Audit Research Research Articles

Patterns of moderate and severe injury in children after the introduction of major trauma networks

ObjectiveTo describe the demographics, mechanisms, presentation, injury patterns and outcomes for children with traumatic injuries.SettingData collected from the UK’s Trauma and Audit Research Network.Design and patientsThe demographics, mechanisms of injury...

Clinical audit research and evaluation of motor neuron disease (CARE-MND): a national electronic platform for prospective, longitudinal monitoring of MND in Scotland

Objectives: Launched in 1989, the Scottish Motor Neuron Disease Register (SMNDR) has provided a resource for prospective clinical data collection. However, in 2015 we aimed to evolve a system to allow: i) A patient-centered approach to care based on recognized standards, ii) Harmonized data sharing between Scottish health professionals in “real-time”, iii) Regular audit of care to facilitate timely improvements in service delivery, and iv) Patient participation in a diverse range of observational and interventional research studies including clinical trials. Methods: We developed a standardized national electronic data platform—Clinical Audit Research and Evaluation of MND (CARE-MND) which integrates clinical audit and research data fields. Data completion pre- and post-CARE-MND were compared, guided by recently published National Institute for Clinical Excellence (NICE) recommendations. Statistical difference in data capture between time periods was assessed using Z-test of proportions. Results: Data field completion for the historical 2011–2014 period ranged from 4 to 95%; median 50%. CARE-MND capture ranged from 32 to 98%; median 87%. 15/17 fields were significantly more complete post-CARE-MND (p < 0.001). All MND nurse/allied health specialists in Scotland use the CARE-MND platform. Management of MND in Scotland is now coordinated through a standardized template. Conclusions: Through CARE-MND, national audits of MND care and interventions have been possible, leading to protocols for harmonized service provision. Stratification of the MND population is facilitating participation in observational and interventional studies. CARE-MND can act as a template for other neurological disorders.

The development of a role description and competency map for pharmacists in an interprofessional care setting.

Background Pharmacists are increasingly being included as members of general practice primary care teams. To date, there have been few published studies describing the competencies of general practice (GP) pharmacists and establishing their subsequent educational needs. Aim of the review The aim of this literature review is to establish the activities of pharmacists in general practice to inform the development of a comprehensive role description and competency map. Method A systematic literature search of EMBASE, MEDLINE, international pharmaceutical abstracts and the Cochrane database of systematic reviews was conducted from the start of the databases to August 2018. The search focused on studies investigating the roles performed by GP pharmacists. Full text peer-reviewed English language articles were included. A qualitative content analysis of included studies was performed. Two researchers reviewed studies to identify pharmacist roles. Subcategories of roles were then agreed by the research team and used to present the data. GP pharmacist's activities were mapped by two researchers to associated competencies. Any discrepancies between role descriptions and competency maps were resolved in consultation with a third member of the research team. Results The search conducted resulted in 5370 potential articles. Two hundred and twenty-seven full text articles were selected for review resulting in 34 articles that were included for analysis. Seven GP pharmacist role sub-categories and 48 GP pharmacist individual roles were identified. The seven GP pharmacist role sub-categories included medication management, patient examination and screening, chronic disease management, drug information and education, collaboration and liaison, audit and quality assurance and research. All FIP competency domains were included in the GP pharmacist competency map. Competencies related to compounding, dispensing and packaging of medications were not found relevant to the GP Pharmacist role. No roles were mapped to competencies relating to re-imbursement for medicines, procurement, or medication production. All areas of professional and personal competence were relevant to the GP pharmacist role. Conclusion A comprehensive role description and competency map for GP pharmacists is described and may be used to inform future research into the education of GP pharmacists.

Major incident triage and the evaluation of the Triage Sort as a secondary triage method

IntroductionA key principle in the effective management of major incidents is triage, the process of prioritising patients on the basis of their clinical acuity. In many countries including the UK,...

The Impact of Independence of Internal Audit Function on Transparency and Accountability Case of Zimbabwe Local Authorities

The study aimed at examining the impact of Internal Audit Function independence on Transparency & Accountability. The study adopted independence as the independent variable and transparency & accountability as the dependent variable, measured by management perception, organization policy, auditees’ cooperation and risk exposure of the organization. Survey data was collected from local authorities in Zimbabwe using semi structured questionnaires. Correlation and regression analysis were used to test the hypothesis that the existence of an independent internal audit function in an organization is positively associated with transparency and accountability. Study findings revealed that the existence of an independent internal audit function in an organization is positively associated with transparency and accountability. The findings concur with results from previous studies which concluded that an independent internal audit function plays a monitoring role, therefore contributing towards promoting good corporate governance practices, supporting the applicability of the Agency Theory and the Theory of Inspired Confidence in internal audit research Keywords: Internal Audit Function, Independence, Transparency & Accountability DOI : 10.7176/RJFA/10-5-06 Publication date :March 31 st 2019

Changing epidemiology of motor neurone disease in Scotland.

Scotland benefits from an integrated national healthcare team for motor neurone disease (MND) and a tradition of rich clinical data capture using the Scottish MND Register (launched in 1989; one of the first national registers). The Scottish register was re-launched in 2015 as Clinical Audit Research and Evaluation of MND (CARE-MND), an electronic platform for prospective, population-based research. We aimed to determine if incidence of MND is changing over time. Capture-recapture methods determined the incidence of MND in 2015-2016. Incidence rates for 2015-2016 and 1989-1998 were direct age and sex standardised to allow time-period comparison. Phenotypic characteristics and socioeconomic status of the cohort are described. Coverage of the CARE-MND platform was 99%. Crude incidence in the 2015-2017 period was 3.83/100,000 person-years (95% CI 3.53-4.14). Direct age-standardised incidence in 2015 was 3.42/100,000 (95% CI 2.99-3.91); in 2016, it was 2.89/100,000 (95% CI 2.50-3.34). The 1989-1998 direct standardised annual incidence estimate was 2.32/100,000 (95% CI 2.26-2.37). 2015-2016 standardised incidence was 66.9% higher than Northern European estimates. Socioeconomic status was not associated with MND. Our data show a changing landscape of MND in Scotland, with a rise in incidence by 36.0% over a 25-year period. This is likely attributable to ascertainment in the context of improved neurological services in Scotland. Our data suggest that CARE-MND is a reliable national resource and findings can be extrapolated to the other Northern European populations.

The evolution of internal audit research: a bibliometric analysis of published documents (1926–2016)

ABSTRACTAddressing the rise of internal auditing in the post-SOX era, this study examines the scientific transformation of the topic within current accounting research. In an attempt to shed light on the existing research themes and core works that have been shaping this topic, we combine co-citation and social network analysis to analyse citation patterns of 170 research articles published in five leading accounting journals between 1926 and 2016. The scientific landscape of internal auditing within accounting research is found to be highly fragmented and partly defined by internal auditors' relationships to other parties of the corporate governance framework. Additionally, results reveal the existence of a research nucleus which emphasises the increasingly important construct of internal audit quality.

Understanding Financial Auditing From a Service Perspective

This paper draws from the service science and professional service literatures to conceptualize financial auditing as an economic service. A central characteristic of economic services is the participation of the customer/client in the production process. The necessity of having the customer/client be a co-producer introduces greater heterogeneity to the provision of services relative to the manufacturing of goods which, in turn, creates a tension between service quality and service efficiency. One implication of this tension is that standardization of the audit process may not increase audit quality. We further argue that audit research should give more attention to the idiosyncratic nature of audit engagements and the importance of successful cooperation between the service provider (the audit firm) and the client for improving audit quality. Utilizing research on service networks, we draw attention to a broader perspective than the dyadic relations of service provider and client to show that the possible frictions between the value of co-creation of the service and the independence of the service professional are endemic to the service process, implying that efforts to maximize auditor independence may have unexpected costs that impair audit quality.

The association between firm characteristics and the quality characteristics of the internal audit function in the UK: an agency perspective

This study investigates firm characteristics that may affect the IAF's quality characteristics: size, independence, methodology, and competence. Its motivation is that a firm's agency and economic costs can affect its way to invest in the IAF quality. In this study, a postal questionnaire survey was sent to the head of internal audit (HIA) in 213 UK non-financial companies with in-source IAF, and archival data were collected from the respondent companies' annual reports. The study found that a firm's size and the proportion of cash flows from its operations are positively associated with the IAF's quality characteristics, a suggestion that a high quality IAF is an important way of compensating for the direct loss of control and of managing internal agency risks. In addition, it found evidence that having a high quality IAF is a costly process; the level of debt had a significant negative association with the IAF's quality characteristics. Furthermore, the supporting OLS regression revealed a positive significant association between the effectiveness of the audit committee and the quality characteristics of the IAF. This study has important implications for both practice and future internal auditing research and provides a composite measure that can be used to assess IAF quality.

Open tibial fractures in major trauma centres: A national prospective cohort study of current practice

AimsTo assess current national practice in the management of severe open tibial fractures against national standards, using data collected by the Trauma and Audit Research Network. Materials and methodsDemographic, injury-specific, and outcome data were obtained for all grade IIIB/C fractures admitted to Major Trauma Centres in England from October 2014 to January 2016. ResultsData was available for 646 patients with recorded grade IIIB/C fractures. The male to female ratio was 2.3:1, mean age 47 years. 77% received antibiotics within 3 h of admission, 82% were debrided within 24 h. Soft tissue coverage was achieved within 72 h of admission in 71%. The amputation rate was 8.7%. 4.3% of patients required further theatre visits for infection during the index admission. The timing of antibiotics and surgery could not be correlated with returns to theatre for early infection. There were significant differences in the management and outcomes of patients aged 65 and over, with an increase in mortality and amputation rates. ConclusionsGood outcomes are reported from the management of IIIB/C fractures in Major Trauma Centres in England. Overall compliance with national standards is particularly poor in the elderly. Compliance did not appear to affect rates of returning to theatre or early infection. Appropriately applied patient reported outcome measures are needed to enhance the evidence-base for management of these injuries.

AN EXAMINATION OF THE RELATIONSHIP BETWEEN AUDIT COMMITTEE CHARACTERISTICS AND FIRM PERFORMANCE IN KUWAIT

ABSTRACT The purpose of the current study is to extend prior audit research on the relation between the characteristics of firm’s Audit Committee (AC) and firm’s performance. In particular, this study performs a regression analysis using data from the Kuwaiti market, to examine the relation between firm’s AC characteristics (i.e., size, independence, and financial expertise) and firm’s performance. The empirical results reported reveal a significantly positive relation between firm’s performance and AC financial expertise as well as firm’s financial leverage. The study’s results, however, do not show evidence of a statistically significant impact of AC size, AC independence, or firm’s size on firm’s performance. The current study’s findings should be of value to audit researchers, stockholders, and market regulators. Keywords Audit committee, firm performance, auditing, Kuwait.

WED 225 Changing epidemiology of motor neurone disease in scotland

Clinical Audit Research and Evaluation for Motor Neurone Disease (CARE-MND) (formerly the Scottish MND Register) is an electronic platform for prospective, population-based research in Scotland. We present the results of recent epidemiological analyses.Capture-recapture methods were adopted to determine incidence of MND in 2015–2016: 1) notifications via CARE-MND, 2) Information Services Division (ISD) data i) hospital admissions, ii) death data, iii) riluzole prescriptions.Crude prevalence of MND in Scotland is 7.61–7.64/100,000 of the population. Direct age standardised incidence in 2015 was 3.42/100,000 (95% CI: 2.99 to 3.91); in 2016, 2.89/100,000 (95% CI: 2.50 to 3.34). Using maximum likelihood estimates, coverage of the CARE-MND platform was 99.6% (2015) and 98.1% (2016). In view of high coverage, CARE-MND estimates alone will be presented for 2017.Previous Scottish MND Register capture-recapture annual incidence estimates were 2.32/100,000 (95% CI: 2.26 to 2.37) in 1989–1998 (direct standardised). Our data suggest a changing landscape of MND in Scotland, with a rise in incidence by 36%. This could be attributed to improved neurological services in Scotland. Incidence is also 67% higher than Northern European estimates, which perhaps reflects our robust ascertainment methods. However, further work using population CARE-MND data aims to determine if genetic or environmental variables account for these findings.

Barriers to Transferring Auditing Research to Standard Setters

AbstractAuditing researchers have published over 24,000 academic articles (Google Scholar September 2016) since 1970. Auditing standard setters and regulators frequently describe an inability to engage with and utilize this research to make evidence‐informed standard setting and regulatory decisions. For society to benefit from the large investment in audit research, the knowledge needs to systematically and effectively transferred to auditing policymakers. We draw on the knowledge transfer literature to identify barriers to transferring academic knowledge and discuss how these concepts apply to audit standard setting. We then examine a paradigmatic example of academic knowledge transfer to policymaking: evidence‐based medicine. Based on this analysis, we propose a tentative strategy to address the barriers to transferring audit research knowledge to policymaking and sketch out potential avenues for research. We conclude with an illustrative example of how to implement a knowledge transfer strategy that is effective in systematically transferring knowledge in other policymaking settings to the context of a specific audit standard‐setting project: group audits.

External Auditors' Judgment and Decision Making: An Audit Process Task Analysis

AbstractThis manuscript reviews the external auditor judgment and decision making (JDM) literature from the past decade by specific tasks in the auditing process. Decomposing the literature review by audit task was chosen to enable audit and behavioral researchers and graduate students to identify the trends of JDM research subsequent to Nelson and Tan's () literature review. In addition to identifying gaps/omissions in the current literature, suggestions for future research are also advanced based on forthcoming transformations in the auditing institutional environment.

New Perspectives in Internal Audit Research: A Structured Literature Review

AbstractThis structured literature review adopts a multimethod and multitheoretical approach to identify current knowledge about internal audit as well as related knowledge gaps. To that end, it provides an overview of post‐Sarbanes‐Oxley Act literature, organizing it under three themes: the multiple roles of internal audit, internal audit quality (IAQ), and the practice of internal audit. Despite the volume of literature published during the period covered by this review (2005 to mid‐2017), the first two themes are still in development, while the third is emergent. We suggest research avenues to fill the following main gaps: (i) Given differing opinions about the expected or actual roles of internal audit, prior literature infers that the internal audit function has become the “jack of all trades” of governance, but does not clearly capture its actual roles. (ii) The viewpoint of external auditors has dominated IAQ research, leading to a misunderstanding of how actors with greater stakes in the practice of internal audit conceptualize and evaluate IAQ. (iii) Knowledge of the actual practice of internal audit and its accountability and ethical issues is fragmentary, therefore the literature's current picture of internal audit is far from comprehensive.

Communication Is a Two-Way Street: Analyzing Approaches Undertaken to Enhance Audit Research Knowledge Transfer to Policymakers

Audit academics and policymakers express ongoing concerns about limited knowledge transfer between audit research and policymaking. We use theory-based knowledge transfer norms to evaluate eight practices used by audit academics to transfer research knowledge to policymakers. The discontinued PCAOB-AAA Auditing Section “Research Synthesis Project” came closest to enacting these theory-based knowledge transfer norms. Hence, we examine why those involved in that project did not follow these norms. Interviews with project authors reveal that their review creation approach anchored on the traditional academic literature review, and insufficiently adjusted it to meet the goal of communicating audit research evidence to policymakers. However, interviews with PCAOB project liaisons indicate that policymakers were engaged with and found value in the review creation process. Thus, we analyze PCAOB rulemaking documents for evidence that policymakers valued and used the project’s reviews in their policymaking. Over the project’s duration, we find increasing citations of research to the reviews themselves and to a broader set of academic research. Our findings of knowledge transfer occurrence in this project warrant further research on the efficacy of mobilizing audit research via research syntheses. We also show how several current audit domain knowledge transfer practices can be combined with the research syntheses approach leading to systematic effective knowledge transfer to policymakers.

Calculating Auditor Industry Specialist Tenure: Code from Gaver and Utke (2018)

Gaver and Utke (2019) show that auditor industry specialist measures can be improved by accounting for the length of time an auditor has been a specialist (specialist tenure) in addition to auditor market share. In this note, I provide the code for calculating Gaver and Utke’s (2019) specialist tenure variables to enable subsequent researchers to use these variables. While this code focuses on industry specialist tenure, accounting for tenure may also be important as archival audit researchers begin measuring audit expertise in areas other than industry expertise, such as auditing goodwill, multinational firms, or tax accounts.

P-Hacking in Experimental Audit Research

ABSTRACTA focus on novel, confirmatory, and statistically significant results by journals that publish experimental audit research may result in substantial bias in the literature. We explore one type of bias known as p-hacking: a practice where researchers, whether knowingly or unknowingly, adjust their collection, analysis, and reporting of data and results, until nonsignificant results become significant. Examining experimental audit literature published in eight accounting and audit journals within the last three decades, we find an overabundance of p-values at or just below the conventional thresholds for statistical significance. The finding of too many “just significant” results is an indication that some of the results published in the experimental audit literature are potentially a consequence of p-hacking. We discuss potential remedies that, if adopted, may to some extent alleviate concerns regarding p-hacking and the publication of false positive results.JEL Classifications: M40.

Abstract P-148: CARE OF CRITICALLY ILL CHILDREN IN GENERAL (ADULT) INTENSIVE CARE UNITS – A TALE OF THREE REGIONS

Aims & Objectives: To study the demographics and epidemiology of children admitted to general (adult) intensive care units (GICUs) across the three regions in England, United Kingdom. Methods A retrospective analysis of paediatric data submitted to the Intensive Care Audit and National Research Centre as part of a case mix programme of adult critical care in UK over one year (Jan –Dec 2015). The three regions studied were South-West England and Wales,The Midlands and North-East England.These are each served by their own specialist paediatric transport service called WATCh,KIDS and NECTAR respectively. Results 21,13 and17 GICUs admitted 229(222), 19(19) and 34(33)(number of children) paediatric critical illness episodes in the catchment areas of WATCh, KIDS and NECTAR respectively.Respiratory followed by neurological pathology were the biggest reason for GICU admission.No statistical difference was found between the overall median time spent in GICUs across the three regions (p =0.898)(see figure 1,2).Specialist transport team unavailability (35%) followed by inaccessibility of PICU bed(18%) at the time of referral were the most common reasons for admission to the local GICU (WATCh data).No correlation was found between the time spent in GICU and patient’s age (r=0.16) or distance of GICU from paediatric transport service base (r=0.152).Conclusions A significant number of critically ill children were treated at local GICUs. Unavailability of specialist transport teams and PICU bed were the major reasons for this stay. A national audit of GICUs against the current PICS standards should be performed while determining merits (cost effectiveness, patient outcomes and family dynamics) of local vs specialised care.

Exploring the Scientific Landscape of Internal Audit Research: A Bibliometric Analysis

Addressing the heavily increased attention on internal auditing in the post-SOX era, this paper aims to unravel the scientific metamorphosis of the topic within current accounting research, including the different scientific subareas that define it. In an attempt to extent the scant body of literature reviews that has focused on the internal audit function (IAF), we pursue an empirical approach to analyze the scientific structures and provide a variety of directions for future internal audit research. In this context, citation patterns extracted from 170 research articles published in five major accounting journals are being studied by combining co-citation and social network analysis in order to investigate different existing research domains of internal auditing and to discover the core work that has been done in this area. The scientific landscape of internal auditing can be characterized as profoundly fragmented and deeply rooted in different adjacent domains of accounting research. Identified subcategories from which research on internal auditing is derived can be summarized as Corporate Governance, Auditor Independence, Auditing Professionalization, Audit Committee Effectiveness, Reliance on Internal Auditing, Internal Control over Financial Reporting, and finally the Regulatory Framework. Additionally, results reveal the existence of a pivotal nucleus of research that emphasizes the increasingly important construct of internal audit quality. The focus of this study lies on the analysis of major accounting journals, namely The Accounting Review, Contemporary Accounting Research, Journal of Accounting Research, Journal of Accounting Economics and Accounting, Organizations and Society and is restricted to the years from 1926 to 2016.