Assessing nuclear medicine practices: a critical evaluation of QUANUM through a quality improvement perspective and its wider relevance.

Quality Management Audits in Nuclear Medicine (QUANUM) is an initiative conceived by the International Atomic Energy Agency to enhance global standards in Nuclear Medicine practices. Acknowledging the intricate regulatory frameworks and the necessity for multidisciplinary collaboration, QUANUM has gained global acceptance, demonstrating widespread implementation and positive impacts on patient care. This manuscript critically evaluates the QUANUM program through the lens of quality improvement (QI), by employing established and validated QI tools. Our analysis identifies areas of conformance, underscores key strengths inherent to QUANUM, and pinpoints further learning opportunities for continuous enhancement. Additionally, we assert that the insights derived from scrutinizing this global project within Nuclear Medicine, have valuable implications for departments aspiring for establishing good quality management systems, thereby contributing to the improvement of patient care.

Com Ciência e Com Respeito: episódio 23

Neste terceiro episódio especial sobre o Projeto de Qualificação de CEPs, vamos falar sobre a leitura que o Q-CEP fez das análises éticas feitas pelos CEPs visitados. Confira!

Com Ciência e Com Respeito: episódio 21

Neste segundo episódio especial sobre o Projeto de Qualificação de CEPs, vamos falar sobre a leitura que o Q-CEP fez dos aspectos administrativos das atividades dos CEPs visitados. Confira!

Procedimientos para auditorías internas de procesos implementados en el MINSAL / Procedures for internal audits of processes implemented in the MINSAL

El presente documento tiene como objetivo evaluar la conformidad, la efectividad y el desempeño de un determinado proceso y sus procedimientos para identificar las brechas existentes y orientar las oportunidades de mejora. Las auditorias están dirigidas a todas las dependencias del MINSAL que están ejecutando procesos y procedimientos según manual de proceso y procedimientos acorde con mapa nivel 0

The objective of this document is to evaluate the conformity, effectiveness and performance of a certain process and its procedures to identify existing gaps and guide improvement opportunities. The audits are aimed at all MINSAL units that are executing processes and procedures according to the process and procedures manual according to the level 0 map

Construction of cleaner production management system in China: mode innovation of cleaner production.

This study is based on the practice of cleaner production (CP) audits in more than 300 enterprises. After reviewing 1484 CP options, it is found that 82.5% of the options are directly and indirectly related to management. Moreover, there are common problems such as the poor sustainability of CP audit results. This shows that enterprise management plays a significant role in implementing CP options. Based on these, this study proposes a new concept of cleaner production management (CPM) system, and draws lessons from the modern environmental management theory and method to establish the framework of CPM system. This system combines the theory and method of CP with the management system of enterprises and presents the CPM requirements in the current enterprise management system, which mainly includes CPM responsibilities, CP objectives, CPM indexes, CP energy resources management, CP process control, CP product management, CPM inspections, and CP performance evaluation. The characteristic of the proposed system is to construct a modern information-based CPM system. With highly systematic, concise structure, and easy operability, this system not only simplifies and improves the CP work in enterprises and reduces several tedious tasks such as document preparation, but also enhance the enterprise management efficiency and motivate the willingness of employees to participate in CP. Innovated and developed for CP implementation, the system has been implemented and applied in Chinese enterprises, and the implementation and application have obvious effects on improving production level as well as environmental and economic benefits.

Audit of surgical specialty patients and beds at Pietersburg Hospital, Limpopo Province, South Africa in 2021.

BACKGROUND: While the absolute number of hospital beds is usually discussed, adequate utilisation of beds is a far better instrument to measure departmental efficiency. OBJECTIVE: To measure the number of beds for each surgical specialty in Pietersburg Hospital as well as the average length of stay (LoS) to compare bed utilisation. METHOD: We conducted a 1-day descriptive cross-sectional audit of patients admitted to surgical wards on 21 April 2021 at Pietersburg Hospital. RESULTS: There were huge discrepancies in the number of beds per surgical specialty as well as the LoS. Over one-third of surgical beds were occupied by patients waiting for either a computed tomography scan, surgical procedure, or transfer. CONCLUSION: There is a need to address the functioning of the surgical specialties with regards to the number of beds allocated as well as the ideal average length of stay.

Audit of surgical procedures in regional and central hospitals in Limpopo Province, South Africa.

BACKGROUND: There is a paucity of data on the functioning and surgical procedures performed in rural hospitals in South Africa. OBJECTIVE: To determine the category of procedures performed at regional and tertiary hospitals in Limpopo Province, South Africa. METHOD: We conducted a retrospective analysis of surgical procedures performed in the regional and tertiary hospitals in Limpopo Province during a 1-year period from 1 March 2019 to 29 February 2020. RESULTS: A total of 24 263 surgical procedures were performed during the study period. More than half of all cases (50.4%; n=12 252) were operated on at the tertiary hospitals while regional hospitals performed the remaining 12 011 operations. CONCLUSION: There is a great necessity to alleviate the central hospitals from the bulk of surgical procedures.

[Implementation of a quality management system in a central sterilization unit: experience in the Hospital Tahar Sfar, Mahdia, Tunisia]. / Mise en place d´un système de management de la qualité dans une unité de stérilisation centralisée: expérience de l´Hôpital Tahar Sfar de Mahdia en Tunisie.

In Tunisia, Hospital sterilization guidelines recommend the establishment of a quality assurance system. The purpose of this study is to give an overview of the situation in a sterilization unit in order to assess the adherence to good practice criteria and to identify opportunities for improvement. We conducted a prospective study in the sterilization unit of the Hospital Tahar Sfar, Mahdia in 2019. Two internal audits were conducted under the same conditions and were carried out one year apart. The first audit identified failures and malfunctions and the outlining of an action plan. The impact of the measures undertaken was tested using a second audit. Data collection was carried out by direct observation of the existing resources and practices. Compliance rate was calculated taking into account compliant criteria and applicable criteria. The results of the first audit revealed a compliance rate of around 28.1%. The analysis used to observe deviations made it possible to identify 5 axes of improvement, in particular the implementation of a system of documentation and a quality management system. In total, we prepared 14 documents related to the managerial processes, 26 to the operational processes and 41 to the support processes. The actions put in place enabled to achieve a compliance rate of 60.4%. The approach taken to upgrade sterilization processes made it possible to standardize them while ensuring traceability.

Audit of the Sydney Local Health District Public Health Unit notification and contact tracing system during the first wave of COVID-19.

OBJECTIVE: To conduct a real-time audit to assess a Continuous Quality Improvement (CQI) activity to improve the quality of public health data in the Sydney Local Health District (SLHD) Public Health Unit during the first wave of COVID-19. METHODS: A real-time audit of the Notifiable Conditions Information Management System was conducted for positive cases of COVID-19 and their close contacts from SLHD. After recording missing and inaccurate data, the audit team then corrected the data. Multivariable regression models were used to look for associations with workload and time. RESULTS: A total of 293 cases were audited. Variables measuring completeness were associated with improvement over time (p<0.0001), whereas those measuring accuracy reduced with increased workload (p=0.0003). In addition, the audit team achieved 100% data quality by correcting data. CONCLUSION: Utilising a team, separate from operational staff, to conduct a real-time audit of data quality is an efficient and effective way of improving epidemiological data. Implications for public health: Implementation of CQI in a public health unit can improve data quality during times of stress. Auditing teams can also act as an intervention in their own right to achieve high-quality data at minimal cost. Together, this can result in timely and high-quality public health data.

An audit of the editorial process at the Indian Journal of Cancer: Lessons learned, and how to improve chances of acceptance of your paper.

BACKGROUND: The editors of the Indian Journal of Cancer (IJC) have not, so far, objectively analyzed the editorial processes involving author, referee, and editor data of the journal. Hence, we aimed at doing so in this audit. METHODS: We retrospectively analyzed manuscripts submitted to the IJC from April 1, 2020, to May 31, 2020, for data related to the peer-review process. Microsoft Excel was used to enter the retrieved information and to carry out the statistical analysis. RESULTS: Three hundred and nineteen manuscripts were submitted during the study period. Of these, three were excluded from the study. Of the 316, 79 (25%) were articles on laboratory medicine; 182 (57.6%) were original articles. About half of the submitted manuscripts (166, 52.5%) were desk-rejected. Of the remaining 149 manuscripts, 105 did not follow the instructions to contributors (ITC) and required a median number of two revisions (range = 1-5) to satisfy the ITC. To review 107 manuscripts, 536 external referees were invited; of them 306 did not respond, 79 declined the invitation, and 151 accepted the invitation. Of these 151, 132 reverted with comments. Of the 200 Indians who were invited as referees, 118 (59%) accepted the invitation, whereas of the 336 non-Indian referees, only 33 (9.8%) did. Of the 107 Indian and 25 non-Indian referees who sent their comments, 86 (80.4%) and 19 (88%), respectively, offered useful comments. The median number of days to decision: for desk-rejection was 1 day (range = 0 - 42) days, for rejection after peer-review was 67 (range = 4 - 309) days, and for acceptance was 133.5 (range = 42 - 305) days. Decision has not yet been taken for 14 manuscripts. CONCLUSION: The study provides evidence that it is difficult to get referees. Also, a significant number of authors do not read or follow the ITC. We suggest that the time taken for a decision can be appreciably improved if these issues are addressed.

The effect of contextual information on professional judgment: Reliability and biasability of expert workplace safety inspectors.

INTRODUCTION: A critical aspect of occupational safety is workplace inspections by experts, in which hazards are identified. Scientific research demonstrates that expectation generated by context (i.e., prior knowledge and experience) can bias the judgments of professionals and that individuals are largely unaware when their judgments are affected by bias. METHOD: The current research tested the reliability and biasability of expert safety inspectors' judgments. We used a two-study design (Study 1, N = 83; Study 2, N = 70) to explore the potential of contextual, task-irrelevant, information to bias professionals' judgments. We examined three main issues: (1) the effect that biasing background information (safe and unsafe company history) had on professional regulatory safety inspectors' judgments of a worksite; (2) the reliability of those judgments amongst safety inspectors and (3) inspectors' awareness of bias in their judgments and confidence in their performance. RESULTS: Our findings establish that: (i) inspectors' judgments were biased by historical contextual information, (ii) they were not only biased, but the impact was implicit: they reported being unaware that it affected their judgments, and (iii) independent of our manipulations, inspectors were inconsistent with one another and the variations were not a product of experience. CONCLUSION: Our results are a replication of findings from a host of other professional domains, where honest, hardworking professionals underappreciate the biasing effect of context on their decision making. The current paper situates these findings within the relevant research on safety inspection, cognitive bias and decision making, as well as provides suggestions for bias mitigation in workplace safety inspection. Practical Application: Our results have implications for occupational health and safety given that inspection is an integral aspect of an effective safety system. In addition to our findings, this study contributes to the literature by providing recommendations regarding how to mitigate the effect of bias in inspection.

An institutional audit of the use of novel drugs in pediatric oncology.

BACKGROUND: Significant challenges persist in treating children with rare, relapsed, or refractory malignancies. Novel molecularly targeted drugs promise improved outcomes for these children with reduced toxicity. However, there is often limited evidence to substantiate their clinical efficacy and guide their use. This raises issues for clinical decision-making, ethical concerns surrounding equity of access to these often-expensive agents, and the management of families' expectations for cure. This audit evaluated the off-label use of novel drugs and associated clinical outcomes in order to guide the development of future clinical and ethical guidelines. AIM: To evaluate the patterns in the off-label use of novel drugs for treating childhood cancer and the associated clinical outcomes to guide prospective studies and inform ethical and clinical governance protocols for the use of these agents. METHODS: A retrospective audit was performed for all patients who received novel drugs off-label as treatment for their malignancy at an Australian pediatric oncology center between 2010 and 2019. RESULTS: One hundred patients with 32 unique diagnoses received 133 novel drugs across 124 regimens. Eighty-four patients received these drugs at the second line of treatment or greater. Novel drug median cost was $15 521 AUD (Range: $6.53 AUD to $258 339 AUD) and was primarily funded by the hospital (N = 60/133, 45.1%) or compassionate access from pharmaceutical companies (N = 52/133, 39.1%). Decision-making related to novel drugs was inconsistently documented. Ninety-one of 124 treatment regimens commenced between 2010 and 2019 resulted in objective responses (73.4%), but only 35 were still ongoing upon review in June 2020 (38.5%). Median response duration was 12.6 months (Range: 0-93.2 months). CONCLUSIONS: While novel drugs were largely unable to definitively cure patients, most achieved objective responses. Prospective trials and more rigorous documentation are needed to fully inform the future use of these agents given the heterogeneity of their applications.

Audit of NZ COVID Tracer QR poster display and use in Dunedin.

AIMS: To assess how well the NZ COVID Tracer QR (Quick Response) code poster is displayed by Dunedin businesses and other venues in which groups of people gather indoors, and to calculate the proportions of visitors to those venues who scan the QR code poster. METHODS: We randomly selected 10 cafes, 10 restaurants, 10 bars, five churches, and five supermarkets and visited them at their busiest times. We evaluated the display of QR code posters using a six-item assessment tool that was based on guidance provided to businesses and services by the Ministry of Health, and we counted the number of people who entered each venue during a one-hour period and the number who scanned the QR code poster. RESULTS: All six criteria for displaying QR code posters were met at half of the hospitality venues, four of five churches, and all supermarkets. Scanning proportions were low at all venues (median 10.2%), and at 12 (30%) no visitors scanned; eight of these venues were bars. CONCLUSION: This audit provides a snapshot of the display and scanning of QR code posters in a city with no managed isolation and quarantine facilities and where no COVID-19 cases have been detected for 10 months.

A atuação da auditoria do Sistema Único de Saúde em um estado brasileiro / The performance of the audit of the Unified Health System in a Brazilian state / La acción de la auditoría del Sistema Único de Salud de un estado brasileño

Objetivo: Descrever a atuação da auditoria do Sistema Único de Saúde em um estado brasileiro. Métodos: Estudo descritivo, realizado nos anos de 2017 e 2018, no estado do Rio Grande do Norte, dividido em quatro etapas: mapeamento dos sistemas de auditoria nos municípios; elaboração de questionários para coleta de dados; envio dos questionários para os auditores; e análise dos dados presentes nos questionários. A população do estudo correspondeu aos 66 auditores, entretanto a amostra final pós-coleta resultou em 18 participantes, dada a recusa de participação. Na análise dos dados utilizou-se uma descrição quantitativa simples de números e porcentagens para caracterização da coleta referente aos sistemas de auditorias existentes e, nas respostas obtidas pelos questionários, realizou-se o tratamento dos dados por meio de análise lexicográfica de similitude. Resultados: Dos 167 (100%) municípios do estado, 95 (57%) municípios afirmaram não usufruir desses serviços e em 63 (38%) municípios não foi possível obter informação, de modo que apenas nove (5%) responderam possuir os serviços de auditoria. A compreensão dos auditores acerca do seu processo de trabalho trouxe a importância, o impacto e a necessidade de formação na área. Conclusão: A descrição da atuação dos componentes de auditoria do estado do RN mostrou um cenário de preocupação. A percepção dos profissionais auditores sobre o seu processo de trabalho denotou a grande importância da contribuição desses serviços para a saúde.

Objective: To describe the performance of the Unified Health System audit in a Brazilian state. Methods: Descriptive study, carried out in 2017 and 2018, in the State of Rio Grande do Norte, divided into four stages: mapping of audit systems in the municipalities; elaboration of questionnaires for data collection; sending the questionnaires to the auditors; and analysis of the data present in the questionnaires. The study population corresponded to 66 auditors, yet, the final post-collection sample resulted in 18 participants due to the participant's refusal. In the data analysis, a simple quantitative description of numbers and percentages was used to characterize the collection regarding the existing auditing systems, and in the responses obtained by the questionnaires, the data was processed through a lexicographical similarity analysis. Results: Of the 167 municipalities (100%) in the state, 95 (57%) said they did not use these services, and in 63 (38%) municipalities, it was not possible to obtain information so that only nine (5%) answered that they had the audit services. The auditors' understanding about their work process brought the importance, impact, and need for training in the area. Conclusion: The description of the performance of the audit components in the state of RN showed a scenario of concern. The perception of professional auditors about their work process denoted the great importance of the contribution of these services to health.

Objetivo: Describir la acción de la auditoría del Sistema Único de Salud de un estado brasileño. Métodos: Estudio descriptivo realizado entre los años 2017 y 2018 en el estado de Río Grande del Norte (RN) que ha sido dividido en cuatro etapas: el mapeo de los sistemas de auditoría de los municipios; la elaboración de cuestionarios para la recogida de datos; el envío de los cuestionarios para los auditores; y el análisis de los datos de los cuestionarios. La población del estudio ha sido de 66 auditores, sin embargo, la muestra final post-recogida de datos ha resultado en 18 participantes debido a recusa de participación. Para el análisis de los datos se utilizó una descripción cuantitativa simple de números y porcentajes para la caracterización de los datos de los sistemas de auditorías existentes y, para las respuestas de los cuestionarios se ha realizado un análisis lexicográfico de similitud. Resultados: De los 167 (100%) municipios del estado, 95 (57%) municipios afirmaron no usar de esos servicios y em 63 (38%) de ellos no ha sido posible tener información de manera que solamente nueve (5%) han contestado tener los servicios de auditoría. El entendimiento de los auditores sobre su proceso de trabajo trajo la importancia, el impacto y la necesidad de formación en el área. Conclusión: La descripción de la acción de los componentes de la auditoría del estado de RN mostró um escenario de preocupación. La percepción de los profesionales auditores sobre su proceso de trabajo presentó la gran importancia de la contribución de esos servicios para la salud.

Improving Quality of Care Through a Mandatory Provincial Audit Program: Ontario's Emergency Department Return Visit Quality Program.

The Emergency Department Return Visit Quality Program was launched in Ontario, Canada, to promote a culture of quality. It mandates the province's largest-volume emergency departments (EDs) to audit charts of patients who had a return visit leading to hospital admission, including some of their 72-hour all-cause return visits with admission and all of their 7-day ones with sentinel diagnoses (ie, acute myocardial infarction, subarachnoid hemorrhage, and pediatric sepsis), and submit their findings to a governmental agency. This provides an opportunity to identify possible adverse events and quality issues, which hospitals can then address through quality improvement initiatives. A group of emergency physicians with quality improvement expertise analyzed the submitted audits and accompanying narrative templates, using a general inductive approach to develop a novel classification of recurrent quality themes. Since the Return Visit Quality Program launched in 2016, 125,698 return visits with admission have been identified, representing 0.93% of the 86 participating EDs' 13,559,664 visits. Overall, participating hospitals have conducted 12,852 detailed chart audits, uncovering 3,010 (23.4%) adverse events/quality issues and undertaking hundreds of quality improvement provincewide projects as a result. The inductive analysis revealed 11 recurrent themes, classified into 3 groupings: patient characteristics (ie, patient risk profile and elder care), ED team actions or processes (ie, physician cognitive lapses, documentation, handover/communication between providers, radiology, vital signs, and high-risk medications or medication interactions), and health care system issues (ie, discharge planning/community follow-up, left against medical advice/left without being seen, and imaging/testing availability). The Return Visit Quality Program is the largest mandatory audit program for EDs and provides a novel approach to identify local adverse events/quality issues to target for improved patient safety and quality of care. It provides a blueprint for health system leaders to enable clinicians to develop an approach to organizational quality, as well as for teams to construct an audit system that yields defined issues amenable to improvement.

Manual de organización y funciones de la Unidad de Auditoría Interna / Organization and functions manual of the Internal Audit Unit

El Manual de Organización y Funciones contiene la estructura organizativa, objetivos, funciones y relaciones que orientan el funcionamiento y la delimitación del campo de acción de los diferentes elementos que intervienen en la Unidad de Auditoría Interna

The Organization and Functions Manual contains the organizational structure, objectives, functions and relationships that guide the operation and the delimitation of the field of action of the different elements that intervene in the Internal Audit Unit

[Assessment model for evaluating the preparedness plan for COVID-19 in a tertiary care hospital]. / Modelo de evaluación del plan de respuesta frente a la pandemia de COVID-19 en un hospital de tercer nivel.

BACKGROUND AND PURPOSE: During the first wave of the epidemic caused by SARS-CoV-2, hospitals have come under significant pressure. This scenario of uncertainty, low scientific evidence, and insufficient resources, has generated significant variability in practice between different health organisations. In this context, it is proposed to develop a standards-based model for the evaluation of the preparedness and response system against COVID-19 in a tertiary hospital. MATERIALS AND METHODS: The study, carried out at the University Hospital of Vall d'Hebron in Barcelona (Spain), was designed in two phases: 1) development of the standards-based model, by means of a narrative review of the literature, analysis of plans and protocols implemented in the hospital, a review process by expert professionals from the centre, and plan of action, and 2) validation of usability and usefulness of the model through self-assessment and hospital audit. RESULTS: The model contains 208 standards distributed into nine criteria: leadership and strategy; prevention and infection control; management of professionals and skills; public areas; healthcare areas; areas of support for diagnosis and treatment; logistics, technology and works; communication and patient care; and information and research systems. The evaluation achieved 85.2% compliance, with 42 areas for improvement and 96 good practices identified. CONCLUSIONS: Implementing a standards-based model is a useful tool to identify areas for improvement and good practices in COVID-19 preparedness and response plans in a hospital. In the current context, it is recommended to repeat this methodology in other non-hospital and public health settings.

Incident Reporting System in an Italian University Hospital: A New Tool for Improving Patient Safety.

Clinical risk management constitutes a central element in the healthcare systems in relation to the reverberation that it establishes, and as regards the optimization of clinical outcomes for the patient. The starting point for a right clinical risk management is represented by the identification of non-conforming results. The aim of the study is to carry out a systematic analysis of all data received in the first three years of adoption of a reporting system, revealing the strengths and weaknesses. The results emerged showed an increasing trend in the number of total records. Notably, 86.0% of the records came from the medical category. Moreover, 41.0% of the records reported the possible preventive measures that could have averted the event and in 30% of the reports are hints to be put in place to avoid the repetition of the events. The second experimental phase is categorizing the events reported. Implementing the reporting system, it would guarantee a virtuous cycle of learning, training and reallocation of resources. By sensitizing health workers to a correct use of the incident reporting system, it could become a virtuous error learning system. All this would lead to a reduction in litigation and an implementation of the therapeutic doctor-patient alliance.

[Construction of data remote monitoring and auditing system for clinical trials].

Clinical trial management system is independently developed by our hospital, which basically realized the whole process management and data collection of clinical trials. Based on the platform, the functional architecture of data remote monitoring and auditing was established. By desensitizing and encrypting of data, the project and subject hologram were visualized to facilitate to review of data. The data remote monitoring and auditing cloud platform adopts the B/S architecture pattern. Users register to apply for an account through the cloud platform, and access to the account via HTTPS security protocol. The authorized users were able to view the relevant items online to ensure the secure data transmission and easy operating. The electronic management of data is the direction of future efforts. By compliance with laws and regulations, the remote monitoring/auditing can be realized, and the data security and personal privacy can be ensured with the application of information technology. In this paper, the feasibility of remote monitoring/auditing mode is explored, specific technical schemes and system functions are suggested, and the realization scenarios are conceived in case of major public health emergencies.