Academic literature on the topic 'Medical audit Australia'

BackgroundThe National Stroke Audit has been used to audit and provide feedback to health professionals and stroke care services in Australia since 2007. The Australian Stroke Clinical Registry was piloted in 2009 and numbers of hospitals participating in the registry are increasing. Considering the changing data landscape in Australia, we designed this study to evaluate the stroke audit and to inform strategic direction.MethodsWe conducted a rapid review of published literature to map features of successful data programmes, followed by a mixed-methods study, comprising national surveys and interviews with clinicians and administrators about the stroke audit. We analysed quantitative data descriptively and analysed open-ended survey responses and interview data using qualitative content analysis. We integrated data from the two sources.ResultsWe identified 47 Australian data programs, successful programs were usually funded by government sources or professional associations and typically provided twice yearly or yearly reports.106 survey participants, 14 clinician and 5 health administrator interview participants were included in the evaluation. The Stroke Audit was consistently perceived as useful for benchmarking, but there were mixed views about its value for local quality improvement. Time to enter data was the most frequently reported barrier to participation (88% of survey participants), due to the large number of datapoints and features of the audit software.Opportunities to improve the Stroke Audit included refining Audit questions, developing ways to automatically export data from electronic medical records and capturing accurate data for patients who transferred between hospitals.ConclusionWhile the Stroke Audit was not perceived by all users to be beneficial for traditional quality improvement purposes, the ability to benchmark national stroke services and use these data in advocacy activities was a consistently reported benefit. Modifications were suggested to improve usability and usefulness for participating sites.

Background: An important aspect of antimicrobial stewardship is the qualitative assessment of antimicrobial prescribing. Owing to lack of standardized tools and resources required to design, conduct and analyze qualitative audits, these assessments are rarely performed. Objective: We designed an audit tool that was appropriate for all Australian hospital types, suited to local user requirements and including an assessment of the appropriateness of antimicrobial prescribing. Methods: In 2011, a pilot survey was conducted in 32 Australian hospitals to assess the usability and generalizability of a qualitative audit tool. The tool was revised to reflect the respondents’ feedback. A second study was performed in 2012 in 85 hospitals. In 2013, following further feedback and refinement, an online auditing tool, the Hospital National Antimicrobial Prescribing Survey (NAPS), was developed. Early audits demonstrated that surgical prophylaxis had the highest rates of inappropriate prescribing. In 2016, the Surgical NAPS was developed to further investigate reasons for this, and the NAPS program was further expanded to audit antimicrobial prescribing practices in Australian aged-care homes (ie, the Aged Care NAPS). Results: Between January 1, 2013, and November 12, 2019, 523 Australian public and private hospitals (53.8%) utilized the Hospital NAPS; 215 (22.1%) have utilized the Surgical NAPS; and 774 of Australian aged-care homes (29.0%) have utilized the Aged Care NAPS. National reporting has identified key target areas for quality improvement initiatives at both local and national levels. The following initiatives have been outlined in 14 public reports: improved documentation; prolonged antimicrobial prophylaxis; compliance with prescribing guidelines; appropriateness of prescribing; access to evidence-based guidelines; and improved microbiology sampling. Conclusions: By utilizing the Plan-Do-Study-Act cycle for healthcare improvement and by involving end users in the design and evaluation, we have created a practical and relevant auditing program to assess both quantitative and qualitative aspects of antimicrobial prescribing in a wide range of settings. This voluntary program is now endorsed by the National Strategy for Antimicrobial Resistance Surveillance, partners with the Antimicrobial Use and Resistance in Australian Surveillance System, and is utilized by facilities to meet mandatory national accreditation standard requirements. With the success of the NAPS program in Australia, it has now been implemented in New Zealand, Canada, Malaysia, Fiji, and Bhutan, with plans for other countries to implement the program soon. Current research is being conducted to expand the program to include audits for family physicians, veterinarians, and remote indigenous communities, and for antifungal use.Disclosures: NoneFunding: None

The most sure-fire way to pass MDSAP audit with flying colours is to have an effective Quality Management System (QMS). Having a good QMS will make sure work is correctly documented, kept up to date, and easy to present to an auditor. For regulators too, it means a reduced burden. There is pooling of regulatory resources. The audits are conducted by Auditing Organizations designated by the regulatory bodies. The MDSAP program is expected to improve audit predictability because a standardized audit model has been introduced. Every audit follows the same set of steps. For the first time, a grading system is introduced for noncompliance. This approach helps reduce subjectivity. MDSAP has a very rigid auditing process to ensure the proper market authorizations have been obtained and facility registrations have occurred but not represent Marketing Authorization. Recently proposed greater alignment of FDA Quality System Regulation (QSR) with ISO 13485, would bring US QMS requirements for medical device manufacturers closer in line with quality system requirements in markets such as the European Union, Japan and Australia, potentially streamlining medical device registration and compliance processes across the US and other markets.

Objective: Men present with complex, diverse and often contradictory expressions of masculinity that are relevant to their health status. This article argues for the inclusion of masculinity into mental health curricula in Australia. Masculinity mediates health outcomes by influencing help seeking and engagement with treatment. Conclusion: An online curricula audit of publicly available information from Australian medical programs and their professional bodies reveals increasing awareness of the needs, but limited practical inclusion of masculinity models in training and practice. Described are the elements essential to training and subsequent clinical practice to curb the poor mental health outcomes of Australian men.

Aim: Cryptococcosis causes significant morbidity and mortality worldwide, but pediatric data are limited. Methods: A retrospective literature review of Australian pediatric cryptococcosis and additional 10-year audit of cases from a large pediatric network. Results: 22 cases of cryptococcosis in children were identified via literature review: median age was 13.5 years (IQR 7.8–16 years), 18/22 (82%) had meningitis or central nervous system infection. Where outcome was reported, 11/18 (61%) died. Of six audit cases identified from 2008 to 2017, 5 (83%) had C. gattii disease and survived. One child with acute lymphoblastic leukemia and C. neoformans infection died. For survivors, persisting respiratory or neurological sequelae were reported in 4/6 cases (67%). Conclusion: Cryptococcosis is uncommon in Australian children, but is associated with substantial morbidity.

The international border between Australia and Papua New Guinea (PNG) serves as a gateway for the delivery of primary and tertiary healthcare for PNG patients presenting to Australian health facilities with presumptive tuberculosis (TB). An audit of all PNG nationals with presumptive TB who presented to clinics in the Torres Strait between 2016 and 2019 was conducted to evaluate outcomes for PNG patients and to consider the consistency and equity of decision-making regarding aeromedical evacuation. We also reviewed the current aeromedical retrieval policy and the outcomes of patients referred back to Daru General Hospital in PNG. During the study period, 213 PNG nationals presented with presumptive TB to primary health centres (PHC) in the Torres Strait. In total, 44 (21%) patients were medically evacuated to Australian hospitals; 26 met the evacuation criteria of whom 3 died, and 18 did not meet the criteria of whom 1 died. A further 22 patients who met the medical evacuation criteria into Australia were referred to Daru General Hospital of whom 2 died and 10 were lost to follow-up. The cross-border movement of people from PNG into Australia is associated with an emergent duty of care. Ongoing monitoring and evaluation of patient outcomes are necessary for transparency and justice.

The progestogen contraceptive implant -Implanon� was launched into the Australian marketplace in May 2001, with intense marketing and extensive training programs for doctors. However, negative media focused on removal problems and unexpected pregnancies, followed by increased medical indemnity requirements for providers, resulted in restricted access for Australian women as many GPs ceased providing insertions. To date there is no published data on the use of this contraceptive implant in Australia. To identify trends in usage, continuation rates, side effects and acceptability of this method, a retrospective chart audit of clients attending Family Planning Queensland (FPQ) clinics for implant insertion and/or removal over a 5 year period was conducted. The audit examined1800 implant users from the two busiest FPQ clinics, one in a regional setting. Preliminary results from the audit indicate:- All age groups across the reproductive years are represented in the group. The major reason for removal is unacceptable bleeding patterns Many women have the device removed because they no longer require contraception. There have been no pregnancies identified with implants The last 2 years have seen significant numbers of women presenting for implant replacement, with these women providing valuable information on factors contributing to longer term acceptability of the method. This presentation will provide an analysis of the audit findings, particularly in relation to duration of use and implications for client acceptability of this contraceptive method. The information about Implanon� use in a clinical setting will be used to make recommendations on improvements in the appropriate selection and counselling of women considering this contraceptive method.

Objectives: There exists a substantial and growing body of evidence suggesting that antipsychotic medications are efficacious in the treatment of many non-psychotic psychiatric disorders. Although indications for the use of antipsychotics (particularly the atypicals) remain relatively narrow in Australia, psychiatrists seem to be using them for an expanding range of disorders in a variety of clinical settings. This has raised issues of costeffectiveness and methods of funding of these medications. The present study aimed to quantify and describe the patterns of prescribing of antipsychotic medications in a large private psychiatric hospital. Another aim was to compare the findings with other published evidence, and consider the implications of antipsychotic use for current clinical practice in Australia. Methods: A retrospective review of the medical records of 100 consecutive patients admitted to a private psychiatric hospital was conducted. The data collected included demographic details, major psychiatric diagnoses, all medications prescribed during the admission and their doses and, in the case of antipsychotics, the target symptoms/conditions for which they were prescribed. Results: Fifty-nine per cent of inpatients received at least one dose of an antipsychotic during their admission. While all patients with psychotic illnesses were treated with antipsychotics, 57% of patients with primary mood disorders and 40% of patients with a primary anxiety disorder also received an antipsychotic. The most common indications for use of antipsychotics included the treatment of psychotic symptoms, augmentation of antidepressants, relief of anxiety symptoms and lessening of agitation, and control of difficult behaviours (including self-harm and aggression) associated with personality disorders. The most frequently used antipsychotic was olanzapine (22%), followed by chlorpromazine (20%), and quetiapine (14%). Eleven per cent of patients received a combination of two antipsychotics. Conclusions: Antipsychotic medications were widely used in a private psychiatric inpatient setting for the treatment of non-psychotic disorders. This finding parallels those from other Australian studies of psychotropic prescribing patterns. The issues of clinical utility, cost-effectiveness and benefits of funding of these medications for such wider indications require further study and evaluation.

Background: The attendance of paediatric medical teams at deliveries has become accepted as an integral part of birth management under current multidisciplinary team arrangements. Under current guidelines, specific clinical indicators have been developed to determine whether paediatric teams need to attend deliveries. High rates of attendance indicate that paediatric medical team resources are being extended beyond the criteria at the expense of essential services being provided elsewhere. Methods: A retrospective clinical audit was used to evaluate the frequency of paediatric team attendance and related clinical indicators. Deliveries were recorded and audited for a randomly selected calendar month. Paediatric team attendance was evaluated against foetal distresses, types of delivery, gestational age and birth weight. Results: A total of 112 deliveries were recorded for the selected calendar month and paediatric medical teams attended 74.1% (n=80) of the deliveries. Participants were comprised of 50.9% (n=57) male and 49.1% (n=55) female babies. Of these deliveries, 66.7% (n=72) were term, 30.6% (n=33) post-term and 2.8% (n=3) pre-term. A total of 69.4% (n=75) of deliveries were spontaneous vaginal deliveries (SVD), while 22.2% (n=24) were caesarean sections and 8.3% (n=9) were instrumental deliveries. Foetal distress was experienced by 16.2% (n=17) of babies. Conclusion: Paediatric medical team attendance at deliveries was higher than the combined rate of caesarean sections, pre-term babies, instrumental deliveries and reported cases of foetal distress.

BackgroundLeadership is a core competency of doctors. However, specific learning outcomes for leadership are often not well defined in medical school curricula. This article uses New Zealand (NZ) and Australian medical school curricula as a case example for conducting a needs analysis of leadership learning outcomes.AimsTo identify which elements of medical leadership development are already met by Australian Medical Council (AMC) Outcomes for Graduates, which elements are missing, and which missing elements might reasonably be included in prequalification curricula in NZ and Australia.MethodsThe Medical Leadership Competency Framework (MLCF) was selected as the reference framework for a general needs analysis of leadership development in the AMC curriculum.To identify curriculum gaps, we first assessed the achievability of MLCF Domains at an undergraduate level. We then considered whether the AMC Outcomes for Graduates would satisfy each MLCF Domain. Where MLCF Domains were judged unachievable at the undergraduate level, we considered whether foundations were sufficiently laid for future development.ResultsFive of eight (63%) undergraduate MLCF Domains and 7 of 12 (58%) postgraduate domains were found to be already satisfied by the AMC Outcomes for Graduates.Some key elements of leadership as described in the MLCF are not yet encapsulated in the AMC Outcomes for Graduates. Two particularly notable absences are audit and quality improvement.ConclusionsLeadership is multidimensional. Some dimensions may be more appropriately learnt after medical school. There are, however, significant gaps in current curricula in Australia and NZ as defined by the AMC. These could be met more effectively using the MLCF.

The past decade has seen the implementation of electronic medical record (EMR) systems being implemented across large-scale healthcare organisations throughout Australia. A first-time implementation of an organisational-wide EMR system required a multi-modal approach to the development of new nursing workflows and appropriate selection of hardware devices to ensure acceptance and adoption of the EMR. The aim of this work was to develop new nursing workflows and associated device requirement principles to allow for continuation of safe, high quality nursing care with an EMR implementation. The incorporation of multi-disciplinary consultations, an audit, observational study and clinical and governance stakeholder engagement was used to develop device requirement principles. This ensured development of standardised nursing workflows were successfully adopted throughout the organisation with the EMR implementation.

Today, there is a shift in the representations of Northern Australia and its environments. While Indigenous stakeholders have come to the forefront of debates, and the existence of ‘natural values’ and Indigenous ownership have become relatively uncontroversial, environmentalists and environmental regulation have been widely criticized. Chapter 2 surveys media coverage of the controversyin order to better understand these and other recent trends in environmental politics both nationally and internationally. In surveying media narratives, I show how the controversy provides an opportune moment to audit media coverage of Indigenous issues and its decisions regarding who was able to speak authoritatively for and about Northern Australia and its rivers. What remained consistent was the presentation of the region as both a remote and pristine environment and an essentially Indigenous domain, underdeveloped due to ‘meddling greenies’. If these were, as stakeholders largely agreed, ‘wild rivers,’ then what does their wildness now count for and for whom?

While references to the concept of “learning community” abound in the literature, a common ingredient is the belief that learning is enhanced when there is a commitment to sharing ideas and knowledge within a collaborative group or network of individuals. To support student teachers completing their practicum placements as part of a one-year Graduate Diploma of Secondary Education at the Australian Catholic University (ACU National), a communities of practice model (Wenger, 1998) was implemented, supported by a social software-based technology framework, to enable mutual engagement, joint enterprise, and a shared repertoire. At the outset, all participants were given hands-on training in the use of the text and audio tools that comprised the technology framework. They then formed peer-to-peer mentoring relationships, creating and sharing web log (blog) entries and voice recordings of critical incidents while on their teaching practicum. The data from the students’ discourse was transcribed, coded, and categorized by evaluating each message unit based upon the type of communication it displayed. The main focus was to identify the discourse elements based on Wenger’s (1998) conceptual framework. The coded scripts were used to explore issues and patterns that were indicators of a learning community. This data, together with post-practicum focus group discussions in which students reflected on the benefits of these media for peer mentoring and support, attests strongly to the relevance and effectiveness of the adopted approach to developing a socio-professional community to support the development of pre-service teachers. It is hoped that this case study will contribute to best practice in the use of social software technologies for online community building and support in professional learning contexts, in ways that transcend organizational and disciplinary boundaries. The authors believe that the best outcomes are achieved when activities are structured, when students are adequately trained in using the technologies, and when instructors or experts are available to scaffold reflection processes as the need arises.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.