Quality Assurance Audit Research Articles

Study of auditor performance determinants: Organizational commitment as moderation (case study of Tangerang city inspectorate)

This study explores the determinants of auditor performance, focusing on the moderating role of organizational commitment within the Tangerang City Inspectorate. Employing stratified random sampling, a sample of 250 auditors was chosen to ensure diversity across experience, departmental affiliation, and roles. Quantitative analysis used SPSS to examine the relationships between auditor performance, organizational commitment, and other relevant variables. Findings indicated that organizational commitment significantly moderates the effects of various social pressures on auditor performance. This underscores the necessity for auditing organizations to foster organizational commitment to enhance auditor efficacy and uphold ethical standards. These results hold substantial implications for governance and audit quality assurance, suggesting that reinforced organizational commitment could lead to more robust auditor performance and ethical conduct within similar urban governance settings. This study contributes valuable insights into the influence of organizational dynamics on auditor behaviour and performance outcomes.

Utility of survivorship care plans: A mixed-method study exploring general practitioners' and cancer specialists' views.

Survivorship care plans (SCP) are recommended as integral to survivorship care but are not routinely provided in many centers. We explore whether SCP from the Sydney Cancer Survivorship Centre (SCSC) clinic was received by general practitioners (GP) and cancer specialists, and their views on SCP. A mixed-method study comprising a quality assurance audit, a questionnaire of GP practices and GP, and semi-structured interviews of cancer specialists who referred patients to the SCSC clinic between 2019-2020. Descriptive statistics were used for quantitative data and content analysis for qualitative data. The audit found 153/190 (80.5%) SCSC attendees had SCP uploaded to hospital medical records. The response rate from GP practices was 41%; among the 55 responding practices, 38 (69%) did not receive the SCP. The response rate from GP was 19%; among the 29 responding GP, 25 (86%) indicated the SCP was worthwhile, especially follow-up plans and multidisciplinary team recommendations. Analysis of 14 cancer specialist interviews identified themes of 1) awareness of SCP; 2) access: SCP difficult to locate; 3) process: access and distribution require improvement; 4) systemic issues; 5) content and layout: more concise and better readability required; 6) value: mainly for GP and survivors; 7) use of SCP: limited; 8) recommendations: improve delivery process, enhance layout/content, more stakeholder input, more tailored information. Although response rates from GP were low, those responding perceived SCP to be useful. Cancer specialists believed SCP were more valuable for GP and survivors. Process issues, especially SCP delivery, need to be improved.

Can natural language processing be effectively applied for audit data analysis in gynaecological oncology at a UK cancer centre?

BackgroundThe British Gynaecological Cancer Society (BGCS) has highlighted the disparity of ovarian cancer outcomes in the UK compared to other European countries. Therefore, cancer quality assurance audits and subspecialty training are important in improving the UK standard of care for these patients. The current workforce crisis afflicting the NHS creates difficulty in dedicating teams of clinicians to these audits. We present a single institution study to evaluate if NLP-generated code can improve the efficiency of ovarian cancer and subspeciality reaccreditations audits. We used the chat bot Google Bard to write Visual Basic Applications algorithms that utilise Excel files from electronic health records. MethodsPrimary ovarian cancer data from 2019 to 2022 was retrospectively collected from the Cambridge University Hospital electronic health records. The surgical subspecialty reaccreditation audit analysed the 2022 surgical database. A modular coding approach with Google Bard was applied to generate audit algorithms. The time to complete these current audits was compared against the 2016 ovarian cancer and 2020 subspeciality reaccreditation audits. ResultsThe previous ovarian cancer audit conducted in 2016 required 3 clinicians for the 135 cases and data collection required 1800 min. Data analysis was completed in 300 min. The current ovarian cancer audit allocated 2 clinicians to the 600 surgical cases. Data collection was completed in 3120 min, 3360 min for code development and 720 min for testing. The 2020 subspecialty reaccreditation audit was completed in 360 min. The 2022 subspecialty reaccreditation audit was completed in 1680 min, with 960 min for code development, 240 for debugging and 480 min for testing. ConclusionWe have demonstrated that NLP-generated code can significantly increase the efficiency of surgical quality assurance audits by eliminating the need for manual data analysis. With the current trajectory of NLP development, increasingly complex algorithms can be developed with minimal programming knowledge.

Cervical cancer in Region Skåne, Sweden 2017-2020 after the implementation of primary HPV screening: A quality assurance audit.

Primary human papilloma virus (HPV) screening to detect cervical cancer and dysplastic lesions was implemented in Region Skåne 2017 for women aged 30-70. The aim of this study was to characterize the screening history of women diagnosed with cervical cancer to evaluate the performance of the screening program, as well as to assess the cancer treatments given and shortcomings in the follow-up of women with cervical dysplasia. We performed a quality assurance audit. The data was collected from the National Cervical Cancer Prevention Registry, Region Skåne Labmedicin database and the Melior Journal system in 2017-2020. We identified 247 women diagnosed with invasive cervical cancer in Region Skåne in 2017-2020. Of these, 35 (14.2%) had a screening history over at least two screening rounds before diagnosis. There were 25 (10.1%) women diagnosed with cervical cancer in between screening intervals, i.e., interval cancer. The most common screening history in women with cervical cancer was irregular screening (143, 57.9%), followed by women being above screening age (44, 17.8%). HPV was detected in 96% of the cases, either in cervical cytology or in the tumor tissue. The screening program detected the disease in 96 (38.9%) of the patients, 149 (60.3%) were diagnosed through symptoms and two (0.80%) as a result of incidental findings. The most powerful tool in the prevention of cervical cancer is screening program attendance. Prolongation with HPV screening among elderly women will also reduce the incidence of cervical cancer. Today, such cancers are usually discovered when symptoms appear.

Results of a multicenter 4D computed tomography quality assurance audit: Evaluating image accuracy and consistency

Background and purpose4D Computed Tomography (4DCT) technology captures the location and movement of tumors and nearby organs at risk over time. In this study, a multi-institutional multi-vendor 4DCT audit was initiated to assess the accuracy of current imaging protocols. Materials and methodsTwelve centers, including thirteen scanners performed a 4DCT acquisition of a dynamic thorax phantom using the institution’s own protocol with the in-house breathing monitoring system. Five regular and three irregular breathing patterns were used. Image acquisition and reconstruction were followed by automated image analysis with our in-house developed 4DCT QA program (QAMotion). CT number accuracy, volume deviation, amplitude deviation, and spatial integrity were assessed per pattern using both the segmented volumes and line profiles. ResultsRegular breathing curves showed relatively accurate results across all institutions, with mean volume and CT number deviations and median amplitude deviation below 2%, 5 HU and 2 mm, respectively. Results obtained for irregular patterns showed more variation across the institutions. Volume and CT number deviations co-occurred with a blurring of the sphere, interpolation, or double-structure artifacts that were confirmed through the line profiles. For some of the irregular patterns, amplitude deviations up to 6 mm were observed. Maximum Intensity Projection (MaxIP) correctly captured the applied motion amplitude with deviations across all institutions within 2 mm except for double amplitude pattern. ConclusionsAll centers invited to participate in the audit responded positively, highlighting the need for a comprehensive yet easy-to-execute 4DCT quality assurance program. The largest variances between the results from one institution to another confirmed that a standardized 4DCT audit is warranted.

Blood culture quality assurance: findings from a RCPAQAP Key Incident Monitoring and Management Systems (KIMMS) audit of blood culture performance

Blood cultures (BC) are the gold standard investigation for bloodstream infection. Standards exist for BC quality assurance, but key quality indicators are seldom measured. The Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP) Key Incident Monitoring and Management Systems (KIMMS) invited laboratories for the first time to participate in an audit to determine adult BC positivity rates, contamination rates, sample fill volumes and the proportion received as a single set. The overall aim of the KIMMS audit was to provide laboratories with a mechanism for peer review and benchmarking. Results from 45 laboratories were analysed. The majority of laboratories (n=28, 62%) reported a positivity rate outside the recommended range of 8-15%. Contamination rates ranged from zero (n=5) to 12.5%, with seven laboratories (15%) reporting a contamination rate greater than the recommended 3%. Fifteen laboratories (33%) reported an average fill volume of less than the recommended 8-10 mL per bottle, with 11 laboratories (24%) reporting fill volumes of 5 mL or less whilst 13 (28%) laboratories were not able to provide any fill volume data. Thirteen laboratories (29%) reported that 50% or more of BC were received as single set, and eight (17%) were not able to report this data. This audit highlights there are deficiencies in BC quality measures across laboratories. To support BC quality improvement efforts, RCPAQAP KIMMS will offer a yearly BC quality assurance audit to encourage laboratories to monitor their BC quality performance.

Gender equality in oil mining companies: a case of Lokichar, Kenya

This paper is on the findings of a study done by the authors of this paper in 2019 on Change in Gender Roles as a Factor in Gender Participation and Empowerment in the Oil Mining Industry: Case of Lokichar. One of the objectives was establishing the extent to which oil mining in Turkana County has contributed to changes in gender equality. Sample size of three hundred (300) respondents was selected through systematic random sampling. Finding indicated that there is no relationship between involvement in oil mining activities and equal opportunity for men and women to work in mining activities. The paper recommended that issues like compensation, decision making, royalty sharing, power relations should be well spelt out in policies like the Mining Bill (2014) to ensure gender mainstreaming and no ambiguity in interpretation and Quality Assurance and gender audits should be adopted by companies ensuring a robust Monitoring and Evaluation.

A Quality Assurance Audit of an Orthoptic-Led Virtual Neuro-Ophthalmology Clinic.

Neuro-ophthalmology is experiencing increasing demand. There is a lack of literature relating to how we deal with the capacity and demand issues, and the use of virtual clinics. Virtual clinics are well-recognised in other subspecialties to help deal with capacity and demand issues, with reports of non-medical-led clinics, and are supported by the National Health Services Long Term Plan and People Plan. We present a quality assurance audit of our orthoptic-led neuro-ophthalmology virtual clinic. The virtual clinic was developed in October 2014 to help deal with capacity and demand issues, however, only since 2019 have orthoptists been trained to virtually review. This paper provides a summary of a quality assurance audit that was completed to determine concurrence between orthoptic and consultant virtual reviews. From January to August 2021, all patients attending the virtual clinic were reviewed by a trained orthoptist and then audited for concordance by a consultant neuro-ophthalmologist; 163 patients were identified. There was 100% agreement between orthoptic reviewers and consultants regarding visual function status and optical coherence tomography interpretation. Of the patients reviewed, 100% of patients were satisfied and 96% of patients would be happy to be seen in the virtual clinic again. Current demands on the neuro-ophthalmology speciality mean that we need to explore new ways of working. Our outcomes demonstrate a high level of agreement between orthoptists and ophthalmologists, and excellent patient satisfaction results. We hope this highlights where orthoptists can play an invaluable role in the care of neuro-ophthalmic patients and help deal with capacity and demand issues.

Preparing for the Next Pandemic: An After-Action Review of Infection Prevention and Control Audit Strategies Within Airport and Hotel Quarantine Program.

Effective infection prevention and control (IPAC) practices within the New South Wales (NSW) Airport Operations and Hotel Quarantine Program (Quarantine Program) were required to mitigate the risk of COVID-19 being transmitted to staff, other guests, contractors, and the community. The Quarantine Program relied on complex logistical arrangements and an end-to-end process that included all steps from the time travelers boarded the returning flight until completion of the quarantine period. This required compliance with relevant IPAC standards historically reserved for health care and the implementation of a quality assurance audit framework. The Clinical Excellence Commission (CEC) as the NSW Health Pillar for quality and safety and the lead in IPAC provided training and resources coupled with an IPAC quality audit framework after program commencement. This approach ensured a clear governance structure and a regular review process to minimize risk and support continuous improvement within the program.

Research Letter-Outcomes of Outpatient Native Kidney Biopsies at the McGill University Health Center: A Quality Assurance Audit.

Percutaneous kidney biopsies are essential for diagnosis and management of kidney diseases. However, post-procedural bleeding is a significant risk associated with biopsies. At the McGill University Health Center, the 2 main hospitals, the Royal Victoria Hospital and the Montreal General Hospital, have different observation protocols for outpatient native kidney biopsies. Currently, patients are admitted for a 24-hour inpatient observation at the Montreal General Hospital, whereas patients biopsied at the Royal Victoria Hospital are discharged after 6 to 8 hours of observation at the end of the day. Most Canadian centers do not admit patients for an overnight observation, and it was unclear why this practice continued at the Montreal General Hospital. Our objective was to determine the incidence of complications post-renal biopsy over the past 5 years at both hospital sites, and compare them to each other, as well as to established rates in the available literature. This assessment was designed as a quality assurance audit. This audit was conducted from a local registry of renal biopsies performed at the McGill University Health Center between January 2015 to January 2020. We included all adult patients (between the ages 18 and 80) with outpatient native kidney biopsies performed at the McGill University Health Center between 2015 and 2020. We collected the included patients' baseline demographics and risk factors at the time of biopsy, including age, BMI, creatinine, estimated glomerular filtration rate, pre- and post-biopsy hemoglobin, platelet, urea, coagulation profile, blood pressure, kidney side/size as well as needle size, and number of passes made. We compared the incidence of both minor and major bleeding complications at the Montreal General and the Royal Victoria Hospital. Variables that were measured included hemoglobin before and after biopsy, incidence of minor bleeding complications (defined by hematomas and gross hematuria), and incidence of major complications (defined by post-biopsy bleeding requiring either transfusions or another procedure to stop the bleeding), as well as the incidence of admissions post-biopsy. The incidence of major complications was 2.87% over 5 years (5/174 patients), which is comparable with that reported in the literature. Our transfusion incidence was 1.72% (3/174 patients) and our embolization incidence was 2.3% (4/174 patients) over the 5 study years. Our total number of major events was low and the patients who had major events had significant risk factors for bleeding. All events occurred within 6 hours of observation. This was a retrospective study with a low event number. Additionally, since the events included only those recorded at the McGill University Health Center, it is possible that the events of interest may have occurred at other hospital sites without the author's knowledge. Based on the results of this audit, all major bleeding events occurred within 6 hours of a percutaneous kidney biopsy, suggesting that patients should be monitored for 6 to 8 hours following biopsy. The next step after this quality assurance audit is a quality improvement project and a cost-effectiveness analysis to assess whether post-biopsy practices should be amended at the McGill University Health Center.

When a segmentectomy is not a segmentectomy: Quality assurance audit and evaluation of required elements for an anatomic segmentectomy

ObjectiveThe advent of lung cancer screening and detection of smaller nodules amplifies the need to clarify the oncological quality of sublobar resections. Furthermore, studies comparing sublobar resections to lobectomies offer conflicting conclusions. We hypothesize that this is driven, in part, by inconsistency in reporting; that is, variable interpretation of what constitutes an operative segment. Without an established standard, 2 very different operations may be reported as segmental resections, leaving the data on sublobar approaches subject to interpretative variability. MethodsA retrospective audit was performed on all segmental resections from May 2016 to December 2019 at Brigham and Women's Hospital. Pathology and operative reports were reviewed, with particular attention to the dissection of the component artery, vein, and bronchus. Resections with dissection and division of at least 1 major vascular structure (the segmental artery or vein), as well as the segmental bronchus, met operative criteria for anatomic segmentectomy. Surgical quality metrics were compared between the 2 groups. ResultsThere were 271 segmental resections: 219 (80.8%) were anatomic segmentectomies and 52 (19.2%) were nonanatomic segmentectomies. For the entire cohort, nonanatomic segmentectomies had smaller margins (1.0 vs 1.5 cm; P = .02), fewer lymph nodes (2.0 vs 6.0; P < .001), and fewer mediastinal lymph node stations sampled (1.0 vs 2.0; P < .001). Similarly, there were smaller margins (1.5 vs 1.8 cm; P = .03), fewer lymph nodes (2.0 vs 6.0; P < .001), and fewer mediastinal lymph node stations sampled (1.0 vs 2.0; P < .001) in nonanatomic segmentectomies for non–small cell lung cancer. ConclusionsNearly 20% of reported segmentectomies may not meet criteria for true segmental resection. Therefore, prior studies may need further scrutiny to clarify outcomes and results. Establishing a professional standard may help mitigate ambiguity in published data on this subject.

Evidence of Interventions and Strategies to Bridge the Quality Improvement Gap Led by HCW at the Frontline in SSA: A Scoping Review

Abstract Introduction Poor quality health care is a significant cause of preventable deaths, especially in low- and middle-income countries (LMICs). Quality improvement is multifaceted and includes strategies such as standard setting, quality assurance and clinic audits. In order to move quality improvement in health care into every day practice it is essential to fully engage the frontline where health care is delivered. The objective of this scoping review is to investigate front line health care worker line led quality improvement in Sub Saharan Africa (SSA). Methods We conducted a scoping review to identify, map and synthesize evidence on health care worker led quality improvement initiatives in Sub Sahara Africa using electronic databases PubMed, Cochrane, Embase, CINAHL, Scopus and Psychinfo to identify peer-reviewed literature published between January 2000 and January 2021. To identify grey literature, we used the same search terms in google search to a maximum of 10 pages or when there was no new information. All evidence was scored based on the 6 criteria described by Backhouse et al., which clearly distinguish quality improvement from clinical audit and research. Inclusion criteria were studies that involved frontline health care workers to test “change ideas” and used data systems to measure improvement in service delivery. Results A total of 75 records were identified and including 52 from the peer review search and 23 records from the grey literature search. Only 15 of 47 countries had publications (peer-review or grey literature) describing QI initiatives. Most quality improvement (QI) initiatives were multicomponent and included knowledge transfer, skills building, mentorship and learning visits. Most publications reported QI initiatives aimed at reproductive, maternal, neonatal and child health (n=23) and HIV (n=14) service delivery. Only 6 had experimental designs. No publications were identified prior to 2012 and a rapid escalation of published quality improvement initiatives from 2012 to 2020 was seen. Conclusion QI is in the very nascent stage in SSA. Most large-scale public health QI initiatives are sector specific, siloed, and donor driven. QI initiatives within sector specific programs have not moved horizontally and have had limited ability to change the broader system. Energy must be exerted to change the status quo. Making health care safer and more effective is not spontaneous.

Significance of QA/QC for Hybrid Annuity Model (HAM) Road projects

A developed country is marked by the efficiency and feasibility of the road network. India has one of the world's largest road networks which has expanded significantly at a distance of 5.3 million kilometers from the capital. Many Private companies are investing in this development by private-public-public partnership (PPP3).The key to success of this investment is Quality Assurance, quality Control And quality Audit. Here an attempt is made to understand these concepts with The Hybrid Annuity Model (HAM) model for road project. Keywords:- Hybrid Annuity Model (HAM), Quality assurance, audit Quality Control

Consistency in the transabdominal ultrasound measurement of cervical length in mid-pregnancy.

The Western Australian Preterm Birth Prevention Initiative recommends a transabdominal cervical length (TACL) measurement at the mid-pregnancy ultrasound to screen low-risk women for preterm birth risk. In view of this recommendation, we assessed the inter-observer consistency of TACL screening in mid-pregnancy. Routinely collected mid-pregnancy TACL ultrasound images were graded from 0 to 4 according to the anatomical landmarks identified by a single expert. A random selection of 10 images of each grade were disseminated in an electronic survey to determine inter- and intra-observer variations in the classification of the cervical image. A total of 244 participants graded 50 TACL images. Six participants repeated the grading. Overall agreement to the exact initial grade for all images was 49.6%, highest for images at both ends of the spectrum (83% Grade 0 and 70.4% for Grade 4). Overall agreement to the initial diagnostic Grades 3 and 4 was 75.3% (95% CI 74.5-76.0%) and was higher when the maternal bladder was empty. There was moderate inter-rater agreement (κ = 0.42) for Grades 3 and 4 (diagnostic) or Grades 1 and 2 (non-diagnostic). The intra-rater agreement was fair to good (κ = 0.59, 95% CI 0.49-0.70) for those who repeated the assessment (including the expert grader). Sonographic CL screening is considered an important tool for the identification of women at high risk of preterm birth. Image classification of TACL performed poorly compared with previous studies assessing transvaginal cervical length. Improved reliability and measurement consistency may be achieved through high levels of quality assurance, ongoing training and image audit.

A RADIATION SAFETY ASSESSMENT OF X-RAY DIAGNOSTIC UNITS IN S.M.S HOSPITAL JAIPUR: AN INSTITUTIONAL STUDY

The aim of a quality assurance (QA) program is to assist a radio-diagnostic facility in consistently obtaining adequate radiological information with a minimum of dose and a minimum of cost. An integrated part of a quality assurance program is quality control (QC) in which a series of examinations and checks on equipment performance are undertaken, so that any changes can be objectively monitored and remedies made. The main objective of the present work was to carry out an independent audit of the important features of QA tests and radiation safety parameters in medical X-ray installations, which would reflect the safety status and to assess the regulatory requirements of the safety code. We conducted a radiological safety and quality assurance audit of 32 medical X-ray diagnostic machines installed in SMS hospital, Jaipur. A QA kit consisting of a kVp test meter, ionization chamber-based radiation survey meter and other standard accessories were used for the required measurements. The study mainly covered eight quality control checks that is accuracy check of accelerating potential (kVp), linearity of tube current (mA station)and timer, congruence of radiation and optical field, and total filtration, beam alignment, focal spot size, leakage radiation survey, and beam out. The status test is carried out in order to establish the functional status of the equipments. They operated and functioned correctly and prevented movement when activated. All measured values were well within the tolerance limit.

8 - Quality Assurance Self-assessment: A Catalyst at Aga Khan University

This article describes the establishment of the Aga Khan University’s Network of Quality Assurance and Improvement in promoting the principles of quality in its programmes. As an international university, the experiences and lessons learned have the potential to inform quality assurance and improvement in similar contexts. The authors reflect on past attempts to improve the quality of educational offerings, which were primarily traditional quality assurance audits. With the advent of the Inter-University Council for East Africa self-assessment process, the next generation of quality assurance and improvement was launched for the Aga Khan University programmes. They found the self-assessment process effective in changing attitudes towards quality enhancement and implementation of improvement plans, because it created ownership in the process. Practically, self-assessment is an important tool for academic quality assurance providing critical feedback, and catalysing action. The article will be useful for those establishing quality teaching and learning units across multi-site, multi-campus universities, especially in resource challenged environments.

Integration of basic occupational health services into primary health care in Thailand: Current situation and progress.

Informal workers are high-risk groups for getting occupational diseases. They also have difficulties in accessing occupational health services (OHSs). The Basic OHS (BOHS) program integrates BOHS activities into existing primary health care. The study aims to describe how the BOHS program has been developed and to update the situation of BOHS in Thailand. Four steps for the development of the program include (1) preparation, (2) model development, (3) implementation and expansion, and (4) quality assurance (QA). The program started with the study of the situation of OHS in primary care units (PCUs) and identification of the gap for OH practice among PCUs' staff. The pilot study was conducted in 19 PCUs. After that, expansion of the model and quality assurance of the services have been implemented until now. In 2019, 84% of PCUs (8242) provided BOHS, but the number decreased to 22% (2123 PCUs) in 2020. The target groups were mainly farmers. The OHS activities include an arrangement of farmers' clinics and conducting outreach activities in the field. The latest health surveillance program for farmers reported that 40.5% of 862,585 farmers had high pesticide exposure by field-kit testing. Regarding the QA audit, 75% of PCUs were certified for basic or higher levels of BOHS standards. Integration of OHS into the PCUs is feasible, successful and replicable. Its sustainability requires policy support, continued empowerment of staff, and resource allocation.

Prevalence of Burnout Syndrome in Medicine Students from a University Institution of Cartagena

Ingrid González Arteta* Author Affiliations Dentist, Specialist in Quality Assurance Systems and Audit of health services, Epidemiology, Master in Technological Resources applied to Education, Columbia Received: June 07, 2021 | Published: June 14, 2021 Corresponding author: Ingrid González Arteta, Dentist, Specialist in Quality Assurance Systems and Audit of health services, Epidemiology, Master in Technological Resources applied to Education, Columbia DOI: 10.26717/BJSTR.2021.36.005859

Audit quality assurance theory and methodology

Audit quality assurance theory and methodology

Quality assurance audit in histopathology reported by Whole Slide Imaging technique

Digital pathology validation study was completed in department of pathology, Glan Clwyd Hospital in December 2016. The pathologists participated in the study started reporting live cases in digital platform. Approximately 10% of routine cases were scanned digitally for routine reporting during the audit period. Digital pathology platform is also utilised for MDT review of dermatopathology and cervical cancer screening cases, performance of audits in sub-specialities like liver biopsies, medical renal biopsies, teaching and for EQA purposes. Secondary review process takes place routinely in the department in the form of MDT case review, clinician requested review or second opinion case reviews as part of quality assurance and error prevention. Currently mostly non-urgent and few urgent cases are scanned to digital platform for primary reporting. Most of these cases do not come under existing review process. This is the rationale behind conducting this audit