Auditing orthopaedic audit

Improving the reporting of orthodontic clinical audits: an evaluation

Aims The aim of this study was to evaluate the reporting of orthodontic audits published between 2013-2019 following the introduction of a submission template in 2015.Methods An audit reporting checklist was developed, with each audit independently assessed by two assessors. Based on the previous quality checklist, an overall score of 4 or less represented poor reporting, 5-8 fair reporting and 9 or greater good reporting. All data variables were collected in a pre-piloted Excel data collection sheet.Results One hundred and fifty-nine audits were identified. A range of reporting scores were evident. The overall mean score was 10.1 (SD 1.5). Reporting scores showed improvement during the study timeframe, with a general increase in scores evident from 2015. Higher scores were achieved by multi-cycle audits (coefficient [coef]: 2.0, 95% CI: 1.38, 2.62, p <0.001). Lower scores were achieved by partial audits (coef: -1.8, 95% CI: -2.23, -1.36, p <0.001), but scores increased every year (coef: 0.2, 95% CI: 0.12, 0.27, p <0.001).Conclusions The reporting of orthodontic audits is rated as good, with yearly improvement in scores evident. The introduction of a submission template had a positive effect on the reporting of audits. Recommendations to further improve the quality of audits are outlined.

A quality improvement project to assess the use of preventative measures against acute alveolar osteitis

Aims

A quality improvement project was conducted in a General Dental Practice environment. The aim was to reduce the rate of Acute Alveolar Osteitis, which was locally found to be at 19.4%.

Methods

A range of quality improvement tools were utilised to determine and measure potential interventions, and the results from the initial Plan-Do-Study-Act cycle utilising perioperative 0.2% Chlorhexidine as a preventative method are presented.

Results

The use of perioperative 0.2% Chlorhexidine mouthwash showed an absolute risk reduction of 6.2%.

Discussion

Generalisation from the results is highly dependent on local factors, although the favourable reduction in acute alveolar osteitis and cost savings found supported the project.

Conclusions

This project highlights the strengths of Quality Improvement methodologies in implementing and assessing changes to improve service provision and patient outcomes.

Frequency of orthopedic problems among patients attending an orthopedic outpatient department: a retrospective analysis of 23 495 cases

BACKGROUND

Baseline statistical data on the current orthopedic outpatient load was needed to highlight the more frequent orthopedic problems.

OBJECTIVE

Describe the frequency of orthopedic problems among patients attending the orthopedic outpatient department (OPD).

DESIGN

Descriptive, retrospective medical record review.

SETTINGS

Four-year data (2013-2017) was extracted from the computer records of patients attending the orthopedics OPD.

PATIENTS AND METHODS

Computer entries of OPD visits were found, and after excluding incomplete and follow up data, age, gender, and diagnoses were described.

MAIN OUTCOME MEASURES

Frequency of orthopedic diagnoses.

SAMPLE SIZE AND CHARACTERISTICS

23 495 patients, 19 377 (82.5%) males and 4118 (17.5%) females, majority (18 155, 77.3%) 19-50 years of age.

RESULTS

Lower back pain (26%), tendinopathies and enthesopathies (18.3%), and bone fractures (11%) were the three common problems followed by arthritis (10.6%), nonspecific body ache (7.4%), and soft tissue injuries (9.9%). Others prominent diagnoses were ligamentous sprains (6.4%), neck-related problems (4.8%), joint stiffness (1.8%) and sports injuries (1%).

CONCLUSION

This overview of the orthopedic problems in a secondary care hospital may aid in the formulation of better protocols and strategies to manage orthopedic disorders in a healthcare setting.

LIMITATIONS

Retrospective and only included the primary diagnosis.

CONFLICT OF INTEREST

None.

Surgical audit: are we not closing the loop?

Purpose

A clinical audit is a key component of the clinical governance framework. The rate of audit completion in general surgery has not been investigated. The purpose of this paper is to assess the rates of audit activity and completion and explore the barriers to successful audit completion.

Design/methodology/approach

This was a multi-centre study evaluating current surgical audit practice. A standardised audit proforma was designed. All clinical audits in general surgery during a two-year period were identified and retrospectively reviewed. Data held by the audit departments were collated, and individual audit teams were contacted to verify the data accuracy. Audit teams failing to complete the full audit cycle with a re-audit were asked to explain the underlying reasons behind this.

Findings

Of the six trusts approached, two refused to participate, and one failed to initiate the project. A total of 39 audits were registered across three surgical directorates. Only 15 out of 39 audits completed at least one audit cycle, with 4 deemed of no value to re-audit. Only seven audits were completed to re-audit. Achieving a publication or a presentation was the most cited reason for not completing the audit loop.

Originality/value

This study demonstrates that the poor rates of audit completion rate found in other areas of clinical medicine pervade general surgery. Improved completion of an audit is essential and strategies to achieve this are urgently needed.

Training in quality improvement for the next generation of psychiatrists

Quality improvement (QI) projects have been shown to positively influence patient care. They provide opportunities for trainees to present and publish their work locally and nationally, and to gain valuable leadership and management experience. We describe a pilot project to engage in QI trainees across a National Health Service trust and a school of psychiatry. After the first year of this programme over half of psychiatry trainees in the school (58% of core trainees and 47% of advanced trainees) are participating in 28 individual QI projects and QI project methodology is to become embedded in the core psychiatry training course. Specialty doctors, consultants, foundation doctors, general practitioner trainees, medical students and the wider multidisciplinary team have all become engaged alongside trainees, working with patients and their families to identify problems to tackle and ideas to test.

Audit of orthopaedic audits in an english teaching hospital: are we closing the loop?

BACKGROUND

Clinical audit is an important tool to improve patient care and outcomes in health service. A significant proportion of time and economic resources are spent on activities related to clinical audit. Completion of audit cycle is essential to confirm the improvements in healthcare delivery. We aimed this study to evaluate audits carried out within trauma and orthopaedic unit of a teaching hospital over the last 4 years, and establish the proportions which were re-audited as per recommendations.

METHODS

Data was collected from records of the clinical audit department. All orthopaedic audit projects from 2005 to 2009 were included in this study. The projects were divided in to local, regional and national audits. Data regarding audit lead clinicians, completion and presentation of projects, recommendations and re-audits was recorded.

RESULTS

Out of 61 audits commenced during last four years, 19.7% (12) were abandoned, 72.1% (44) were presented and 8.2 % (5) were still ongoing. The audit cycle was completed in only 29% (13) projects.

CONCLUSION

Change of junior doctors every 4~6 months is related to fewer re-audits. Active involvement by supervising consultant, reallocation of the project after one trainee has finished, and full support of audit department may increase the ratio of completion of audit cycles, thereby improving the patient care.