Audit of emergency obstetric referrals at a Tertiary Center in Kano

Introduction: Maternal and perinatal deaths could be prevented if functional referral systems are in place to allow pregnant women to get appropriate services when complications occur. Methodology: The study was a 1-year retrospective study of obstetric referrals in Aminu Kano Teaching hospital, from 1st January to 31st December 2019. Records of all emergency obstetrics patients referred to the hospital for 1 year were reviewed. A structured proforma was used to extract information such as sociodemographic characteristics of the patients, indications for referral, and pre-referral treatment. The care given at the receiving hospital was extracted from the patients' folders. An Audit standard was developed and the findings were compared with the standards in order to determine how the referral system in the study area perform in relation to the standard. Results: There were total of 180 referrals, the mean age of the women was 28.5 ± 6.3 years. Majority (52%) of the patients were referred from Secondary Centres and only 10% were transported with an ambulance. The most common diagnosis at the time of referral was severe preeclampsia. More than half of the patients (63%) had to wait for 30 to 60 minutes before they see a doctor. All the patients were offered high quality care and majority (70%) were delivered via caesarean section. Conclusion: There were lapses in the management of patients before referral; failure to identify high risk conditions, delay in referral, and lack of treatment during transit to the referral centre.

Implementation of a patient blood management program based on a low-income country-adapted clinical decision support system

ABSTRACT Introduction: Patient blood management (PBM) programs are associated with better patient outcomes, a reduced number of transfusions and cost-savings The Clinical Decision Support (CDS) systems are valuable tools in this process, but their availability is limited in developing countries This study assesses the feasibility and effectiveness of an adapted CDS system for low-income countries. Methods: This was a prospective study of the PBM program implementation, in a 200-bed tertiary hospital, between February 2019 and May 2020. Outcome measures were red blood cell (RBC), fresh frozen plasma (FFP) and platelet unit transfusions, the transfusion of a single unit of red blood cells and an RBC adequacy index (RAI). Results: Comparing the post-PBM program era with the pre-PBM system era, there was a decrease in red blood cell transfusions (p = 0.05), with an increase in single unit red blood cell transfusions (p = 0.005) and RAI (p < 0.001). Conclusions: The PBM programs, including electronic transfusion guidelines with pre-transfusion medical auditing, was associated with improved transfusion practices and reduced product acquisition-related costs.

Morbidity and mortality of tetanus at Kenyatta National Hospital: a ten-year case audit

Introduction: Tetanus is a major health problem in developing countries, and is associated with high a morbidity and mortality. There are no recent local data in Kenya on the impact of the disease in terms of morbidity and mortality. The objective of this study was to describe the type, severity, risk factors, immunization history and outcome of tetanus patients at Kenyatta National Hospital (KNH). Method: This was a retrospective descriptive study of patients with a clinical diagnosis of tetanus admitted to KNH over ten years, who were aged 13 years and above. All available files with tetanus diagnosis were selected, and the patients' data were retrieved and analysed using SPSS Software version 21.0. Results: Out of 53 patients with tetanus, 50 (94.3%) were males and 3 (5.7%) were females. The mean age at presentation was 33.2 years (SD= 15.6). Only 4 (7.5%) patients had prior tetanus immunization. The commonest risk factor was acute injury - seen in 37 (69.8%) patients. The common site of injury was the lower limb - seen in 26 (49.1%) patients. The incubation period ranged from 3 to 90 days (IQR 7-17). Generalized tetanus was the commonest form found in 50 (94.3%) patients. Only 16 (30.2%) patients were managed in the Intensive Care Unit (ICU). The overall mortality was 49.1%. Conclusion: Tetanus mortality is still high as reported in many other studies. Most patients were males without prior immunization history. Only few patients were managed in Intensive Care Unit. We recommend advocacy on tetanus immunization and booster dosing

An audit of CT brain findings in adults with new-onset seizures in a resource restricted setting in South Africa

Background: Globally, adults presenting with seizures account for 1% ­ 2% of visits to emergency departments (EDs), of which 25% are new-onset seizures. Neuroimaging is essential as part of the initial workup. Multiple studies have demonstrated abnormal CT brain (CTB) findings in these patients. Objectives: To review the CTB findings in adults presenting with new-onset seizures in a resource restricted setting. Method: A retrospective review of 531 CTBs was conducted at a tertiary hospital in Gauteng on adults presenting to the ED with new-onset seizures. Results: The mean age of the patients was 45.6 ± 17.1 years, and the male to female ratio was 1.2:1. Generalised and focal seizure types were almost equally represented. Of the total 531 patients, 168 (31.6%) were HIV positive. The CTB findings were abnormal in 257 (48.4%) patients, albeit vascular pathology accounted for 21.9%. Infective pathology accounted for 14.1% with a statistically significant association with HIV (p = 0.003). Trauma related pathology was 2.4%, whilst neoplastic pathology was seen in 3.0%. Other causes included congenital pathology, calcifications, atrophy and gliosis. Clinical factors associated with abnormal CTB findings were age ≥ 40 years, HIV infection, hypertension, focal seizures, low Glasgow Coma Scale (GCS), raised cerebrospinal fluid (CSF) protein and presence of lymphocytes. Conclusion: A high yield of abnormal CTB findings was noted in adult patients who presented with new-onset seizures, supporting the use of urgent CTB in patients with certain clinical risk factors. Patients without these risk factors can be scanned within 24­48 h in a resource restricted setting.

Design and Application of Ultrasound Audit Workstation System / 中国医疗器械杂志

According to the problems exist in the original ultrasound system, the study elaborates the design and application of the ultrasound audit workstation system, including the workflow, trace information recording, information management, audit data interaction, application effects, et al. This study points out that the system can optimize the ultrasound process, help to improve the quality and efficiency of ultrasound report audit as well as improve the efficiency of patients' ultrasound examination and medical treatment experience.

Aplicación de la clasificación de Robson para el análisis de la tasa de cesárea en el Hospital Doctor Peset / Review of cesarean rate in Hospital Doctor Peset using the Robson classification

OBJECTIVE: To analyze the caesarean deliveries attended in our hospital, grouping them according to the Robson Classification System and to establish measures in order to reduce caesarean delivery rates. METHOD: Prospective study of all the deliveries attended at Hospital Doctor Peset in 2019 using the Robson classification. RESULTS: A total of 1113 births have been analyzed with a total cesarean section rate of 25.3%. The largest contribution to the total cesarean delivery rate with 34.4% was group 2A (nulliparous women with a single fetus in cephalic presentation, 37 weeks or more pregnant who started labor by induction). Secondly, group 5 (multiparous women with at least previous cesarean section, with single cephalic fetus, 37 weeks or more pregnant) which represents the 20.1% of the total. Inductions in nulliparas multiply the cesarean section rate by 3 compared to nulliparas that initiate labor spontaneously. CONCLUSIONS: Robsons classification is a tool that allows to easily classify and analyze the groups in which to implement measures to reduce the number of caesarean sections performed. Analyzing the induction indications and reviewing action protocols could suppose a substantial decrease in the caesarean section rate in our center.

OBJETIVO: Analizar las cesáreas realizadas en nuestro centro agrupándolas según la clasificación de Robson para establecer medidas que permitan reducir la tasa de cesáreas. MÉTODO: Auditoría prospectiva de los nacimientos asistidos en el Hospital Doctor Peset en el año 2019 mediante la clasificación de Robson. RESULTADOS: Se han analizado 1113 nacimientos con una tasa de cesárea del 25.3%. El grupo que más contribuyó al total de cesáreas realizadas, con un 34.4%, fue el 2A (nulíparas con feto único en presentación cefálica, de 37 semanas o más de embarazo, que iniciaron el parto mediante inducción). En segundo lugar, el grupo 5 (multíparas con al menos una cesárea previa, con un feto único en presentación cefálica, de 37 semanas o más de embarazo), con un 20.1%. Las inducciones en nulíparas multiplican por tres la tasa de cesárea respecto a las nulíparas que inician el trabajo de parto de manera espontánea. CONCLUSIONES: La clasificación de Robson es una herramienta que permite clasificar y analizar de manera sencilla los grupos en los que implantar medidas para reducir el número de cesáreas realizadas. Analizar las indicaciones de inducción y revisar los protocolos de actuación podría suponer una disminución sustancial en la tasa de cesáreas en nuestro centro.

Calidad de atención y mejora continua en el abordaje integral del cáncer de mama: Evaluación de indicadores en una Unidad de Mastología / Quality of care and continous improvement in a comprehensive approach of breast cancer management: evaluation of indicators in a breast center

Introducción: las Unidades de Mastología son organizaciones que tienen por objetivo abordar la patología mamaria de manera multidisciplinaria e integral. A nivel mundial se han implementado programas para evaluar la calidad de atención a través del cumplimiento de indicadores propuestos por Sociedades Científicas u organismos gubernamentales. Algunos de estos han sido propuestos y revisados por la Sociedad Europea de Mastología (EUSOMA). Objetivo: evaluar la calidad de atención de la Unidad de Mastología del Hospital Juan A. Fernández a través del análisis de una serie de indicadores propuestos por EUSOMA como estándares de calidad de atención en centros de patología mamaria. Material y método: estudio descriptivo retrospectivo analizando la base de datos de las pacientes con cáncer de mama estadios 0 a III operadas entre 2015 y 2019. Se analizaron 25 indicadores de procesos propuestos por EUSOMA en 2017. Se registraron las características de la población, y el porcentaje de pacientes en las cuales se cumple la condición de cada uno de los indicadores. Se registró si el indicador alcanza o supera el mínimo estándar, o si alcanza o supera el valor ideal. Resultados: se evaluaron 284 pacientes. Se observó el cumplimiento de la mayoría de los estándares propuestos (18 de 25), alcanzando o superando en el 25% de los indicadores evaluados el valor ideal. Se lograron alcanzar los estándares de calidad de atención relacionados con el diagnóstico clínico y preoperatorio, caracterización anatomopatológica completa en carcinoma invasor, evaluación multidisciplinaria, tratamiento quirúrgico primario en carcinoma invasor e in situ. Se alcanzaron los objetivos tendientes a evitar el sobretratamiento quirúrgico en carcinoma invasor y en cirugía conservadora en carcinoma in situ. En relación a los tratamientos adyuvantes, se alcanzaron los estándares relacionados con radioterapia post cirugía conservadora y post mastectomía, así como también el tratamiento con hormonoterapia y quimioterapia. El seguimiento de los pacientes se realizó en tiempo en tiempo y forma de acuerdo al indicador establecido. Existen 3 indicadores de calidad obligatorios en los que no se alcanzó el estándar mínimo: se observó la necesidad de mejorar la accesibilidad a los tratamientos antiHer2neu en neoadyuvancia, y de reducir los tiempos de espera al inicio del tratamiento. Conclusiones: se observó el cumplimiento de la mayoría de los estándares propuestos. Dado que existen indicadores obligatorios en los que no se alcanzó el estándar mínimo, los esfuerzos primarios deberán centrarse prioritaria e inicialmente en diseñar una planificación que permita alcanzar estos objetivos, así como también mantener en el tiempo los valores positivos ya alcanzados. Se pone de manifiesto la necesidad de implementar políticas a nivel sanitario nacional que permitan mejorar la accesibilidad a medicación oncológica. A su vez, destacamos la importancia de definir indicadores propios con valores ajustados a las características de nuestro país y mantener una evaluación periódica de la calidad de atención a través de los mismos.

Introduction: Breast Units are organizations that manage Breast Cancer in a comprehensive and multidisciplinary approach. Worlwide, programs have been developed in order to evaluate quality of care through the achievement of certain standards of care that have been proposed by scientific organizations, medical associations or government health departments. Some of these indicators have beeb proposed by the European Society of Breast Cancer Specialist (EUSOMA). Objective: to evaluate quality of care in the Breast Unit at Hospital Juan A Fernández (Buenos Aires, Argentina) through the analysis of a series of indicators described by EUSOMA as standard of care in breast centers. Material and method: we performed a descriptive, retrospective analysis of our database including patients with breast cancer stage 0 to III that wer treated between 2015 and 2019. We studied 25 quality of care process indicators proposed by EUSOMA in 2017. We registered population characteristics and the percentage of patients in which each indicator mínimum requirements were achieved. We also studied whether our results achieved or were beyond the ideal targets for each indicator. Results: a total of 284 patients were evaluated. The mínimum standard of care was achieved in most of the evaluated indicators (18 of 25) and in 25% of these, our results achieved or exce3ded the ideal requirements. The indicators in which the mínimum or ideal standard of care was accomplished were regarding clinical and preoperative diagnosis anatomopathological characterisation in invasive breast cancer, multidisciplinary approach, primary surgical management in invasive and in situ breast cancer, avoidanc of overtreatement in invasive breast cancer and breast conserving therapy in carcinoma in situ. Regarding adjuvant treatment, the standard of care was achieved in radiotherapy after breast conserving surgery and after mastectomy, endocrine therapy and chemotherapy. The follow up timing was according to the indicator. There were 3 mandatory indicators in which the mínimum standards were not achieved and were regarding accesibility to anti Her2neu agents in neoadjuvant setting, and timing form diagnosis to firts treatment. Conclusions: we observed that out Breast Unit achieved most of the quality of care indicators described by EUSOMA. However, there 3 mandatory indicators where the results were below the mínimum. This is why future efforts should be focused on designing and planning new measures that will allow these objectives to be accomplished, as well as maintaining what has already been achived. Our results also show the imperious need to implement national public health pólices that would grant a better accesiblility to oncologic medications. We also analysed the importance of defining our own local quality of care indicators in relation to our health policies and current situation, as well as the importance of a continuous evaluation of quality of care through these indicators.

Consecutive use of the 52 mg levonorgestrel-releasing intrauterine system: variations in bleeding patterns / Uso consecutivo do sistema intrauterino de levonorgestrel 52 mg: variações no padrão de sangramento

Abstract Objective Changes in bleeding patterns could influence the decisions of healthcare professionals to change the levonorgestrel-releasing intrauterine system (LNG-IUS) before 7 years of use, the recommended period of extended use. We evaluated changes in the bleeding patterns of users of the 52 mg LNG-IUS at the end of use of the first (IUS-1) and during the second device (IUS-2) use. Methods We performed an audit of the medical records of all women who used two consecutive LNG-IUSs at the Family Planning clinic. We evaluated the sociodemographic/gynecological variables, the length of use, and the bleeding patterns reported in the reference periods of 90 days before removal of the IUS-1 and at the last return in use of IUS-2. We used the McNemar test to compare bleeding patterns. Statistical significance was established at p < 0.05. Results We evaluated 301 women aged (mean ± SD) 32 (±6.1) years, with lengths of use of 68.9 (±16.8) and 20.3 (±16.7) months for the IUS-1 and IUS-2, respectively. No pregnancies were reported. Bleeding patterns varied significantly among women who used the IUS-2 for ≥ 7 months to 6 years when compared the bleeding patterns reported in IUS-1 use. Eighty-nine out of 221 (40%) women maintained amenorrhea and infrequent bleeding; 66 (30%) evolved to bleeding patterns with light flow, and 66 (30%) maintained or evolved to heavy flow patterns (p = 0.012). No differences were observed among the 80 women with ≤ 6 months of use. Conclusion Changes in bleeding patterns occur during the use of LNG-IUS and should not be decisive for the early replacement of the device.

Resumo Objetivo Variações no padrão de sangramento podem afetar a decisão de troca do sistema intrauterino de levonorgestrel (SIU-LNG) antes do período de uso estendido recomendado de 7 anos. Nós avaliamos mudanças no padrão de sangramento de usuárias ao final do uso do primeiro SIU-LNG 52 mg (SIU-1) e durante o uso do segundo dispositivo (SIU-2). Métodos Revisamos os prontuários de todas as mulheres que inseriram consecutivamente o SIU-LNG no ambulatório de Planejamento Familiar. Foram avaliadas as variáveis sociodemográficas/ginecológicas, o tempo de uso, e os padrões de sangramento relatados nos períodos de referência de 90 dias antes da remoção do SIU-1 e no último retorno em uso do SIU-2. Usamos o teste de McNemar para comparar os padrões de sangramento. A significância estatística foi estabelecida em p < 0,05. Resultados Analisamos os dados de 301 mulheres com idade (média ± desvio padrão [DP]) de 32 (±6,1) anos e tempo de uso de 68,9 (±16,8) e 20,3 (±16,7) meses para o SIU-1 e SIU-2, respectivamente. Nenhuma gravidez foi relatada. Os padrões de sangramento variaram significativamente durante o uso do SIU-2 (≥ 7 meses a 6 anos) em relação ao padrão relatado no SIU-1. Oitenta e nove das 221 (40%) mulheres mantiveram amenorreia e sangramento infrequente; 66 (30%) evoluíram para padrões de sangramento com fluxo leve e 66 (30%) mantiveram ou evoluíram para padrões de fluxo intenso (p = 0,012). Não foram observadas diferenças entre as 80 mulheres que utilizavam o SIU-2 há ≤ 6 meses. Conclusão Mudanças nos padrões de sangramento ocorrem durante o uso do LNG-IUS e não devem ser decisivas para a troca precoce do dispositivo.

Blood components requests at an orthopedic hospital: a critical survey

Abstract Introduction The correct completion of the blood components request form is the starting point to ensure good transfusion care. Many guidelines have been developed to search for hemoglobin values that trigger the need for transfusion and show the importance of Patient Blood Management, a scientific evidence-based approach in processes where transfusion is a possibility, such as in elective surgeries. Objective The cross-sectional study aimed to analyze the transfusion requests at a complex orthopedic hospital over a one-year period. Method The completion quality was classified as Good, Regular, Bad or Very Bad, according to the information given by the physician. Transfusion medicine professionals analyzed the transfusion indication reported on the request form and classified it as Correct, Not based on Patient Blood Management (PBM), in accordance or not with the institutional Maximum Surgical Blood Order Schedule, Impossible to evaluate due to lack of information on the form, and Incorrect. Results The study categorized the completion quality of 2011 requests as Good (8.80%), Regular (9.30%), Bad (72.75%) and Very Bad (9.15%). Analysis of the indications revealed that 54.90% of the requests were in accordance with the current blood transfusion recommendations, and on 23.12% of the forms this field had not been filled out. Conclusion The majority of blood components (63%) requests are in tune with current blood transfusion recommendations, despite the great number of incorrectly completed forms; nevertheless, it is mandatory to reach much better appropriateness rates.

Aporte de un sistema predictivo de contraloría médica en la gestión de licencias médicas electrónicas / Contributions of a predictive medical audit system in the electronic management of sick leaves

INTRODUCCIÓN: El retraso del procesamiento de las licencias médicas (LMs) representa un problema de salud pública en Chile, considerando que esto afecta el pago del subsidio a las personas destinado a realizar el reposo médico prescrito mientras no se pueda trabajar. El objetivo de este estudio fue explorar las diferencias en el tiempo de procesamiento de las licencias médicas electrónicas (LMEs) evaluadas por contraloría médica (CM) y las evaluadas por un sistema predictivo de contraloría médica (SPCM) basado en redes neuronales artificiales. MATERIALES Y MÉTODOS: El tiempo de procesamiento de LMEs procesadas con SPCM fue comparado con el tiempo de procesamiento de LMEs examinadas solo con CM, usando curvas de Kaplan Meier, prueba de log-rank y modelos multivariados de Cox. RESULTADOS: La tasa de procesamiento del SPCM fue entre 1,7 a 5,5 veces más rápida que la tasa de procesamiento de la CM, ajustando por potenciales confusores. DISCUSIÓN: La implementación del SPCM permitió disminuir el tiempo de procesamiento de las LMEs, beneficiando a los trabajadores afiliados al seguro público.

INTRODUCTION: The delay in the processing of sick leaves (SLs) is a public health pro-blem in Chile, considering that this affects the payment of the subsidy to the indivi-duals destined to perform the prescribed medical rest while unable to work. The aim of this study was to explore the differences in the processing time of electronic SLs (ESLs) evaluated by medical audit (MA) and the SLs evaluated by a predictive medi-cal audit system (PMAS) based on artificial neural networks. MATERIALS AND METHODS:The processing time of the ESLs that were processed by PMAS was compared with the processing time of those that were examined only by MA, using Kaplan Meier curves, log-rank test, and multivariate Cox models. RESULTS: The processing rate for PMAS was 1.7-fold to 5.5-fold faster than MA, after adjusting for potential confoun-ding variables. DISCUSSION: The implementation of the PMAS reduced the processing time of ESLs, which benefits the workers affiliated to the public insurance system in Chile. (AU)

Auditoria de historias clínicas en hospitales públicos provinciales: Utilidad del Global Trigger Tool / Audit of clinical histories in provincial public hospitals: Utility of the Global Trigger Tool

INTRODUCCIÓN: La auditoría de historias clínicas, fundamental en el proceso de control de calidad de atención, es deficitaria en los hospitales públicos de la provincia de Buenos Aires. Existe una herramienta de disparadores globales que puede ser adaptada para la realización de auditorías en dichas instituciones. MÉTODOS: La herramienta definió 53 disparadores en 6 módulos. El equipo de revisión constó de 3 personas, que auditaron una muestra aleatoria de 20 historias clínicas mensuales en busca de triggers o disparadores que pudieran corresponder a eventos adversos. Luego se generaron datos duros en forma de indicadores. RESULTADOS: Se auditaron 240 historias clínicas en 2019, y se hallaron 70 eventos adversos (el 80% en el primer semestre y el 20% en los meses restantes). DISCUSIÓN: No se debe subestimar la importancia de la auditoría en los hospitales públicos de la provincia de Buenos Aires. La herramienta presentada tiene importantes ventajas desde el punto de vista costo-beneficio. Conviene adaptar el Global Trigger Tool para la auditoría en dichas instituciones.

Auditing Appendectomy in Benue State University Teaching Hospital, Makurdi, Nigeria

Appendicitis is the leading cause of surgical admission in most hospitals in Nigeria and the removed appendix, a frequent surgical specimen in most routine histopathological laborato-ries in Nigeria. The aim of this study is to audit the appendectomy procedures in Benue State University Teaching Hospital. Sixty-two appendices removed for acute appendix in Benue State University Teaching Hospital, Makurdi, Nigeria middle belt, over an 8-year period were analyzed. Twenty-eight (45%) were found to be normal, while 29 (46%) showed histopathological eviden-ce of acute inflammation. There were 5 (9%) cases of unusual pathologies which include a case each of metastatic adenocarcinoma and chronic granulomatous inflammation (2% each) and 3 (5%) cases of schistosomiasis. The Negative Appendectomy Rate (NAR) was 27% in females compared with 18% in males. Adult (>16 years) represented 29% of the NAR. The overall NAR was 45%. The NAR in this study is considerable higher when compared with existing literature. In a poor resource center like Benue State University Teaching Hospital, due diligence in taking detailed history coupled with good clinical examination cannot be over emphasized. The use of a combination of Total Leukocyte Count (TCC) and C-Reactive Protein (CPR) in every patient may help in reducing NAR, though it's definitely going to be impossible to eradicate it.

Auditoria em saúde e economia da saúde: análise de um estudo de caso / Audit in health and health economics: analysis of a case study

Objective: to analyze the results of the health audit in the area of orthoses, prostheses and special materials (OPM), multiple and sequential surgeries (CMS), performed by the State Health Department of Rio Grande do Sul, Brazil (SES/RS). Methodology: Descriptive quantitative study, based on secondary data from SES/RS, in the area of OPM and CMS, referring to the period of post-payment audit practice, from March 2013 to January 2017, using the case study approach. Results: 1,004 completed observations were analyzed for the period; the number of administrative processes requiring a return of financial resources did not have a tendency in the analyzed historical series, a result influenced by the presence of administrative processes that were not conclusive, especially from 2014, on the execution of the audit or even the judicialisation of the subject audited institutions. As for the financial value requested for the return of the analyzed processes, it was higher in 2014, decreasing in 2015 and decreasing considerably in the years 2016 and 2017. Considering the 30 health regions of the state of Rio Grande do Sul, Brasil, three hospitals were highlighted, the first with 43 administrative processes requesting the return of financial resources; the second with 30; and the third with 28. Conclusion: health actions in this area can be qualified through special attention to the regions of health and hospital institutions that repeat more and have large financial volume glossed. (AU).

Objetivo: analisar os resultados da auditoria em saúde na área de órteses, próteses e materiais especiais (OPM) e cirurgias múltiplas e sequenciais (CMS), realizada pela Secretaria Estadual de Saúde do Rio Grande do Sul (SES/RS). Metodologia: estudo quantitativo descritivo, baseado em dados secundários da SES/RS, na área de OPM e CMS, referente ao período da prática de auditoria de pós-pagamento, de março de 2013 a janeiro de 2017, utilizando a abordagem estudo de caso. Resultados: foram analisadas 1.004 observações concluídas para o período; o número de processos administrativos com solicitação de devolução de recursos financeiros não teve uma tendência na série histórica analisada, resultado influenciado pela presença de processos administrativos não conclusos, em especial a partir de 2014, relativos à execução da auditoria ou até mesmo a judicialização do assunto pelas instituições auditadas. Quanto ao valor financeiro solicitado para devolução dos processos analisados, foi maior em 2014, decrescendo em 2015 e diminuiu consideravelmente nos anos 2016 e 2017. Considerando as 30 regiões de saúde do estado do Rio Grande do Sul, três instituições hospitalares tiveram destaque, a primeira com 43 processos administrativos com solicitação de devolução de recursos financeiros; a segunda com 30; e a terceira com 28. Conclusão: as ações em saúde, nessa área, podem ser qualificadas por meio de atenção especial para as regiões de saúde e instituições hospitalares que mais reincidem e tem grandes volumes financeiros glosados. (AU).

Objetivo: analizar los resultados de la auditoría de salud en el área de ortesis, prótesis y materiales especiales (OPM), cirugías múltiples y secuenciales (CMS), realizadas por el Departamento de Salud del Estado de Rio Grande do Sul, Brasil (SES / RS). Metodología: estudio cuantitativo descriptivo, basado en datos secundarios de SES / RS, en el área de OPM y CMS, en referencia al período de la práctica de auditoría posterior al pago, desde marzo de 2013 hasta enero de 2017, utilizando el enfoque de estudio de caso. Resultados: se analizaron 1,004 observaciones completas para el período; el número de procesos administrativos que requirieron un retorno de los recursos financieros no tuvo una tendencia en las series históricas analizadas, un resultado influenciado por la presencia de procesos administrativos que no fueron concluyentes, especialmente a partir de 2014, en la ejecución de la auditoría o incluso la judicialización del sujeto Instituciones auditadas. En cuanto al valor financiero solicitado para el retorno de los procesos analizados, fue mayor en 2014, disminuyó en 2015 y disminuyó considerablemente en los años 2016 y 2017. Considerando las 30 regiones de salud del estado de Rio Grande do Sul, Brasil, se destacaron tres hospitales, el primero con 43 procesos administrativos solicitando la devolución de recursos financieros; el segundo con 30; y el tercero con 28. Conclusión: las acciones de salud en esta área se pueden calificar a través de una atención especial a las regiones de salud y las instituciones hospitalarias que repiten más y tienen grandes volúmenes financieros. (AU).

An audit of licensed Zimbabwean radiology equipment resources as a measure of healthcare access and equity

Introduction: approximately two-thirds of the world's population has no access to diagnostic imaging. Basic radiological services should be integral to universal health coverage. The World Health Organization postulates that one basic X-ray and ultrasound unit for every 50000 people will meet 90% of global imaging needs. However, there are limited country-level data on radiological resources, and little appreciation of how such data reflect access and equity within a healthcare system. The aim of this study was a detailed analysis of licensed Zimbabwean radiological equipment resources.Methods: the equipment database of the Radiation Protection Authority of Zimbabwe was interrogated. Resources were quantified as units/million people and compared by imaging modality, geographical region and healthcare sector. Zimbabwean resources were compared with published South African and Tanzanian data.Results: public-sector access to X-ray units (11/106 people) is approximately half the WHO recommendation (20/106 people), and there exists a 5-fold disparity between the least- and best-resourced regions. Private-sector exceeds public-sector access by 16-fold. More than half Zimbabwe's radiology equipment (215/380 units, 57%) is in two cities, serving one-fifth of the population. Almost two-thirds of all units (243/380, 64%) are in the private sector, routinely accessible by approximately 10% of the population. Southern African country-level public-sector imaging resources broadly reflect national per capita healthcare expenditure.Conclusion: there exists an overall shortfall in basic radiological equipment resources in Zimbabwe, and inequitable distribution of existing resources. The national radiology equipment register can reflect access and equity in a healthcare system, while providing medium-term radiological planning data

Estructura organizacional de la Coordinación Regional No. 1 Red de Donación y Trasplantes de Bogotá, D. C. / Organizational structure of the Regional Coordination No. 1 Donation and transplants Bogotá, D.C. / Estrutura organizacional da coordenação Regional No. 1 Red de doação e transplantes Bogotá, D.C.

Objetivo: La Secretaría Distrital de Salud de Bogotá D.C. (SDS), atendiendo a la normativa de la organización y la estructura de la Coordinación Regional No. 1 Red de Donación y Trasplantes, creada para satisfacer las necesidades de una larga lista de pacientes de este ámbito, conformó equipos de trabajo con funciones asignadas favoreciendo la honestidad y la transparencia de los procedimientos del trasplante. Fechas y lugares de ejecución de la experiencia: Se inicia en 2007, a partir de la expedición del Decreto 2493 de 2004 del Ministerio de Salud. Es así como, en coordinación con este, el Instituto Nacional de Salud (INS) y las entidades territoriales de salud, crearon las coordinaciones para facilitar el trabajo en red de la donación. Método: Acorde con las condiciones geográficas y tecnológicas manifiestas en la normatividad, la red se estructura en dos grandes niveles de coordinación: el nacional y el regional; el primero, a cargo del INS, y el segundo, en cabeza de la SDS y las direcciones departamentales de salud de Antioquia, Valle, Santander, Atlántico y Huila (Resolución No. 3272 de 2011), ubicadas estratégicamente de acuerdo con la infraestructura existente, para así facilitar la actividad trasplantadora y la cobertura, y cuyas sedes están en Bogotá, D.C., Medellín, Cali, Bucaramanga, Barranquilla y Neiva. Resultados: Se logró la articulación intra, interinstitucional e intersectorial que organizó, estructuró y fortaleció la Coordinación Regional No.1, lo cual, a su vez, permitió: 1) construir e impulsar acuerdos ante el Concejo relacionados con el tema; 2) diseñar, implementar y desarrollar la estructura organizacional de la Coordinación Regional No. 1 tomando en cuenta procedimientos, lineamientos y la inclusión de profesionales de planta, y así garantizar su fortalecimiento y su continuidad, y 3) avanzar significativamente en el Programa de Garantía de Calidad y Donación de Órganos y Tejidos con fines de Trasplante Hospital Generador de Vida, para ayudar en la transformación cultural del proceso. Conclusiones: Se fortalecieron en la ciudad los programas existentes de donación y trasplante avanzando en una política pública nacional al respecto que permita la implementación y el desarrollo de las Coordinaciones Operativas de la Donación en el ámbito hospitalario, así como el seguimiento de los trasplantes a través de procedimientos de auditoría.

Objective: The District Health Secretariat of Bogotá, D. C., following the regulations of the organization and structure of the Regional Coordination No. 1 Donation and Transplant Network; Created to meet the needs of the long list of patients, it formed work teams with assigned functions, favoring the honesty and transparency of the transplant procedures. Dates and places of execution of the experience: It begins in 2007, from the issuance of Decree 2493 of 2004 of the Ministry of Health, this is how, in coordination with it, the National Institute of Health and territorial health entities; Coordinations were créate to facilitate donation networking. Method: According to the geographical and technological conditions manifested in the regulations, this network is structured in two great levels of coordination: the National and the Regional; the first by the National Institute of Health and the second at the head of the District Health Secretariat of Bogotá, D. C. and the Departmental Health Directorates of Antioquia, Valle, Santander, Atlántico and Huila, (Resolution No. 3272 of 2011), strategically located in accordance with the existing infrastructure facilitating the transplanting activity and coverage; being its headquarters Bogotá, D. C., Medellín, Cali, Bucaramanga, Barranquilla and Neiva. Results: The intra, inter-institutional and intersectoral articulation that organized, structured and strengthened Regional Coordination No.1 was achieved, allowing: 1. Build and promote Agreements before the Council, related to the subject. 2. Design, implement and develop the organizational structure of Regional Coordination No. 1, taking into account procedures, guidelines and the inclusion of plant professionals guaranteeing their strengthening and continuity. 3. Advance significantly in the Quality Assurance Program and Organ and Tissue Donation for the purpose of "Life Generating Hospital" Transplant, helping in the cultural transformation of the process. Conclusions: Existing donation and transplant programs were strengthened in the city, advancing in a National Public Policy allowing the implementation and development of the Operational Donation Coordinations at the hospital level and the follow-up of transplants through audit procedures.

Objetivo: A Secretaria Distrital de Saúde de Bogotá, D. C., seguindo os regulamentos da organização e estrutura da Rede de Doação e Transplante de Coordenação Regional Nº 1; Criado para atender às necessidades da longa lista de pacientes, formou equipes de trabalho com funções atribuídas, favorecendo a honestidade e a transparência dos procedimentos de transplante. Datas e locais de execução da experiência: Iniciada em 2007, a partir da emissão do Decreto 2493 de 2004 do Ministério da Saúde, é assim que, em coordenação com ele, o Instituto Nacional de Saúde e entidades territoriais de saúde ; Coordenações foram criadas para facilitar a rede de doações. Método: De acordo com as condições geográficas e tecnológicas manifestadas nos regulamentos, essa rede está estruturada em dois grandes níveis de coordenação: o Nacional e o Regional; o primeiro pelo Instituto Nacional de Saúde e o segundo pelo chefe da Secretaria Distrital de Saúde de Bogotá, D. C. e as Diretorias Departamentais de Saúde de Antioquia, Valle, Santander, Atlántico e Huila (Resolução nº 3272 de 2011), estrategicamente localizadas de acordo com a infraestrutura existente, facilitando a atividade e cobertura de transplantes; sendo sua sede Bogotá DC, Medellín, Cali, Bucaramanga, Barranquilla e Neiva. Resultados: Foi alcançada a articulação intra, interinstitucional e intersetorial que organizou, estruturou e fortaleceu a Coordenação Regional Nº 1, permitindo: 1. Construir e promover Acordos perante o Conselho, relacionados ao assunto. 2. Planejar, implementar e desenvolver a estrutura organizacional da Coordenação Regional Nº 1, levando em consideração procedimentos, diretrizes e a inclusão de profissionais da fábrica, garantindo seu fortalecimento e continuidade. 3. Avançar significativamente no Programa de Garantia da Qualidade e doação de órgãos e tecidos com o objetivo de transplante "Hospital Gerador de Vida", auxiliando na transformação cultural do processo. Conclusões: Os programas de doação e transplante existentes foram fortalecidos na cidade, avançando em uma Política Pública Nacional que permitia a implementação e o desenvolvimento das Coordenações Operacionais de Doação no nível hospitalar e o acompanhamento dos transplantes por meio de procedimentos de auditoria.

Interpretive Performance and Inter-Observer Agreement on Digital Mammography Test Sets

OBJECTIVE: To evaluate the interpretive performance and inter-observer agreement on digital mammographs among radiologists and to investigate whether radiologist characteristics affect performance and agreement. MATERIALS AND METHODS: The test sets consisted of full-field digital mammograms and contained 12 cancer cases among 1000 total cases. Twelve radiologists independently interpreted all mammograms. Performance indicators included the recall rate, cancer detection rate (CDR), positive predictive value (PPV), sensitivity, specificity, false positive rate (FPR), and area under the receiver operating characteristic curve (AUC). Inter-radiologist agreement was measured. The reporting radiologist characteristics included number of years of experience interpreting mammography, fellowship training in breast imaging, and annual volume of mammography interpretation. RESULTS: The mean and range of interpretive performance were as follows: recall rate, 7.5% (3.3–10.2%); CDR, 10.6 (8.0–12.0 per 1000 examinations); PPV, 15.9% (8.8–33.3%); sensitivity, 88.2% (66.7–100%); specificity, 93.5% (90.6–97.8%); FPR, 6.5% (2.2–9.4%); and AUC, 0.93 (0.82–0.99). Radiologists who annually interpreted more than 3000 screening mammograms tended to exhibit higher CDRs and sensitivities than those who interpreted fewer than 3000 mammograms (p = 0.064). The inter-radiologist agreement showed a percent agreement of 77.2–88.8% and a kappa value of 0.27–0.34. Radiologist characteristics did not affect agreement. CONCLUSION: The interpretative performance of the radiologists fulfilled the mammography screening goal of the American College of Radiology, although there was inter-observer variability. Radiologists who interpreted more than 3000 screening mammograms annually tended to perform better than radiologists who did not.

Desarrollo e implementación de una herramienta para la validación de cuentas médicas y gestión de glosas en el sector salud en Colombia / Development and implementation of a validation tool for medical bills and disallowance management in the health sector in Colombia / Desenvolvimento e implementação de uma ferramenta para a validação de contas médicas e gestão de glosas no setor saúde na Colômbia

Objetivo: la investigación pretende validar una herramienta de auditoría para la validación de cuentas médicas y la gestión de glosas en los procesos de auditoría con el fin de evaluar, controlar y mejorar los estándares de calidad y gestión en las instituciones de salud. Metodología: se optó por un estudio de corte exploratorio mixto. La investigación se realizó en tres fases: primero, se identificaron las principales causas por la que las EPS glosan las facturas a las IPS; posteriormente, se diseñó una herramienta que permite la auditoría interna de las facturas, previo envío a las EPS y la gestión de las glosas recibidas y; finalmente, se sometió la herramienta a validación por medio de un panel de expertos. Resultados: se diseñó una herramienta incorporando criterios de validación de facturas para los conceptos de tarifas y soportes, se incorporaron seis módulos que permiten parametrizar contratos EPS ­ IPS, registrar facturas, auditar soportes y tarifas, cargar facturas de forma masiva, gestionar glosas y generar indicadores y soportes del proceso de gestión. La herramienta fue validada con un panel de expertos, conformado por cinco miembros, quienes valoraron la usabilidad, claridad, facilidad y factibilidad de aplicación de la herramienta en el sector salud. Conclusiones: la investigación propone una herramienta constituida por diferentes módulos de acuerdo con el proceso y se valoraron criterios de claridad, cumplimiento de normatividad y factibilidad de aplicación en las IPS del país. El panel de expertos coincidió en la importancia del desarrollo de estas herramientas que entregan información de cumplimiento normativo y de la gestión hospitalaria ya que benefician la toma de decisiones acertada y oportuna en la gestión de glosas y los procesos de recuperación de cartera en las IPS.

Objective: This study aims to validate an audit tool for medical accounts and the management of disallowances in the audit processes to assess, control, and improve quality standards and management in the hospitals. Methodology: A mixed, exploratory study was conducted. Research was carried out in three phases: first, we identified the main causes for which the EPS deny the medical bills to the IPS; subsequently, a tool was designed to internally audit invoices before sending them to the EPS and the management of the disallowances received; lastly, the tool was submitted to validation by a panel of experts. Results: A tool was designed that incorporates the validation of rates and supports. Six modules were incorporated to parameterize EPS - IPS contracts, register invoices, validate accounting supports and rates, batch invoicing, manage disallowances and generate indicators and accounting supports of the management process. The tool was validated by 5-member panel of experts who evaluated the usability, clarity, ease, and viability of the application of the tool in the health sector. Conclusions: This study proposes a tool made up of different modules based on the process and the criteria assessed included clarity, regulation compliance, and feasibility of application in the IPS offices around the country. The panel of experts agreed on the importance of the development of tools that provide information on regulation compliance and hospital management, as they benefit correct and opportune decision-making in the management of disallowances and portfolio recovery processes in the hospitals.

Objetivo: a investigação pretende validar una ferramenta de auditoria para a validação de contas médicas e a gestão de glosas nos processos de auditoria com o fim de avaliar, controlar e melhorar os padrões de qualidade e gestão nas instituições de saúde. Metodologia: se optou por um estudo de corte exploratório misto. A investigação se realizou em três fases: primeiro, se identificaram as principais causas pela que as EPS glosam as faturas às IPS; posteriormente, se desenhou uma ferramenta que permite a auditoria interna das faturas, prévio envio às EPS e a gestão das glosas recebidas e; finalmente, se submeteu a ferramenta a validação por meio de um painel de especialistas. Resultados: se desenhou uma ferramenta incorporando critérios de validação de faturas para os conceitos de tarifas e suportes, se incorporaram seis módulos que permitem parametrizar contratos EPS ­ IPS, registrar faturas, auditar suportes e tarifas, carregar faturas de forma massiva, gerir glosas e gerar indicadores e suportes do processo de gestão. A ferramenta foi validada com um painel de especialistas, conformado por cinco membros, quem valoraram a usabilidade, claridade, facilidade e factibilidade de aplicação da ferramenta no setor saúde. Conclusões: a investigação propõe uma ferramenta constituída por diferentes módulos de acordo com o processo e se valorizaram critérios de claridade, cumprimento de normatividade e factibilidade de aplicação nas IPS do país. O painel de especialistas coincidiu na importância do desenvolvimento destas ferramentas que entregam informação de cumprimento normativo e da gestão hospitalar já que beneficiam a toma de decisões acertada e oportuna na gestão de glosas e os processos de recuperação de carteira nas IPS.

Otitis Externa in Secondary Care: A Change in Our Practice Following a Full Cycle Audit

Abstract Introduction Patients presenting with otitis externa are a common thing in otolaryngology units. However, the practice has not been standardized due to a lack of consensus over the management of this condition in secondary care. The National Institute for Health and Care Excellence (NICE) guidelinehas beenpublished targetingthe general practitioners, but it may be relevant in cases of hospital first-time attenders. Objective To conduct an audit of the investigative and prescription practice for hospital first-time attenders in our department against the NICE guideline for otitis externa. Methods The case notes of the patients presenting with otitis externa were reviewed. The data collation included the performance of ear swabs and choice of eardrops. Results An initial audit showed that ear swabs were sent in 14 out of 19 cases, of which 11 grew either Pseudomonas aeruginosa or Staphylococcus aureus (organisms that are sensitive to empirical treatment). A re-audit showed higher adherence to NICE recommendations, with ear swabs sent in only 3 out of 25 cases. The initial audit also demonstrated Sofradex (Sanofi-Aventis, Paris, France) as the most popular empirical eardrop. Following our recommendation, the re-audit showed that Betnesol-N (GSK, Brentford, UK) was administered in 24 out of 25 cases. Conclusion We recommend Betnesol-N due to its cost-effectiveness. Ear swabs should be reserved for refractory cases only. Posters and email reminders are effective means of disseminating information within the hospital.

An audit of the informed consent process at the surgical department of Korle Bu teaching hospital, Accra

Background: Surgeons carry out procedures on patients daily, many of which are invasive and may be associated with some risks and complications. The concept of informed consent in surgical practice was introduced after certain legal issues arose. Today patients are entitled to know and be accorded the right to determine what happens to their bodies. This study set out to determine if there had been any improvement in the informed consent process over the years, taking a closer look at the various aspects of the information given :This was a cross-sectional study carried out at the Department of Surgery, Korle Bu Teaching Hospital. One hundred consecutive post-operative patients were recruited and interviewed on information discussed at various stages during the preoperative period and on the administration of the consent form. Results: Thirty seven (66.0%) out of 56 elective cases felt they had been given enough information to their understanding to enable them give informed consent. Thirty (68.1%) out of 44 emergencies also felt they had been given enough information. Forty (71.4%) of elective cases were able tell what their diagnosis was but only 23 (41.0%) knew what procedure had been done. Similarly 32 (72.2%) emergency cases were able to tell what their diagnosis was but only 16 (36.3%) knew what procedure had been done. Conclusion: Informed consent in the Department of Surgery of the Korle Bu Teaching Hospital is unsatisfactory and needs to be improved