a pilot of the workshop offered in a single TTad PWP workforce (n=139). The workshop was successfully developed and a series of five workshops were delivered to 74% of the PWP workforce. Feedback was overwhelmingly positive, and a majority of PWPs reported improved confidence in key skills covered during the workshop, and a positive attitude towards working with clients with personality difficulties after the workshop. PWPs described enhanced capability, opportunity and motivation to undertake work with this client group following the workshop. The workshop showed potential to improve PWP confidence and skill to support TTad clients in the context of personality difficulties, although it is not yet known if this translates to better treatment outcomes for clients. Implications for practice and future research are discussed. Key learning aims (1) Understand the feasibility of gathering feedback and outcome data of a Continuing Professional Development (CPD) workshop delivered in routine practice for PWPs. (2) Understand PWP perspectives on attending a CPD workshop to support tailoring PWP treatments for depression and anxiety in the context of personality difficulties. (3) Reflect on potential opportunity to enhance PWP treatments in the context of personality difficulties via brief training workshops. (4) Consider how COM-B can be used to explore barriers and enablers to PWPs implementing new learning to their practice.

P120 What's driving this disease activity score? A support framework to aid your decision

Abstract Background/Aims NICE now enables patients with a DAS of > 3.1 to < 5.2 to be treated with advanced drug therapies. To ensure correct and cost-effective use of resources it is essential that we identify a moderate DAS that is driven by inflammatory joint disease as opposed to a differential diagnosis. A reference-based tool entitled “DAS drivers: A nursing decision-making algorithm“ was designed to support nurses in their clinical decision making around appropriate treatment for moderate disease. Clinical trials suggest that advanced therapy provides similar benefits for people with moderate disease as well as those with severe disease. After a pragmatic review of existing evidence. NICE guidance was introduced in 2021 to include patients with a moderate RA DAS (>3.1 - < 5.2) to be eligible for advanced therapies. This is a positive step to improving access to advanced treatment options for patients and will help stem the burden of disability associated with RA. The algorithm presented was initially developed to support nurses identify and navigate around management plans for patients with moderate RA disease and would be freely available for all of rheumatology community to use in their daily practice. It is recognised in the BSR report ‘Specialist Nursing in Rheumatology - The State of Play’ that there is a need for succession planning and an increase in appropriately skilled rheumatology nursing workforce. The authors are experienced, longstanding members of the rheumatology workforce and thus are sharing knowledge and experience with the next generation of nurses to allow for continued quality of patient care as part of the succession planning program that rheumatology services now face. The algorithm aims to address these challenges by supporting the identification of patients with active inflammation in moderate RA therefore ensuring that appropriate patients are given access to valuable limited resources within the NHS. Methods Round-table discussions between three advanced rheumatology nurse leaders (the authors) with a cumulative and varied rheumatology experience of 70+ years, lead to the development of an algorithm specifically around identifying active inflammation in moderate RA. The authors drew on relevant publications and clinical experience to develop the algorithm and refine over a 12-month period. The intention of the algorithm is to make it user friendly and support standardised decision making in a clinical setting for all nurses working within rheumatology, irrespective of experience. Results The algorithm provides a structured approach and promotes ideas to consider when assessing and treatment patients with rheumatoid arthritis. Conclusion To endorse and disseminate the algorithm as an education tool and develop a publication. An audit on the use of the algorithm amongst nurses in clinical practice with a pilot audit with nurses who have attended educational events delivered by the authors. Disclosure B. Rhys-Dillion: Honoraria; B.R.D. has received honoraria from Galapagos. A. Kent: Honoraria; A.K. has received honoraria from Galapagos, Roche, Pfizer, Gilead, BMS, Amgen, Chugai-Pharma, Sanofi Aventis and UCB Pharma. J. Painter: Honoraria; J.P. has received honoraria from Galapagos, Pfizer, Novartis and Roche/Chugai-Pharma.

5612994 A ONE-YEAR AUDIT OF PREGNANCY MANAGEMENT AND OUTCOMES IN WOMEN WITH SICKLE DISORDERS AT A SINGLE UK CENTRE

Background: Women with sickle cell disorders (SCD) have increased morbidity and mortality in pregnancy due to increased sickle and pregnancy-related complications and require multidisciplinary team management, including obstetrician and midwife with experience of high-risk antenatal care and haematologist with links to a Specialized Hemoglobinopathy Team1. About 15,000 individuals live with SCD in the UK, with 110-200 pregnancies per annum1. Aims: To determine whether King’s College Hospital followed recently published British Society of Haematology (BSH) guidelines for the management of pregnancy in SCD. Pilot a proposed BSH audit proforma and assess mode of delivery, neonatal birth weight and special care baby unit (SCBU) requirements for this cohort. Methods: Pregnancy management and outcomes were audited using a proforma based on recent BSH guidelines (Appendix 1). Review of electronic patient records (EPR) for all women attending joint obstetric hemoglobinopathy clinics with SCD who completed a pregnancy between 01/10/20 and 01/10/21, including miscarriage and termination of pregnancy (TOP). Results: 23 pregnancies resulted in 19 live births (one twin pregnancy), 3 miscarriages (10/40 + 1, 10/40 + 1, 14/40 + 6); and 2 TOPs (10/40, 10/40). Maternal haemoglobin genotype was 74% HbSS, 23% HbSC, and 4% HbS other. The average maternal age at delivery (excluding miscarriage and TOP) was 33.6 years (24.8-40.8 years). Average gestational age at delivery (excluding miscarriage and TOP) was 37.9 weeks (32/40 + 1 to 40/40 + 1). 13 pregnancies were delivered by Caesarean section (9 emergency) and 5 by vaginal delivery (4 forceps). 14 women who had a live birth underwent transfusion during pregnancy, 1 was transfused postnatally and 3 were not transfused. Maternal complications were recorded in 94% pregnancies (excluding miscarriage and TOP). 47% of women had sickle vaso-occlusive crises, 56% had an infection, 17% had acute kidney injury and 6% required Intensive Therapy Unit care. Neonatal complications were recorded in four neonates. Three had intrauterine growth restriction, and were delivered at 32 + 1, 33 + 6 and 38 + 1 gestation respectively, with one requiring care in SCBU. One neonate had jaundice requiring five days of phototherapy. The average neonatal birth weight was 2770g (960-3715g) with a birthweight centile ranging from 0-0.4 to 75-91. Discussion: Audit barriers included an initial lack of access to information due to separate EPR system (BadgerNet) for maternal notes, rectified by collaboration with the obstetric team and access to BadgerNet. Summary/Conclusion: This pilot audit enabled assessment of collecting required data for a proposed BSH audit proforma; monitoring compliance with newly published BSH guidelines for management of pregnancy in SCD1; and provided insight into pregnancy outcomes in women with SCD who delivered within a 12-month period at a single large centre. The higher-than-expected transfusion rate during pregnancy was likely due to ongoing recruitment to the TAPS2 trial, with eligible women offered randomisation to usual practice or pre-emptive red cell exchange transfusion 6-10 weekly from 6-20 weeks gestation. A high proportion of live births were delivered by Caesarean section, reflecting a high proportion of multiparous women with previous Caesarean sections in this cohort. Although complication rates were high, most complications were relatively minor and non-life threatening. Keywords: Pregnancy, Sickle cell disease Reference 1. Oteng‐Ntim E et al. Br J Haematol 2021;194(6):980-995.

Data quality validation of the Spanish Incisional Hernia Surgery Registry (EVEREG): pilot study.

The Spanish Incisional Hernia Surgery Registry (EVEREG) was promoted by the Abdominal Wall Section of the Spanish Association of Surgeons, starting data collection in July 2012 and currently has more than 14,000 cases. The objective of this study was to validate the data collected through a pilot audit process. A sample of hospitals participating in the EVEREG registry since the beginning was selected. Patients registered in these centers in the 2012-2020 period were included. A stratified random sampling was carried out, with the inclusion of 10% of registered cases per center with a minimum of 20 cases per center. At each participating center, two researchers not belonging to the center undergoing the audit checked (on site or telematically) the concordance between the data in the registry and the data contained in the case history of each patient. 330 patients have been analyzed, out of a total of 2673 registered, in 9 participating centers. The average accuracy has been 95.7%. Incorrect data 1.5% and missing data 2.3% CONCLUSION: The group of pilot hospitals from this EVERG incisional hernia surgery registry shows a very high precision of 95.7%. The confirmation of these findings in all the centers participating in the registry will make it possible to guarantee the quality of the studies made and their comparability with other similar national registries. nnTrial registration number: ClinicalTrials.gov ID:NCT03899012.

Determination of the Absorbed Dose in Water for Small Photon Beams Using Micro-TLDs of LiF:Mg,Ti (Pilot Audit Proposal)

Background: Small-field dosimetry remains an open challenge globally. Thus, it is crucial to consider adequate reference codes of practice for the performance of dosimetry. Furthermore, as part of good clinical practice, the implementation of new codes of practice implies the development of a dosimetry audit program. In this work, a pilot dosimetric audit protocol is established for measuring the absolute dose in water for small fields using micro-TLDs LiF:Mg,Ti dosimeters. Methods: The dosimeters were irradiated with a 6 MV X-ray beam in a linear accelerator. The TLDs were calibrated between 0.5 and 3 Gy for different field sizes. For audit, the TLDs were irradiated at 2 Gy for different circular field sizes. The proposed protocol consists of five TLD dosimeters forming a cross with a marked radiochromic film to identify the position of the central dosimeter during irradiation. Only the dosimeter measurement in the center of the field is used. Results: It was found that the percentage difference between the measured dose and the prescribed dose (2 Gy) for irradiation in circular fields is less than 3%. Conclusions: A pilot dosimetric audit was carried out using the proposed protocol over a linear accelerator using small circular collimator photon beams.

Remote EPID-based dosimetric auditing using DVH patient dose analysis

Objective. The aim of this work was to develop and validate a method for remote dosimetric auditing that enables dose-volume histogram parameter comparisons of measured and planned dose in the patient CT volume. Approach. The method is derived by adapting and combining a remote electronic portal imaging (EPID) based auditing method (Virtual Epid based Standard Phantom Audit—VESPA) and a method to estimate 3D in-patient dose distributions from planar dosimetric measurements. The method was tested with a series of error-induced plans including monitor unit and multileaf collimator (MLC) positioning errors. A pilot audit study was conducted with eleven radiotherapy centres. IMRT plans from two clinical trials, a post-prostatectomy (RAVES trial) plan and a head and neck (HPV trial) plan were utilized. Clinically relevant DVH parameters for the planned dose and estimated measured dose were compared. Main results. The method was found to reproduce the induced dose errors within 0.5% and was sensitive to MLC positioning errors as small as 0.5 mm. For the RAVES plan audit all DVH results except one were within 3% and for the HPV plan audit all DVH results were within 3% except three with a maximum difference of 3.2%. Significance. The results from the audit method produce clinically meaningful DVH metrics for the audited plan and could enable an improved understanding of a centre’s radiotherapy quality.

Reducing Exposure to X-Ray in Patients With Conservatively Managed Distal Radius Fractures: A Closed-Loop Pilot Audit.

Introduction British Orthopaedic Association Standards for Trauma (BOAST) guidelines state that a radiograph of the wrist at the time of removal of immobilisation is not required in conservatively managed distal radius fracture (DRF) patients unless there is clinical cause for concern.The aim of this pilot audit was to investigate local compliance with these guidelines. Materials and methods The first cycle of a retrospective audit was performed on conservatively managed DRF patients presenting between August and October 2021. An intervention was introduced in the form of education to highlight current guidelines. A second cycle was then performed prospectively on patients presenting between February and April 2022. Data was analysed to assess whether radiographs were taken at the time of cast removal, if the indication for the radiograph was documented and whether it affected the management plan. Results In the first cycle, 20 of 46 patients (43.5%) had repeat radiographs at the time of cast removal compared to 12 of 41 patients (29.3%) in the second cycle (p=0.170). None of the first-cycle patients had any documentation on the indication for radiograph at the time of cast removal and none of the radiographs altered the management plan. In the second cycle documentation on the indication for the radiograph was present for seven of the 12 radiographs and two altered the management plan. Conclusion Through education on adherence to national guidelines, the number of radiographs in patients with conservatively managed DRFs was reduced.

OC-081 VALIDATION OF THE DATA QUALITY OF THE SPANISH INCISIONAL HERNIA SURGERY REGISTRY (EVEREG). PILOT STUDY

Abstract Aim The Spanish Incisional Hernia Surgery Registry (EVEREG) is promoted by the Abdominal Wall section of the Spanish Association of Surgeons, starting data collection in July 2012 and currently has more than 13,500 cases. The objective of this study is to validate the data collected through a pilot audit process Material & Methods A sample of hospitals participating in the EVEREG registry since 2012 is selected. Patients registered in these centers in the period 2012–2019 are included. A stratified random sampling is carried out, with the inclusion of 10% of registered cases per center with a minimum of 20. In the 2020–2021 period, a selection of researchers, different from that of the center to be audited, checks the concordance between the registry data and the data collected in the patient's clinical history, either in person or online. Results 330 patients have been analyzed, out of a total of 2673 registered, in 9 participating centers. The average accuracy has been 95.7% (99.1–79.35%). With 1.5% incorrect data and 2.28% missing data Conclusions This is the first validity study of an abdominal wall registry The accuracy greater than 95% obtained allows us to determine an excellent quality in the data collection of the EVEREG registry. We believe that the confirmation of these data in all the centers participating in the registry would guarantee the quality of the studies carried out and their comparison with other international registries

The Enhancing Error Management of Pilot and Line Operation Safety Audit

The Enhancing Error Management of Pilot and Line Operation Safety Audit

Widespread gaps in the quality of care for primary biliary cholangitis in UK

ObjectivePrimary biliary cholangitis (PBC) is a progressive, autoimmune, cholestatic liver disease affecting approximately 15 000 individuals in the UK. Updated guidelines for the management of PBC were published by The...

Pluralism and Political Studies in the UK: A Pilot Study into Who Gets What in the Discipline

How pluralist is political studies? How are resources distributed across the discipline? In this article, we turn one of the fundamental questions of politics – who gets what, when, and how – back on to the study of politics itself. Our focus is on two areas that are central concerns to pluralism: gender and sub-discipline. We pose two specific questions: What is the gender and sub-disciplinary composition of political studies? And how are various resources – ranging from jobs to prizes – distributed along gender and sub-disciplinary lines? In addressing these questions, we draw on a pilot and partial audit of departments, journals and other key indicators from 1998 to 2018. The article contributes to long-standing debates about the character of political studies and the extent to which the field is pluralistic or not.

Reaudit of transvaginal ultrasound practice in a general gynecology clinic.

A recent pilot audit found that the quality of transvaginal ultrasound practice in a teaching hospital did not reflect current guidelines. This was a concern given the frequency and importance of ultrasound examinations in approaching a diagnosis. Interventional measures involved ad hoc training sessions coincident with installation of updated equipment. A reaudit was performed to assess any changes in the standard of ultrasound practice. Data were collected by random direct observation. To minimize the Hawthorne effect, staffs were not made aware of when active data collection took place. Observations of both patients and end user were compared with current guidelines. Data collected maintained the anonymity of users throughout. Practice was graded as: compliant, partially-compliant, or noncompliant. Descriptive statistics were used to demonstrate any change post-intervention. Observations (n = 48) of completed gynecology ultrasound practice were recorded, and results described as percentage frequencies (%). Image optimization noncompliant rates declined in the reaudit from 65.1% to 41.67% (P = .07) and noncompliant rates of global examination of gynecology decreased from 60.47% to 14.58% (P < .05). Substantial improvements were seen in terms of image annotations (initial audit, 41.9% vs reaudit, 66.67%), and end user examination of bladder, vagina and cervix when indicated (initial audit, 25.6% vs reaudit, 77.08%). Regular audit, ad hoc ultrasound training sessions and updated ultrasound equipment resulted in considerably improved compliance of transvaginal ultrasound practice in gynecology.

Multidisciplinary Management of Diabetic Foot Ulcers in Primary Cares in Quebec: Can We Do Better?

A growing body of evidence supports the presence of integrated foot care based on multidisciplinary and interdisciplinary teams in the management and prevention of diabetic foot ulcer (DFU) worldwide. This model of care is however rare in the clinical setting in Quebec, Canada. Many best practice gaps are identified as well as probable causal hypothesis are listed in this commentary. We support our opinions with a pilot audit conducted as part of a continuous quality improvement process in managing patients with DFU in our area and on Canadian facts and data. Our pilot study (n = 27 hospitalized patients) included a typical DFU population with neuropathy, peripheral arterial disease and previous amputation. It highlights underachievement of best practice recommendations implementation such as multidisciplinary DFU management and offloading interventions in our establishment. Due the high morbidity and mortality associated with DFU patients, four died during the studied hospitalization episode. Several barriers were encountered in the pilot audit justifying that no robust conclusion can be raised. However, our observations are concerning. Even though data accessibility was limited, our observations are sadly coherent with what is found in the literature. Economic data of what this means for our health system is put forward in the overall discussion. We are preoccupied by the trends outlined by some facts and observations, and this commentary was written with this in mind. In the face of the diabetes crisis that is arising, a plea is made to reassess care pathway for this vulnerable population as we emphasize the importance of teamwork in managing DFU.

AB181. Venous thrombo-embolism prophylaxis on colorectal wards: a pilot audit of standard

AB181. Venous thrombo-embolism prophylaxis on colorectal wards: a pilot audit of standard

Pilot Audit of Trichiasis Surgery Outcomes Using a Mobile App in the Republic of Chad.

PURPOSE:The purpose of the study was to assess the feasibility of a mobile data collection app for use in trichiasis surgical audits in the Melfi and Mangalme districts of the Guera region of the Republic of Chad and to perform a cost analysis to determine if the auditing mechanism could be implemented nationally.MATERIALS AND METHODS:Patients who underwent trichiasis surgery 6 months prior and who had follow-up 7–14 days after surgery were included in the study. Each surgeon had a sample of 20% of operated eyelids; nine surgeons with data for ≥20 eyelids were included. A trichiasis recurrence rate of ≥25% suggested that the surgeon needed retraining. Smartphones captured data using the data collection app, which transmitted data to an online server. Direct costs and supervision costs were collated and summed.RESULTS:There were 916 eyelids operated on; 170 patients (269 eyelids, 29% follow-up rate) participated in the audit. Twenty participants (11.8%) had recurrence. The mean recurrence rate among surgeons was 8.3% (standard deviation: 0.07%; range: 0%–17.9%). None had a recurrence rate of ≥25%; thus, no retraining was necessary. The total cost of the audit was US$15,111.25 ($12,882.28 in direct costs and $2,228.97 in supervision costs).CONCLUSIONS:The simple, easy-to-use, and low-cost mobile auditing mechanism is a practical solution for conducting surgical audits in remote and resource-limited settings and is undergoing national scale-up by the Chadian trachoma elimination program.