RESUMO
To assess adherence to standard clinical practice for the diagnosis and treatment of patients undergoing prostate cancer (PCa) radiotherapy in four European countries using clinical audits as part of the international IROCA project. Multi-institutional, retrospective cohort study of 240 randomly-selected patients treated for PCa (n = 40/centre) in the year 2015 at six European hospitals. Clinical indicators applicable to general and PCa-specific radiotherapy processes were evaluated. All data were obtained directly from medical records. The audits were performed in the year 2017. Adherence to clinical protocols and practices was satisfactory, but with substantial inter-centre variability in numerous variables, as follows: staging MRI (range 27.5-87.5% of cases); presentation to multidisciplinary tumour board (2.5-100%); time elapsed between initial visit to the radiation oncology department and treatment initiation (42-102.5 days); number of treatment interruptions ≥ 1 day (7.5-97.5%). The most common deviation from standard clinical practice was inconsistent data registration, mainly failure to report data related to diagnosis, treatment, and/or adverse events. This clinical audit detected substantial inter-centre variability in adherence to standard clinical practice, most notably inconsistent record keeping. These findings confirm the value of performing clinical audits to detect deviations from standard clinical practices and procedures.
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Auditoria Clínica/normas , Auditoria Médica/normas , Neoplasias da Próstata/radioterapia , Radioterapia (Especialidade)/normas , Idoso , Europa (Continente) , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologiaRESUMO
BACKGROUND: Maternal Death Reviews (MDR) can assist in formulating prevention strategies to reduce maternal mortality. To support MDR, an adequate MDR instrument is required to accurately identify the underlying causes of maternal deaths. We conducted a systematic review and meta-analysis to determine the reliability of maternal death instruments for conducting the MDR process. METHOD: Three databases: PubMed, ProQuest and EBSCO were systematically searched to identify related research articles published between January 2004 and July 2019. The review and meta-analysis involved identification of measurement tools to conduct MDR in all or part of maternal audit. Eligibiliy and quality of studies were evaluated using the Modified Quality Appraisal of Diagnostic Reliability (QAREL) Checklist: Reliability Studies. RESULTS: Overall, 242 articles were identified. Six articles examining the instrument used for MDR in 4 countries (4 articles on verbal autopsy (VA) and 2 articles on facility-based MDR) were included. None of studies identified reliability in evaluation instruments assessing maternal audit cycle as a comprehensive approach. The pooled kappa for the MDR instruments was 0.72 (95%CI:0.43-0.99; p < 0.001) with considerable heterogeneity (I2 = 96.19%; p < 0.001). Subgroup analysis of MDR instruments showed pooled kappa in VA of 0.89 (95%CI:0.52-1.25) and facility-based MDR of 0.48 (95%CI:0.15-0.82). Meta-regression analysis tended to show the high heterogeneity was likely associated with sample sizes, regions, and year of publications. CONCLUSIONS: The MDR instruments appear feasible. Variation of the instruments suggest the need for judicious selection of MDR instruments by considering the study population and assessment during the target periods.
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Causas de Morte , Auditoria Clínica , Mortalidade Materna , Auditoria Clínica/métodos , Auditoria Clínica/normas , Feminino , Humanos , Morte Materna , Gravidez , Complicações na Gravidez/mortalidade , Reprodutibilidade dos TestesRESUMO
BACKGROUND: National Clinical Audits (NCAs) are a well-established quality improvement strategy used in healthcare settings. Significant resources, including clinicians' time, are invested in participating in NCAs, yet there is variation in the extent to which the resulting feedback stimulates quality improvement. The aim of this study was to explore the reasons behind this variation. METHODS: We used realist evaluation to interrogate how context shapes the mechanisms through which NCAs work (or not) to stimulate quality improvement. Fifty-four interviews were conducted with doctors, nurses, audit clerks and other staff working with NCAs across five healthcare providers in England. In line with realist principles we scrutinised the data to identify how and why providers responded to NCA feedback (mechanisms), the circumstances that supported or constrained provider responses (context), and what happened as a result of the interactions between mechanisms and context (outcomes). We summarised our findings as Context+Mechanism = Outcome configurations. RESULTS: We identified five mechanisms that explained provider interactions with NCA feedback: reputation, professionalism, competition, incentives, and professional development. Professionalism and incentives underpinned most frequent interaction with feedback, providing opportunities to stimulate quality improvement. Feedback was used routinely in these ways where it was generated from data stored in local databases before upload to NCA suppliers. Local databases enabled staff to access data easily, customise feedback and, importantly, the data were trusted as accurate, due to the skills and experience of staff supporting audit participation. Feedback produced by NCA suppliers, which included national comparator data, was used in a more limited capacity across providers. Challenges accessing supplier data in a timely way and concerns about the quality of data submitted across providers were reported to constrain use of this mode of feedback. CONCLUSION: The findings suggest that there are a number of mechanisms that underpin healthcare providers' interactions with NCA feedback. However, there is variation in the mode, frequency and impact of these interactions. Feedback was used most routinely, providing opportunities to stimulate quality improvement, within clinical services resourced to collect accurate data and to maintain local databases from which feedback could be customised for the needs of the service.
Assuntos
Auditoria Clínica/normas , Retroalimentação , Confiabilidade dos Dados , Atenção à Saúde , Inglaterra , Pessoal de Saúde/psicologia , Humanos , Motivação , Melhoria de QualidadeRESUMO
BACKGROUND: The potentials of audit and feedback (AF) to improve healthcare are currently not exploited. To unlock the potentials of AF, this study focused on the process of making sense of audit data and translating data into actionable feedback by studying a specific AF-case: limiting antimicrobial resistance (AMR). This was done via audit and feedback of AMR prevention measures (APM) that are executed by healthcare workers (HCW) in their day-to-day contact with patients. This study's aim was to counterbalance the current predominantly top-down, expert-driven audit and feedback approach for APM, with needs and expectations of HCW. METHODS: Qualitative semi-structured interviews were held with sixteen HCW (i.e. physicians, residents and nurses) from high-risk AMR departments at a regional hospital in The Netherlands. Deductive coding was succeeded by open and axial coding to establish main codes, subcodes and variations within codes. RESULTS: HCW demand insights from audits into all facets of APM in their working routines (i.e. diagnostics, treatment and infection control), preferably in the form of simple and actionable feedback that invites interdisciplinary discussions, so that substantiated actions for improvement can be implemented. AF should not be seen as an isolated ad-hoc intervention, but as a recurrent, long-term, and organic improvement strategy that balances the primary aims of HCW (i.e. improving quality and safety of care for individual patients and HCW) and AMR-experts (i.e. reducing the burden of AMR). CONCLUSIONS: To unlock the learning and improvement potentials of audit and feedback, HCW' and AMR-experts' perspectives should be balanced throughout the whole AF-loop (incl. data collection, analysis, visualization, feedback and planning, implementing and monitoring actions). APM-AF should be flexible, so that both audit (incl. collecting and combining the right data in an efficient and transparent manner) and feedback (incl. persuasive and actionable feedback) can be tailored to the needs of various target groups. To balance HCW' and AMR-experts' perspectives a participatory holistic AF development approach is advocated.
Assuntos
Auditoria Clínica/métodos , Farmacorresistência Bacteriana , Pessoal de Saúde , Controle de Infecções/métodos , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Auditoria Clínica/normas , Feminino , Hospitais/estatística & dados numéricos , Humanos , Controle de Infecções/normas , Masculino , Pessoa de Meia-Idade , Países Baixos , Melhoria de Qualidade/normasRESUMO
Background: The Tokyo Guidelines were published in 2007 and updated in 2013 and 2018, with recommendations for the diagnosis and management of acute cholecystitis. We assessed guideline adherence at our academic centre and its impact on patient outcomes. Methods: This is a retrospective chart review of patients with acute calculous cholecystitis who underwent cholecystectomy at our institution between November 2013 and March 2015. Severity of cholecystitis was graded retrospectively if it had not been documented preoperatively. Compliance with the Tokyo Guidelines' recommendations on antibiotic use and time to operation was recorded. Cholecystitis severity groups were compared statistically, and logistic regression was used to determine predictors of complications. Results: One hundred and fifty patients were included in the study. Of these, 104 patients were graded as having mild cholecystitis, 45 as having moderate cholecystitis, and 1 as having severe cholecystitis. Severity was not documented preoperatively for any patient. Compliance with antibiotic recommendations was poor (18.0%) and did not differ by cholecystitis severity (p = 0.90). Compliance with the recommendation on time to operation was 86.0%, with no between-group differences (p = 0.63); it improved when an acute care surgery team was involved (91.0% v. 76.0%, p = 0.025). On multivariable analysis, comorbidities (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.19-1.85, p < 0.001) and conversion to laparotomy (OR 13.45, 95% CI 2.16-125.49, p = 0.01) predicted postoperative complications, while severity of cholecystitis, antibiotic compliance and time to operation had no effect. Conclusion: In this study, compliance with the Tokyo Guidelines was acceptable only for time to operation. Although the poor compliance with recommendations relating to documentation of severity grading and antibiotic use did not have a negative affect on patient outcomes, these recommendations are important because they facilitate appropriate antibiotic use and patient risk stratification.
Contexte: Les Tokyo Guidelines, publiées en 2007, puis mises à jour en 2013 et en 2018, contiennent des recommandations sur le diagnostic et la prise en charge de la cholécystite aiguë. Nous avons évalué le respect de ces lignes directrices dans notre centre universitaire et son incidence sur les issues pour les patients. Méthodes: Ce document est une revue rétrospective de dossiers des patients atteints de cholécystite aiguë calculeuse qui ont subi une cholécystectomie dans notre établissement entre novembre 2013 et mars 2015. La gravité de la cholécystite a été établie de manière rétrospective si elle n'avait pas été documentée avant l'opération. Le respect des recommandations des Tokyo Guidelines concernant le recours à des antibiotiques et la durée de l'opération a été étudié. Nous avons comparé statistiquement les groupes de gravité de la cholécystite, et avons utilisé une régression logistique pour déterminer les prédicteurs de complications. Résultats: Au total, 150 patients ont été inclus dans l'étude. Parmi eux, 104 avaient une cholécystite légère, 45, une cholécystite modérée et 1, une cholécystite grave. La gravité de la maladie n'avait été documentée avant l'opération pour aucun patient. Le respect des recommandations sur les antibiotiques était faible (18,0 %) et ne variait pas selon la gravité de la cholécystite (p = 0,90). Le respect des recommandations sur la durée de l'opération était de 86,0 %, sans différence entre les groupes (p = 0,63); il était toutefois plus élevé lorsqu'une équipe de soins chirurgicaux aigus participait aux soins (91,0 % c. 76,0 %, p = 0,025). L'analyse multivariée a permis de déterminer que les comorbidités (rapport des cotes [RC] 1,47, intervalle de confiance [IC] de 95 % 1,191,85, p < 0,001) et la conversion en laparotomie (RC 13,45, IC de 95 % 2,16125,49, p = 0,01) étaient des prédicteurs de complications postopératoires, alors que la gravité de la cholécystite et le respect des recommandations sur les antibiotiques et la durée de l'opération n'avaient pas d'effet. Conclusion: Dans cette étude, le respect des Tokyo Guidelines était acceptable seulement pour la durée de l'opération. Bien qu'un faible respect des recommandations quant à la documentation de la gravité et à l'utilisation d'antibiotiques n'ait pas eu d'effets négatifs sur les issues pour les patients, ces recommandations sont importantes parce qu'elles favorisent l'utilisation appropriée des antibiotiques et une bonne stratification du risque pour le patient.
Assuntos
Antibacterianos/uso terapêutico , Colecistectomia/normas , Colecistite Aguda/cirurgia , Auditoria Clínica/normas , Fidelidade a Diretrizes , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colúmbia Britânica/epidemiologia , Colecistite Aguda/diagnóstico , Colecistite Aguda/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: Highly publicized safety issues arising from poor sterile compounding practices in facilities around the United States have garnered substantial attention in recent years. This attention has led to increased scrutiny of health systems by regulatory bodies, new regulatory requirements, and changes to existing regulations or their interpretation. Health systems are often resource constrained, and the added work resulting from this scrutiny challenges pharmacy departments in meeting regulatory requirements and United States Pharmacopeia chapter 797 standards for sterile compounding. This article describes the creation of a dedicated compounding compliance team (CCT) and the team's responsibilities in support of pharmacy operations in achieving compliance with those standards. SUMMARY: Visits to our organization by several regulatory bodies resulted in findings that required substantial work in order to achieve compliance with sterile compounding standards. Given the number and complexity of findings and the need for timely resolution, it was felt that specialized staff were needed to understand, evaluate, and correct identified deficiencies and help the already overburdened staff and leadership comply with existing standards. A CCT was formed, and work was simultaneously initiated on ensuring proper credentialing and training of all compounding staff, development of standard operating procedures, improvements in facilities, environmental monitoring, equipment certifications, practice auditing, and documentation. Key activities of the team included strategic planning, building relationships, communicating with stakeholders, self-education, and record keeping. Key partners included environmental services, facilities, and infection prevention and control personnel and departmental staff and leaders. CONCLUSION: The formation and collaborative work of a CCT at an academic medical center was successful in changing the culture of the organization and achieving compliance during visits from several regulatory agencies.
Assuntos
Auditoria Clínica/organização & administração , Composição de Medicamentos/normas , Contaminação de Medicamentos/prevenção & controle , Serviço de Farmácia Hospitalar/organização & administração , Centros Médicos Acadêmicos , Auditoria Clínica/normas , Comunicação , Humanos , Motivação , Cultura Organizacional , Serviço de Farmácia Hospitalar/normas , Estados UnidosRESUMO
BACKGROUND: In activity based funding systems, the misclassification of inpatient episode Diagnostic Related Groups (DRGs) can have significant impacts on the revenue of health care providers. Weakly informative Bayesian models can be used to estimate an episode's probability of DRG misclassification. METHODS: This study proposes a new, Hybrid prior approach which utilises guesses that are elicited from a clinical coding auditor, switching to non-informative priors where this information is inadequate. This model's ability to detect DRG revision is compared to benchmark weakly informative Bayesian models and maximum likelihood estimates. RESULTS: Based on repeated 5-fold cross-validation, classification performance was greatest for the Hybrid prior model, which achieved best classification accuracy in 14 out of 20 trials, significantly outperforming benchmark models. CONCLUSIONS: The incorporation of elicited expert guesses via a Hybrid prior produced a significant improvement in DRG error detection; hence, it has the ability to enhance the efficiency of clinical coding audits when put into practice at a health care provider.
Assuntos
Teorema de Bayes , Auditoria Clínica/normas , Codificação Clínica/normas , Interpretação Estatística de Dados , Grupos Diagnósticos Relacionados/classificação , Grupos Diagnósticos Relacionados/normas , Erros de Diagnóstico/prevenção & controle , Prova Pericial/estatística & dados numéricos , Humanos , Funções VerossimilhançaRESUMO
BACKGROUND: User-centered design (UCD) methods are well-established techniques for creating useful artifacts, but few studies illustrate their application to clinical feedback reports. When used as an implementation strategy, the content of feedback reports depends on a foundational audit process involving performance measures and data, but these important relationships have not been adequately described. Better guidance on UCD methods for designing feedback reports is needed. Our objective is to describe the feedback report design method for refining the content of prototype reports. METHODS: We propose a three-step feedback report design method (refinement of measures, data, and display). The three steps follow dependencies such that refinement of measures can require changes to data, which in turn may require changes to the display. We believe this method can be used effectively with a broad range of UCD techniques. RESULTS: We illustrate the three-step method as used in implementation of goals of care conversations in long-term care settings in the U.S. Veterans Health Administration. Using iterative usability testing, feedback report content evolved over cycles of the three steps. Following the steps in the proposed method through 12 iterations with 13 participants, we improved the usability of the feedback reports. CONCLUSIONS: UCD methods can improve feedback report content through an iterative process. When designing feedback reports, refining measures, data, and display may enable report designers to improve the user centeredness of feedback reports.
Assuntos
Auditoria Clínica/organização & administração , Retroalimentação , Instituições Residenciais/organização & administração , United States Department of Veterans Affairs/organização & administração , Auditoria Clínica/normas , Humanos , Ciência da Implementação , Planejamento de Assistência ao Paciente , Melhoria de Qualidade/organização & administração , Instituições Residenciais/normas , Estados Unidos , United States Department of Veterans Affairs/normasRESUMO
The objective of this commentary is to provide a framework and ethical justification for a more proactive model of continual, active monitoring of research. We outline what the increased monitoring should consist of, and the practical constraints associated with executing these monitoring functions. We also defend the idea that adequate post-initial-review monitoring requires greater REB involvement, rather than trust and researcher's assurances.
Assuntos
Auditoria Clínica/organização & administração , Ensaios Clínicos como Assunto/ética , Ensaios Clínicos como Assunto/organização & administração , Comitês de Ética em Pesquisa/organização & administração , Auditoria Clínica/normas , Ensaios Clínicos como Assunto/normas , Comitês de Ética em Pesquisa/normas , HumanosRESUMO
OBJECTIVE: The aim of this study was to explore the prevalence of congenital HIV infection of neonates at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between 2015 and 2017, as well as compare the HIV PCR positive and HIV PCR negative neonates. RESULTS: A total number of 1443 HIV exposed neonates was examined for the study period out of a total of 5029 admissions (HIV exposure 28.6%) The study found that the rate of HIV transmission at birth was 2.52%. The majority of infants had low birth weight and were also born prematurely. These results show that, despite the introduction of the extended mother to child transmission programme, HIV transmission is high.
Assuntos
Auditoria Clínica/estatística & dados numéricos , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Centros de Atenção Terciária , Auditoria Clínica/métodos , Auditoria Clínica/normas , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Masculino , Triagem Neonatal/métodos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Estudos Retrospectivos , África do Sul/epidemiologiaRESUMO
Invasive fungal disease (IFD) is responsible for significant morbidity and mortality in patients with acute leukemia. Antifungal stewardship (AFS) programs are utilized in this patient group but have been infrequently evaluated in clinical practice. Adults diagnosed with acute leukemia at an Australian tertiary center over two years were identified, with subsequent auditing of IFD prophylaxis and treatment, and identification of further opportunities for AFS activities. Proven or probable IFD occurred in 6% of cases, including 14% of acute lymphoblastic leukemia (ALL) patients and 6% of acute myeloid leukemia (AML) patients. Mold-active antifungal prophylaxis was used in 84% of cases overall, including in 94% of AML cases and 23% of ALL cases. Local auditing identified target areas for AFS in this complex patient cohort, including modification of clinical guidelines, enhanced patient screening, improved access to fungal diagnostics and therapeutic drug monitoring, and the establishment of a specialized, embedded AFS program.
Assuntos
Auditoria Clínica , Leucemia/complicações , Leucemia/epidemiologia , Micoses/epidemiologia , Micoses/etiologia , Antifúngicos/uso terapêutico , Gestão de Antimicrobianos , Auditoria Clínica/métodos , Auditoria Clínica/normas , Feminino , Humanos , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/epidemiologia , Infecções Fúngicas Invasivas/etiologia , Infecções Fúngicas Invasivas/prevenção & controle , Leucemia/tratamento farmacológico , Masculino , Micoses/tratamento farmacológico , Micoses/prevenção & controle , Garantia da Qualidade dos Cuidados de Saúde , Melhoria de Qualidade , Centros de Atenção Terciária/normas , Resultado do TratamentoRESUMO
BACKGROUND: Audit and feedback (A&F) is a common quality improvement strategy with highly variable effects on patient care. It is unclear how A&F effectiveness can be maximised. Since the core mechanism of action of A&F depends on drawing attention to a discrepancy between actual and desired performance, we aimed to understand current and best practices in the choice of performance comparator. METHODS: We described current choices for performance comparators by conducting a secondary review of randomised trials of A&F interventions and identifying the associated mechanisms that might have implications for effective A&F by reviewing theories and empirical studies from a recent qualitative evidence synthesis. RESULTS: We found across 146 trials that feedback recipients' performance was most frequently compared against the performance of others (benchmarks; 60.3%). Other comparators included recipients' own performance over time (trends; 9.6%) and target standards (explicit targets; 11.0%), and 13% of trials used a combination of these options. In studies featuring benchmarks, 42% compared against mean performance. Eight (5.5%) trials provided a rationale for using a specific comparator. We distilled mechanisms of each comparator from 12 behavioural theories, 5 randomised trials, and 42 qualitative A&F studies. CONCLUSION: Clinical performance comparators in published literature were poorly informed by theory and did not explicitly account for mechanisms reported in qualitative studies. Based on our review, we argue that there is considerable opportunity to improve the design of performance comparators by (1) providing tailored comparisons rather than benchmarking everyone against the mean, (2) limiting the amount of comparators being displayed while providing more comparative information upon request to balance the feedback's credibility and actionability, (3) providing performance trends but not trends alone, and (4) encouraging feedback recipients to set personal, explicit targets guided by relevant information.
Assuntos
Auditoria Clínica/normas , Prática Clínica Baseada em Evidências , Feedback Formativo , Modelos Teóricos , Avaliação de Processos em Cuidados de Saúde , Melhoria de Qualidade/normas , Benchmarking , Pesquisa sobre Serviços de Saúde , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Intercostal chest catheter (ICC) insertion is a common hospital procedure with attendant risks including life-threatening complications such as pneumothorax and visceral damage. AIM: To investigate the effect of a quality improvement (QI) initiative on complications associated with inpatient thoracostomy tube insertion. METHODS: Following an audit of ICC complications in inpatients over a 2-year period we implemented a comprehensive QI programme. This involved formal training in and mandatory use of thoracic ultrasound, standardisation of the procedure and documentation, a dedicated procedure room with nurses trained in assisting ICC insertion and senior supervision for medical staff. An audit over 2 years post-implementation of the QI protocol was compared with pre-implementation results. RESULTS: A total of 103 cases were reviewed pre-implementation and 105 cases were reviewed post-implementation of the QI programme. All procedures following the QI initiative were image guided compared to 23.3% of cases pre-implementation. The rate of developing a pneumothorax requiring intervention post-implementation was less than pre-implementation (1.9% vs 5.8% (P = 0.023). Post-implementation, there were no instances of dry taps, viscera perforation, clinically significant bleeding or wrong side ICC insertion and documentation improved. CONCLUSION: QI initiative applied to thoracostomy tube insertion in hospital inpatients can reduce complications and improve procedure documentation.
Assuntos
Tubos Torácicos/normas , Hospitalização , Segurança do Paciente/normas , Pneumotórax/prevenção & controle , Melhoria de Qualidade/normas , Toracostomia/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Tubos Torácicos/efeitos adversos , Auditoria Clínica/métodos , Auditoria Clínica/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Pneumotórax/diagnóstico , Pneumotórax/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Toracostomia/efeitos adversos , Resultado do Tratamento , Adulto JovemRESUMO
Clinical practice guidelines (CPG) have been shown to decrease practice variation, reduce resource use, and improve patient outcomes. The purpose of this study was to audit compliance of a pediatric complicated appendicitis CPG to identify areas for continued improvement. A comprehensive complicated appendicitis CPG was implemented in a children's hospital system. Outcomes were compared for 48 months pre- (01/2012 to 12/2015) and 28 months post-implementation (01/2016 to 04/2018). A detailed compliance audit was nested within the post-implementation period in 60 consecutive patients from 11/2017 to 03/2018. Feedback was provided to care providers throughout the audit. Overall, 2370 children with complicated appendicitis were identified (1366 pre-CPG and 1004 post-CPG). The CPG resulted in decrease in mean length of stay from 5.3 days to 4.5 days (p = 0.751), postoperative returns to the system (13.0% to 10.1%, p = 0.030), and readmissions (5.3% to 4.3%, p = 0.237). Central line use decreased from 11.2% to 5.5% (p < 0.001) and antibiotic selection improved from 47.0% to 84.1% (p < 0.001). On audit, only 15% (9/60) had full CPG compliance and 49% (29/60) received recommended antibiotic durations. Compliance increased from 7% to 23% with audit-derived feedback. After stratifying by appendicitis severity, audits resulted in improved antibiotic duration compliance for patients with severe appendicitis (38.1% to 66.7%, p = 0.07) and postoperative ambulation for patients with lower grade disease (37.5% to 83.3%, p = 0.06). Audit cycles on a complicated appendicitis CPG and feedback to providers improved CPG compliance and more granular outcomes of interest.
Assuntos
Apendicite/cirurgia , Auditoria Clínica/normas , Fidelidade a Diretrizes/normas , Hospitais Pediátricos/normas , Guias de Prática Clínica como Assunto/normas , Adolescente , Antibacterianos/administração & dosagem , Criança , Feminino , Humanos , Tempo de Internação , Masculino , Readmissão do Paciente , Melhoria de Qualidade/normas , Índice de Gravidade de DoençaRESUMO
PROGRAMME FOR THE CONTINUOUS IMPROVEMENT OF TEAM WORK TO IMPROVE THE SAFETY OF PATIENT CARE.: The analysis of the causes of care-related adverse events shows that in order to improve safety, human and organisational factors must be taken into account, and action taken to target team work. Based on this observation, the French National Health Authority designed and tested with volunteer teams the Programme for the Continuous Improvement of Team Work, between 2013 and 2016. This programme provides professionals with a series of tools and methods to improve they way they work in a team. Eventually, the implementation of the programme will be a requirement for the certification of healthcare facilities.
Assuntos
Equipe de Assistência ao Paciente/organização & administração , Segurança do Paciente , Melhoria de Qualidade/organização & administração , Auditoria Clínica/métodos , Auditoria Clínica/normas , Humanos , Equipe de Assistência ao Paciente/normas , Segurança do Paciente/normas , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/normasRESUMO
OBJECTIVE: To study to what extent internal audit results of hospitals can be shared with external supervisors and the necessary preconditions for this. DESIGN: Qualitative interview research. METHOD: In 2013-2015, we interviewed 36 individuals from six hospitals: 12 department heads (all medical specialists), 10 department managers; five members of the Board of Directors; five members of the Supervisory Board and the four account-holding hospital inspectors. We also performed a focus group interview with six other hospital inspectors of the Health and Youth Care Inspectorate. The interview data were analysed thematically. RESULTS: The interviewees pointed out that there is no coordination between internal and external supervision. They were in favour of sharing internal audit results with external supervisors to reduce the supervisory burden. They stated that internal audits give insight into quality improvements, how hospital directors govern quality and safety and the culture of improvement within healthcare provider teams. With this information, the Inspectorate can assess to what extent hospitals are learning organisations. The interviewees mentioned the following preconditions for sharing audit results: reliable and risk-based information about quality and safety, collected by expert, trained auditors and careful use of this information by the Inspectorate in order to maintain openness among audited healthcare providers. CONCLUSION: Internal audit results can be shared conditionally with external supervisors like the Health and Youth Care Inspectorate. When internal audit results show that hospitals are open, learning and self-cleansing organisations, the Inspectorate can supervise the hospitals remotely and supervisory burden will probably be reduced.
Assuntos
Auditoria Clínica/normas , Administração Hospitalar/normas , Hospitais/normas , Qualidade da Assistência à Saúde/normas , Humanos , Países Baixos , Melhoria de QualidadeRESUMO
Purpose The purpose of this paper is to assess nursing staff perceptions regarding the clinical audit tool used for relicensing inspections within private hospitals in eThekwini district. Design/methodology/approach An exploratory sequential mixed method research design was used with a qualitative first phase involving a total population of 40 nurse managers through purposive sampling. Nurse managers ( n=24) were interviewed. This was followed by a quantitative phase in which a structured questionnaire was administered to nurses ( n=270) who were randomly sampled for the study from ( n=4) hospitals. Documentation review, a third phase was used to corroborate the findings of the first two phases of the study. Findings The results of the study showed that the participants perceptions of the selected private hospitals in eThekwini district is that they have not fully implemented the approach to practice standards and healthcare audits in relation to three clinical domains of the National Core Standards and the Batho Pele principles. These findings were significant and denoted the need for a standardised clinical audit tool for private hospitals in eThekwini district. Research limitations/implications This study was confined to an independent group of hospitals and the findings may not be suitable for generalising across all private hospitals in eThekwini district. Originality/value These findings led to the development of a clinical audit tool with measurements representing elements of care that are critical to the provision of safe, quality health care services.