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A clinical audit is a quality improvement process that seeks to improve services and outcomes through a systematic review of care against explicit criteria. It is now a recognized tool for improving clinical quality of care. However, in transfusion medicine, they have been utilized in a limited manner. This review intends to discuss the methodology of carrying out a clinical audit systematically. Clinical audit is not research and focuses on the improvement of ordinary and routine practices. Various methodologies for selecting and prioritizing a good audit topic can be employed. Based on the Donabedian model, process-based audits from donor selection to the actual bedside transfusion could be audited to bring in improvement. Likewise, transfusion processes can be audited based on the dimensions of quality in the context of timeliness, effectiveness, and appropriateness. Prioritization of a topic can be done through a quality impact assessment. The objectives help quantify the aim of the audit, while the standards include criteria that are quantified against targets, based on the current evidence for the best possible care. A snapshot sample (20-50 cases) is sufficient to carry out a clinical audit. Where targets are not met, root-cause analysis and quality improvement tools guide the implementation of changes in transfusion practices. To ensure that change is implemented and internalized, it is necessary to have the entire team and the management on board; communication with all stakeholders is key. Re-audit, after the change has been internalized, is an essential part of all clinical audits. Meticulously planning and proper implementation ensure improvement of the care that transfused patients receive. [ABSTRACT FROM AUTHOR]

Background: Several studies have justified use of chest computed tomography (CT) in diagnosis, evaluation of severity, treatment response, and complications of coronavirus disease 2019 (COVID‑19) pneumonia. Increased utilization of CT in patients with known or suspected COVID‑19 pneumonia has resulted in concerns of overuse, lack of protocol optimization, and radiation exposure. Aims: The study was conducted to develop and implement optimized protocol for chest CT for reducing radiation dose in adult patients suspected or diagnosed to have COVID‑19 infection. Setting and Design: The study was conducted in the department of radiology of a rural tertiary care teaching hospital in western India. Clinical audit was used as a tool to impart and assess the impact of optimized chest CT protocol. Methods and Material: The pre‑intervention audit included radiation dosimetry data, number of phases and length of scan of 50 adult patients, undergoing non‑contrast chest CT scans in March 2021. A brief educational intervention outlining the parameters of optimized protocol was conducted on April 1, 2021.The post‑intervention audit consisted of two cycles for 109 and 67 chest CT scans in the months April and May 2021. Results: The optimized protocol was found clinically adequate with a good inter‑rater reliability. The compliance to the optimized protocol was weak in audit cycle 2, which improved significantly in audit cycle 3 after reinforcement. The mean (SD) per scan Computed Tomography Dose Index‑Volume (CTDI‑vol) reduced significantly across audit cycles [22.06 (12. 31) Vs. 10.58 (7.58) Vs. 4.51 (2.90) milli Gray, respectively, P < 0.001]. Similar findings were noted for Dose Length Product (DLP). Conclusion: Clinical audit of chest CT protocol and resultant radiation doses provided adequate feedback for dose optimization. A simple educational intervention helped achieve dose optimization. [ABSTRACT FROM AUTHOR]

To evaluate the antibiotic prescribing practice in pediatric patients for enteric fever, and to assess the need of developing and implementing the Antibiotic Stewardship Program (ASP) for the hospital. A prospective audit was completed in the pediatric ward of tertiary care hospital of Lahore for one year. Blood culture reports were collected from microbiology departed and clinical data were assessed regarding the choice of antibiotics, frequency, dosage and clinical outcome. All the statistics were analyzed using SPSS software and compared with the guidelines. Out of 157 cases hospitalized with suspicion of enteric fever, 137 cultures were positive for salmonella. Monotherapy of ceftriaxone (70%) was prescribed mostly as empirical therapy. About 20% of patients received a combination of antibiotics empirically. Susceptibility reports showed only 7 cases were of non-resistant typhoid, 15 multi-drug resistant and 115 extensively drug-resistant. Nearly 46% of patients were discharged earlier whose empirical therapy was changed either before or promptly after susceptibility reporting. Commonly used definitive antibiotics (32%) were a combination of azithromycin and meropenem. Inappropriate use of antibiotics was noted frequently as compared to the guidelines. However, recommendations themselves need to be reviewed as antibiotic resistance patterns are changing drastically. [ABSTRACT FROM AUTHOR]

Background: Ruptured ovarian cysts are common gynaecological presentation to health institutions with abdominal pain. While this phenomenon is generally self-limiting, surgery may be necessary in cases of haemodynamic compromise or association with torsion. The aim of this audit is to identify the trend of hospital presentations, as well as the review the management of modern gynaecology practice.Methods: A retrospective audit of all women who presented to the emergency department with an imaging diagnosis of ruptured ovarian cysts was conducted over a 5-year period at St Vincent's Hospital, Sydney.Results: During the study period, 408 women were identified. There was a trend towards conservative management, as observed in 84.7% of women, while the remaining 15.4% underwent surgery. Haemorrhagic or ruptured corpus luteum was the most common diagnoses. As expected, women who had surgical intervention were more likely to have larger cysts (20 vs 50%; p<0.05), and larger free fluid findings on imaging (1.4 vs 23.8%; p<0.05) compared with those managed conservatively. There were no statistically significant differences in location of ovarian cysts (right or left) or antecedent to hospital presentation (vaginal intercourse or trauma).Conclusion: Ruptured ovarian cysts of both functional and non-functional types remained a common clinical presentation of acute pain for women to the emergency department. Majority of women were managed conservatively in our cohort, and indications for surgery were large ovarian cysts and large free fluid seen on imaging findings. Surgery was largely feasible with minimal complications. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to evaluate hospital mortality rates, readmission rates and length of hospital stay (LOS) among adult medical patients admitted to a teaching hospital in Ethiopia., Design: We performed a retrospective study using routinely collected electronic data., Setting: Data were collected from Yekatit 12 Hospital Medical College between January 2021 and July 2023., Participants: The analysis included 3499 (4111 admissions) adult medical patients with complete data., Outcome Measures: We used mortality rates, readmission rates and LOS to measure the quality of the outcomes for the top 15 admission diagnoses. A multivariable Cox proportional hazard model was used to identify the statistically significant predictors of mortality with p values<0.05 and a 95% CI. The Kaplan-Meier curve was used to estimate the failure rate (mortality) of the admitted patients., Results: The median age of patients was 50 years and men accounted for 1827 (52.3%) of all admitted cases. Non-communicable diseases accounted for 2537 (72.5%) admissions. In descending order, stroke, 644 (18.29%); heart failure, 640 (18.41%); and severe pneumonia, 422 (12.06%) were the three most common causes of admission. The readmission rate was 25.67% (1056/411), and 61.9% of them were readmitted within 30 days of index discharge. The overall median LOS was 8 days. The median LOSs in the index admission (11 vs 8 days, p value=0.001) of readmitted patients was significantly higher than not readmitted. The in-hospital mortality rate was 438 (12.5%), with the highest number of deaths occurred between days 30 and 50 of admission. The mortality rate is significantly higher among patients with communicable diseases (adjusted HR, 1.64, 95% CI: 1.34, 2.10) and elderly patients (≥65 years) (adjusted HR, 1.79, 95% CI: 1.44, 2.22). Septicemia, chronic liver diseases with complications and HIV with complications were the three common causes of death with a proportional mortality rate of 55.2%, 27.93% and 22.46%, respectively., Conclusions: Mortality, median LOSs and readmission rate were comparable to other national and international studies. Multicentre compressive research using these three quality patient outcomes is required to establish national standards and evaluate institutional performance., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

There is evidence that antibiotics are sometimes prescribed inappropriately by dental practitioners, which can lead to undesirable outcomes. This study aimed to assess the impact of a clinical audit on antibiotic prescribing practices at Taibah University Dental Hospital in Madina, Saudi Arabia. The study retrospectively analyzed antibiotic-prescribing data for pediatric patients by dental interns and faculty members over a period of 8-months. The data collected revealed that inappropriate antibiotic prescription was prevalent initially, with a total of 119 antibiotic-prescriptions issued. After implementing an action plan that included the use of guidelines and educational sessions, a second cycle of the audit was conducted over a 4-month period. During the second cycle, the number of antibiotic prescriptions significantly decreased to 58, indicating a reduction of 48%. Across both cycles, amoxicillin emerged as the most frequently prescribed antibiotic, closely followed by Augmentin. Notably, pulpal diseases and peri-radical complications were consistently ranked as the conditions with the highest number of antibiotic prescriptions in both study periods. The results suggest that the clinical audit, along with the implementation of guidelines and educational sessions, had a positive impact on antibiotic prescribing practices at Taibah University Dental Hospital, leading to a significant reduction in inappropriate antibiotic prescriptions., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Objective: To evaluate the frequency and interrelationships among neonatal near miss (NNM) criteria and the anticipated workload for audits in high-income countries., Design: Observational retrospective descriptive study., Setting: Tertiary maternal and neonatal units at Mater Mothers' Hospital, Brisbane, Queensland, Australia., Participants: Cases of stillbirths (n = 483), neonatal deaths (n = 203), and live births (n = 66,353) from January 2016 to July 2022 (N = 67,039)., Methods: We identified eight prespecified NNM criteria nominated by perinatal experts. Primary outcomes were NNM frequency, their interrelationships, and related workload. We used descriptive statistics and analysis of variance and considered p < .05 significant., Results: We found 2,243 unique NNM cases (33.7/1,000 live births). The NNM ratio per 1,000 live births according to each of the eight criteria were: unplanned resuscitation at birth (25.09/1,000 live births), birth asphyxia needing surveillance for hypoxic ischemic encephalopathy (8.46/1,000 live births), metabolic acidosis at birth (8.04/1,000 live births), advanced resuscitation at birth (3.68/1,000 live births), seizures and/or stroke (0.96/1,000 live births), severe intraventricular hemorrhage and/or cerebellar hemorrhage (0.95/1,000 live births), moderate to severe hypoxic ischemic encephalopathy (0.9/1,000 live births), and severe birth trauma (0.44/1,000 live births). Almost one third of NNM cases met more than one criterion. Anticipated workload for monthly NNM audits varied from 0.04 to 2.8 cases per 1,000 live births., Conclusion: Different sets of NNM criteria considerably alter the frequency of NNMs and the anticipated workload for NNM audits. Their interrelationships are likely attributable to the fact that some of the criteria are risk factors for or are part of the causal pathway for other NNM criteria. These findings can assist with the determination of a pragmatic NNM definition considering the feasibility of NNM audits in high-income countries., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2024 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Background Temporal artery biopsy (TAB) is the recommended index diagnostic method for giant cell arteritis (GCA). Per the British Society for Rheumatology (BSR) guidelines, we assessed our procedural performance. Additionally, we evaluated the occurrence of GCA diagnosis in immunosuppressed patients and other comorbidities. Methods Following the audit registration, a retrospective analysis of prospectively collected data was conducted from 2017 to 2022 at a large university hospital in North Midlands, England. Data on demographics and comorbidities were gathered. The study's primary outcome was adherence to BSR guidelines and our service provisions. Secondary outcomes included examining the relationship between biopsy-confirmed GCA and other comorbidities. Statistical analysis was carried out using SPSS version 29 (IBM Corporation, Armonk, New York, United States of America). Two-sample t-test and Chi-square/Fisher exact test were used for continuous and categorical variables, respectively. Holm-Bonferroni method was incorporated to adjust for multiple comparisons. Results A total of 156 patients who underwent temporal artery biopsy (TAB) were included in the study, with a male-to-female ratio of 0.44:1. The median age was 73. Among the patients, 19% were smokers. The procedures were performed by either a vascular surgeon (119, 76%) or by an ophthalmologist (37, 24%). Two-thirds of the patients underwent TAB within seven days of referral. In 73, 47% of cases, the post-fixation biopsy sample size exceeded 10 mm. Positive biopsy results were found in 45 patients (29%). GCA was confirmed in 39% of patients with polymyalgia rheumatica (PMR), 24% with diabetics, 20% with hypothyroidism, 29% with hypertension, 32% with hyperlipidaemia, and 26% with other inflammatory diseases. However, the p-value was below the statistically significant threshold. The biopsy outcome was also not dependent on the speciality, time from referral to biopsy, nor on the length of the post-fixation specimen. Conclusions Temporal artery biopsy remains a valuable and crucial diagnostic tool in challenging equivocal cases of giant cell arteritis (GCA), although it is limited by its sensitivity, but there is also room for improvement. There is still uncertainty regarding the relationship between biopsy positivity, post-fixation sample size, and the interval between referral and procedure. Additionally, the speciality of the clinician performing the biopsy does not appear to significantly influence the likelihood of a positive result. We still do not fully understand why this is, but the association of the GCA with other comorbidities was unpredictably insignificant., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Quality, Safety and Compliance Department issued approval CA05623. This Audit was registered with number CA05623, in the Quality, Safety and Compliance Department at the University Hospitals of the North Midlands. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Dhahri et al.)

Smile aesthetics is an important factor to consider during orthodontic treatment planning. The aim of the present study is to assess the predictability of Invisalign SmileView for digital AI smile simulation in comparison to actual smile treatment outcomes, using various smile assessment parameters. A total of 24 adult subjects (12 females and 12 males; mean age 22 ± 5.2 years) who chose to be treated using Invisalign were prospectively recruited to have their pretreatment smiles captured using the Invisalign SmileView to simulate their new smiles before treatment was started. Patients were then treated using upper and lower Invisalign aligners with average treatment time of 18 ± 6 months. Full post-treatment records were obtained and full smile frame images of simulated smile and actual final smile of each subject were evaluated by an independent examiner using an objective assessment sheet. Ten smile variants were used to assess the characteristics of the full smile images. Significance level was set at P < 0.05. The ICC for the quantitative parameters showed that there was an overall excellent & good internal consistency (alpha value > 0.7 & > 0.9). The Independent t test was performed amongst the quantitative variables. The P value was not significant for all except maxillary inter canine width (P = 0.05), stating that for the five variables namely; philtrum height, commissure height, smile width, buccal corridor and smile index, actual mean values were similar to the simulation mean values. For the qualitative variables, the Kappa value ranged between 0.66 and - 0.75 which showed a substantial level of agreement between the examiners. Additionally, the Chi square test for the qualitative variables, revealed that the P value was found to be significant in all except lip line. This implies that only the lip line values are comparable. More optimal lip lines, straighter smile arcs and more ideal tooth display were achieved in actual post treatment results in comparison to the initially predicted smiles. Five quantitative smile assessment parameters i.e., philtrum height, commissure height, smile width, buccal corridor, and smile index, could be used as reliable predictors of smile simulation. Maxillary inter canine width cannot be considered to be a reliable parameter for smile simulation prediction. A single qualitative parameter, namely the lip line, can be used as a reliable predictor for smile simulation. Three qualitative parameters i.e., most posterior tooth display, smile arc, and amount of lower incisor exposure cannot be considered as reliable parameters for smile prediction.Trial Registration number and date: NCT06123585, (09/11/2023)., (© 2024. The Author(s).)

The French Health Authority recently published guidelines about patient self-administration of medications for voluntary hospitalized patients under medical supervision. This study aimed to assess medication management practices in our hospital and provide recommendations for self-administration medication. A prospective monocentric study was performed from January to June 2023, involving patient and nurse surveys based on the guidelines from the French Health Authority. A total of 207 patients participated in the survey, with a mean age of 59.6years. Among them, 56% were inclined to self-manage treatments initiated during hospitalization. Among patients with regular treatments, 62% were inclined to self-manage them in the hospital. In weekday hospitalization units, 92% of patients were inclined to self-manage their regular treatments, and 75% of those initiated during hospitalization. Among the 26 surveyed nurses, 71% reported patient autonomy for taking drugs in narrative transmissions, and 88% verified medication intake through self-administration, while 96% digitally traced it. The concept of self-administration of medication appears promising, especially within weekday hospitalization units, particularly for patients with a good understanding of their treatment. Nurses currently assess patient autonomy without specific monitoring tools. Collaborative efforts among healthcare professionals, with pharmacists playing a central role, are essential for the success of this innovative approach., (Copyright © 2024 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Objective The objective of this audit was to find out whether brain CT scans performed on patients with head trauma in Basra Teaching Hospital (BTH) adhere to the 2023 National Institute of Excellence (NICE) guidance for head injury (NG232) and whether we can improve this with selected interventions. Methodology We performed a clinical audit in two cycles; in the first cycle, we collected data retrospectively over a month in February 2024. The data was sourced from the imaging request forms and patient records at BTH. We then analyzed the data and implemented four key interventions to improve the outcome. After that, we performed our second audit cycle over an additional 30-day period during April 2024. Results Cycle One involved 59 patients, while Cycle Two involved 46. There was a significant decrease in scans requested outside of the NICE guidance, from 59.3% in Cycle One to 17.4% in Cycle Two (p<0.05). We also noticed a significant increase in the one-hour indication scans, from 32% in Cycle One to 65.2% in Cycle Two (p<0.05). Conclusion Our study findings reveal that by following some simple interventions, we significantly improved the adherence of our emergency department to the 2023 NICE guidelines for head CT following head trauma., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sadeq et al.)

In 2016, a new, improved and modern intensive care unit was constructed at Kamuzu Central Hospital in Lilongwe, Malawi. Having been operational for about 4 years, there has not been a systematic audit to gauge its performance. Therefore, this quantitative retrospective cohort study aimed at investigating the performance of the intensive care unit at Kamuzu Central Hospital in Lilongwe, Malawi. We analysed the patterns of admission through 250 clinical cases and their respective outcomes spanning from 1st January 2019 to 31st December 2019 using STATA. Descriptive and inferential statistics were computed. We also had a follow-up discussion with the Head of the unit to better understand the unit's functioning. Out of the 250 admissions, we evaluated 249 case files. About 30.8% of all patients were referred from the main operating theatre, and 20.7% from the casualty (emergency medicine). Head injury (26.7%) and peritonitis (15.7%) were the commonest causes of admission. The overall mortality was 52.2% with more females (57.5%) dying than males (47.9%). Head injury and peritonitis had the highest contribution to the mortality accounting for 25.3% and 16.9% of all deaths respectively. In conclusion, despite the new unit registering an improved performance compared to the old unit's 2012 mortality of 60.9%, the current mortality rate of 52.2% generally reflects a suboptimal performance. The intensive care unit is still grappling with a number of challenges that need immediate attention including few working beds, shortage of critical care specialists and nursing staff and lack of standard admission criteria., (© 2024. The Author(s).)

Background: Difficult airway management is one of the main challenges in paediatric anaesthesia, particularly in low- and middle-income countries., Aims: The aim of this study was to investigate the main predictors of difficult paediatric intubation., Methods: In this observational study, we included all children aged less than five years undergoing intra-abdominal surgery with endotracheal intubation. Patients were divided into two groups according to the incidence of difficult intubation. Then, we investigated predictors for difficult paediatric intubation., Results: We included 217 children, and difficult intubation was observed in 10% of them. Predictors were as follows: Mallampati III-IV class (adjusted odds ratio = 2.21; 95% confidence interval = 1.1-6.4), limited mouth opening (adjusted odds ratio = 2.4; 95% confidence interval = 1.8-3.5), facial dysmorphia (adjusted odds ratio = 2.6; 95% confidence interval = 1.32-7.4) and anaesthesia without muscle relaxant (adjusted odds ratio = 1.8; 95% confidence interval = 1.0-5.1) or without opioids during crash inductions (adjusted odds ratio = 1.7; 95% confidence interval = 1.01-4.8)., Conclusion: Facial dysmorphia and limited mouth opening were predictors of difficult intubation in children. Furthermore, it seems that Mallampati class and anaesthesia technique may also predict challenging intubation, which may guide us to change our perioperative practice., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Background:  Red blood cell (RBC) transfusion is one of the most critical and expensive lifesaving treatment modalities. A clinical audit is a valuable instrument to determine whether transfusion practices align with the guidelines and identify knowledge deficiencies. The study aimed to evaluate the RBC transfusion practices and patient outcomes at the National District Hospital in Bloemfontein, South Africa, and to determine adherence to transfusion guidelines., Methods:  A retrospective descriptive study was conducted. All blood transfusion registers in the hospital were used to identify transfusion episodes during the study period. Files were retrieved from the admissions office and information captured on a paper-based datasheet. The appropriateness of the transfusion and adherence to the South African transfusion guidelines were evaluated using specific criteria., Results:  Of the 118 transfusion episodes during the study period, 78 files were retrieved and 76 included in the study. The patients' median age was 47 years (interquartile range [IQR]: 32-66 years), with human immunodeficiency viruses (HIV) (n = 34; 44.7%) being the most common comorbid condition. Pre-transfusion haemoglobin was documented for all patients with a median of 4.6 g/dL (IQR: 3.95 g/dL - 5.5 g/dL). The audit revealed that in 68.4% (n = 52) of the cases, the guidelines were applied appropriately., Conclusion:  The study described the blood transfusion practices and identified shortcomings when compared with the standard clinical guidelines.Contribution: The study highlights the importance of applying rationale, caution and consideration of the specific patient profile when performing transfusions.

Introduction: Defibrillation is a critical intervention in managing cardiac emergencies, yet healthcare workers (HCWs) preparation for utilizing defibrillators remains inadequate, particularly in low and middle-income countries. This quality improvement project aimed to assess and enhance HCWs' knowledge, skills, and attitudes toward defibrillator use in the emergency department (ED) through a 1-h defibrillator workshop., Methodology: An observational clinical audit was conducted within the ED of a tertiary care hospital. Pre- and post-workshop data were collected from the participants using structured questionnaires for demographics, knowledge assessment (20 multiple-choice questions), skills assessment (10-step checklist), and attitude evaluation (Likert-scale statements). The workshop included theoretical instruction and hands-on practice, with a post-workshop assessment conducted one week later. Data analysis employed descriptive statistics and paired t -tests, while ethical considerations ensured confidentiality and consent., Results: The study included 38 participants, demonstrating significant gaps in defibrillator knowledge, skills, and attitudes pre-workshop. Post-workshop assessments revealed a marked improvement in knowledge scores ( P <0.05), attitudes ( P <0.05), and practical skills ( P <0.05). Participants' confidence and preparation for managing cardiac emergencies notably increased, indicating the workshop's efficacy in addressing the identified deficiencies., Conclusion: The 1-h defibrillator workshop effectively enhanced HCWs' competence and readiness to utilize ED defibrillators. The observed improvements underscore the importance of targeted educational interventions in bridging knowledge gaps and fostering proactive attitudes toward emergency management. Regular training sessions should be conducted to sustain these enhancements and improve patient outcomes in the ED., Competing Interests: All authors declare no conflict of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: Up to 40% of care provided to patients is either wasteful or harmful. The practice of audit and feedback can help identify where care can be improved. However, such audits must be executed in a systematic way that engages with clinicians to maximize the impact of feedback, ultimately improving patient outcomes. Currently, audit training is not integrated into formal education pathways and clinicians need guidance to support them in this activity. This paper explores contemporary research, with the aim of providing practical advice for recommendations to maximize the impact of audit and feedback., Spanish Abstract: http://links.lww.com/IJEBH/A239., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2024 JBI. Unauthorized reproduction of this article is prohibited.)

Objective: The objective of this study was to assess the implementation of Zero Projects in Critical Care Units (CCUs) through Internal Audits (IA)., Materials and Methods: Design: Real-time observational safety analysis. A questionnaire was developed with defined items to ensure objectivity. After IAs, a survey was conducted with the auditors., Scope: 11 CCUs in hospitals of the Servizo Galego de Saúde and Ribera-POVISA., Patients or Participants: 24 auditors in 9 teams composed of medical, nursing, and quality personnel from health areas and 34 patients were assessed., Main Variables of Interest: Compliance with the quality standard (≥60% of items), strengths, areas for improvement, auditor's interest in IA, conformity with the organization and items., Results: 100% CCUs met the quality standard. 18.03% of items were fulfilled by all CCUs. Strengths: staff motivation, positive reception of auditors, and use of computer tools in some CCUs. Areas for improvement: deficit of automatic systems for controlling endotracheal tube cuff pressure (compliance rate in 9.1% of CCUs), training needs, communication issues, and not using checklists (45.5% of the reports). Auditors found IA very interesting, and 19% suggested improving organization and items., Conclusions: All CCUs met the previously agreed-upon quality standard. Numerous improvement opportunities were identified and communicated to the audited CCUs. For greater homogeneity and objectivity, a review of previously agreed items and definitions is required., (Copyright © 2024 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background Patient discharge summaries not only play a vital role in ensuring continuity of care and patient safety but also serve as a communication tool between the primary and tertiary care settings. However, despite their paramount importance, most discharge summaries are either inaccurate or miss essential clinical information, posing considerable danger to patients. This clinical audit assesses the quality of discharge summaries at Mardan Medical Complex, Mardan, Pakistan, to identify areas for improvement. Aim The aim of this study is to assess the discharge summaries of patients at Mardan Medical Complex in Mardan, Pakistan, with a focus on their completeness, accuracy, and timeliness. Methods A cross-sectional, observational, and retrospective study was carried out in the Medical A ward of Mardan Medical Complex, Mardan, Pakistan, from September 2023 to October 2023. Out of the 897 discharge slips, a sample size of 105 participants was determined using Epi Info software. A systematic random sampling technique was used. Data was extracted from the hospital management information system and evaluated using a clinical audit tool based on standard guidelines from the Royal College of Physicians, Islamabad Healthcare Regulatory Authority, and Khyber Pakhtunkhwa Health Care Commission. To analyze the data, descriptive statistics were applied. Results The clinical audit revealed significant deficiencies in discharge summaries. Important patient demographics, such as contact details and safety alerts, were completely absent in 100% of the cases, and 48% of the summaries lacked the father's name. Admission details were similarly inadequate, with nearly all summaries missing critical information like admission time and reasons for admission. Clinical summaries and procedural details were absent in 73% and 87% of the cases, respectively. Discharge planning also showed major gaps, as special instructions according to the primary diagnosis and discharge destination were frequently neglected. Follow-up visits were recommended in only 71% of cases. Additionally, there were significant errors in in-home medication prescriptions, with 61% missing medication doses, 28% missing the route of administration, and 20% lacking the duration of treatment. Conclusions This clinical audit identified critical areas for improvement by revealing significant errors in the quality of discharge summaries at Mardan Medical Complex. It is recommended that standardized discharge slip templates be implemented, healthcare workers receive proper training, and thorough monitoring be conducted before patients are discharged. These measures aim to enhance the standard of documentation. Additionally, regular future clinical audits are essential for tracking the impact of these interventions and ensuring patient safety and continuity of care., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ali et al.)

Objective: The primary objective of this study is to assess the adherence of our department to the British Orthopaedic Association's Standards for Trauma and Orthopaedics (BOAST) guidelines for "the care of the older or frail orthopaedic trauma patient" and the results of this adherence on clinical patient outcome measures., Methods: This was a clinical audit. All ≥65-year-olds admitted to the orthopaedic department with a fragility fracture between 8 September 2022 and 8 March 2023 with a length of stay (LOS) of >72 hours were included. Patients were stratified into hip fracture (HF) and non-hip fracture (NHF) patients. A further similar cohort of NHF admissions between 8 March and 8 May 2023 was added to the data. The adherence of both cohorts to the national guidelines was recorded. Primary outcome measures of each cohort were recorded such as LOS and patient mortality., Results: Data from 70 patients was collected. HF patients adhered to the guideline 79.4% of the time (31/39 patients) compared to NHF patients at only 19.3% of the time (6/31 patients) (p<0.001). Further, on average, HF patients were seen by an orthogeriatrician 15 times compared to just five times for NHF patients during their hospital stay (p<0.001). No significant difference in LOS or in mortality at 30 days post-admission was observed., Conclusion: Medical orthogeriatric care is unequal despite similar LOS and mortality between both cohorts; thus, increasing orthogeriatrician input in NHF patients may lead to better patient outcomes for these patients., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tahoun et al.)

Objectives: In the UK, guidelines recommend pancreatic enzyme replacement therapy (PERT) to all people with unresectable pancreatic cancer. In 2023, we published a national audit of PERT which showed suboptimal prescribing and wide regional variation in England. The aim of this manuscript was to describe how we used the PERT audit to drive improvements in healthcare., Methods: Building on the PERT audit, we deployed an online dashboard which will deliver ongoing updates of the PERT audit. We developed a collaborative intervention with cancer nurse specialists (CNS) to improve care delivered to people with pancreatic cancer. The intervention called Creating a natiOnAL CNS pancrEatic cancer network to Standardise and improve CarE (COALESCE) will use the dashboard to evaluate improvements in prescribing of PERT., Results: We demonstrated how large databases of electronic healthcare records (EHRs) can be used to improve cancer care. The PERT audit was implemented into a dashboard for tracking the progress of COALESCE. We will measure improvements in PERT prescribing as the intervention with CNS progresses., Conclusions: Improving healthcare is an ongoing and iterative process. By implementing the PERT dashboard, we created a resource-efficient, automated evaluation method enabling COALESCE to deliver a sustainable change. National-scale databases of EHRs enable rapid cycles of audits, providing regular feedback to interventions, working systematically to deliver change. Here, the focus is on pancreatic cancer. However, this methodology is transferable to other areas of healthcare., Implications for Nursing Practice: Nurses play a key role in collecting good quality data which are needed in clinical audits to identify shortcomings in healthcare. Nurse-driven interventions can be designed to improve healthcare. In this study, we capitalize on the unique role of CNS coordinating care for every patient with cancer. COALESCE is the first national collaborative study which uses CNS as researchers and change agents., Competing Interests: Declaration of competing interest BG received research funding from the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, NHS England, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, the World Health Organization, UKRI MRC, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies program; he is a Non-Executive Director at NHS Digital; he also receives personal income from speaking and writing for lay audiences on the misuse of science. BMK is employed as a pharmacist by NHS England and seconded to the Bennett Institute., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The Ottawa Rules are clinical decision tools designed to assist healthcare providers in determining the need for radiographs in patients with ankle or knee injuries. Compliance with these rules can lead to more efficient use of resources and reduced radiation exposure., Objective: This retrospective clinical audit aimed to evaluate healthcare provider's compliance with the Ottawa Rules in an Emergency Department setting and assess the positivity rates of requested knee and ankle X-rays., Methods: A two-cycle retrospective audit was conducted at Lincoln County Hospital's Emergency Department, involving 648 X-rays collected in two cycles. In between, multiple interventions were implemented to improve the outcomes., Results: The study revealed varying levels of compliance with the Ottawa Rules, with higher compliance observed for knee X-rays than ankle X-rays. The compliance for knee X-rays improved from 74.6% to 89.9% and ankle X-rays improved from 33.1% to 75.8%. Positivity rates for ankle radiographs were higher than knee radiographs in both cycles. The interventions implemented between the cycles significantly improved compliance rates with the Ottawa Rules., Conclusion: The findings underscore the importance of adherence to the Ottawa Rules in optimizing patient care and resource utilization. The study suggests the need for continued education and periodic audits to maintain and further improve compliance rates. Additionally, the higher positivity rates for ankle radiographs highlight the importance of targeted imaging strategies based on clinical guidelines., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Clinical Governance Department, Lincoln County Hospital issued approval first cycle (L0928) and second cycle (L1116). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Dalla Ali et al.)

Background: UK guidelines for managing adults with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), published by the British Association of Dermatologists (BAD) in 2016, outline a set of audit standards., Objectives: To audit current management of SJS/TEN in adults against standards in the BAD guidelines., Methods: BAD members were invited to submit data on five consecutive adults with SJS/TEN per department over an 8-week period in 2022., Results: Thirty-nine dermatology centres in the UK (29%) participated, and data for 147 adults with SJS/TEN were collected. Within 24 h of the diagnosis being made or suspected, the following were documented, per 147 submitted cases: Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) for 76 (52%), list of medications for 113 (77%) and timelines for commencement/alterations of medications for 104 (71%). The initial assessment was documented of the eyes by an ophthalmologist in 71 (48%), of the mouth in 130 (88%), of the genital skin in 103 (70%) and of the urinary tract in 93 (63%). During the first 10 days after a suspected or confirmed diagnosis of SJS/TEN, daily assessments of the mouth were documented in 26 of 147 cases (18%), of the eyes in 12 (8%), and of the urinary tract and genital skin in 14 (10%). At discharge, a drug was declared to be the cause of SJS/TEN for 130 of 147 cases (88%), while 9 (6%) were thought to be secondary to infection. Eleven of 147 (8%) had no response to this question. Documentation regarding advice was present on avoidance of the culprit drug in 76 of 130 declared SJS/TEN cases (58%), and on requesting a MedicAlert® bracelet/amulet in 9 of the 147 cases (6%)., Conclusions: This audit suggests that a clinical review checklist might be needed to enable colleagues to maintain standards outlined in the guidelines, including documentation of SCORTEN, daily assessments of mucosal areas, and advice to avoid culprit drug(s) and to request a MedicAlert® bracelet/amulet., (© British Association of Dermatologists 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background Aseptic protocol adherence and sterilization are the most important factors in a patient's satisfactory recovery after surgery. The standard hand scrubbing procedure helps control infection and keeps the surgical site clean by adhering to aseptic principles. Methods Thirty-six young residents and house officers participated in this prospective audit after ethical clearance was obtained. The World Health Organization (WHO) standard criteria were adhered to both before and after the intervention. Participants were observed in the surgical operation theatre (OT) without prior notice to ensure hand hygiene compliance before surgical procedures. The intervention included a video presentation as well as a live demonstration. Results Only 64.41% (n=23) of residents and house officers followed the recommended standard hand hygiene procedures before the intervention. This percentage rose to 93.92% (n=33) following the intervention, suggesting a noteworthy improvement. Conclusion Significant changes in the acceptance rates for the essential requirements of hand hygiene were observed after the evaluation in the second cycle. Adhering to WHO guidelines for procedures will help reduce the risk of infections and promote awareness of asepsis in practice., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee (IEC) of Al Manaqil Teaching Hospital issued approval SUD23/11/MAN-22. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Yousif Mohamed et al.)

(1) Background: Medication adherence is influenced by a variety of intricate factors, presenting hurdles for nurses working to improve it among adults with chronic conditions. Pinpointing the reasons for non-adherence is crucial for customizing interventions. The objective of this quality improvement project was to improve medication adherence among adults with chronic diseases in primary healthcare by promoting evidence-based practices, identifying barriers and facilitators to compliance, and developing strategies to ensure optimal adherence through engaging the nursing team, enhancing knowledge, and evaluating the effectiveness of the implemented strategies. (2) Methods: This study was a quality improvement project that utilized the JBI Evidence Implementation framework, the Practical Application of Clinical Evidence System, and the Getting Research into Practice audit tool across three phases: (i) forming a project team and conducting a baseline audit, (ii) offering feedback via the GRiP tool, and (iii) conducting a follow-up audit to assess best practice outcomes. The study was conducted between September 2021 and March 2022 in the community care unit of Algarve Regional Health Administration, targeting adults with chronic illnesses. (3) Results: A total of 148 individuals were audited, including 8 nurses, 70 baseline patients, and 70 post-implementation patients. Initial compliance with key best practices was low, with several criteria at 0% compliance at baseline. Post-intervention, we observed significant improvements; compliance with key best practices improved dramatically, with many reaching 100%. Notable improvements included enhanced patient education on medication management, regular medication adherence assessments, and increased engagement of healthcare professionals in adherence activities. (4) Conclusions: This quality improvement project demonstrated that structured, evidence-based interventions could significantly enhance medication adherence among adults with chronic diseases. The success of the project highlights the potential of similar strategies to be applied broadly in primary healthcare settings to improve health outcomes.

Background: Surgical antibiotic prophylaxis (SAP) is an important preventive measure, aiming to minimize surgical site infections. However, despite evidence-based guidelines, adherence to SAP protocols remains suboptimal in clinical practice. The aim of this study was to assess the adequacy of SAP in a high-complexity hospital and investigate associated factors., Methods: A cross-sectional design was conducted, involving surgeries performed by expert teams in cardiology, urology, neurology, and gastrointestinal. SAP prescriptions were evaluated based on indication, antibiotic choice, dosage, and duration, according to the hospital protocol. Data analysis included descriptive statistics and association tests between protocol adherence and patient demographics, clinical variables, surgical teams, and types of surgeries., Results: Out of 1,864 surgeries, only 20.7% adhered to SAP protocols. Lower adherence rates were observed for antibiotic choice and duration of prophylaxis. Neurological surgeries exhibited significantly lower adherence, particularly concerning antibiotic choice and duration. Factors associated with nonadherence included elevated preoperative blood glucose levels, prolonged hospitalization, and extended surgical duration. Logistic regression analysis identified surgical teams as significant factors influencing protocol adherence., Conclusions: Despite the relatively high adherence to antibiotic dosage, challenges persist in antibiotic choice and duration adjustment. Poor glycemic control, prolonged surgery, and surgical teams were variables associated with inappropriate practice., (Copyright © 2024 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Leave against medical advice (LAMA) is defined as 'a decision to leave the hospital before the treating physician recommends discharge', and is associated with higher rates of readmission, longer subsequent hospitalization, and worse health outcomes. In addition to this, they also contribute to poor healthcare resource utilization. We conducted a single-center audit to establish patient demographics and contributing factors of patients leaving against medical advice from our emergency department (ED). We benchmarked our data against locally available clinical policy guidelines. We interrogated our electronic health record system (known as Salamtak ® ), which is a Cerner-based platform (Cerner Corporation, Kansas City, MO 64138) for patients who signed LAMA from ED from 2018 to 2023. We selected a convenience pilot sample of 120 subjects. Based on a literature review, we identified patient demographics (age, gender, nationality, socioeconomic status, marital status, religion), possible contributing factors (time of attendance, insurance status, length of ED stay), and patient outcomes (reattendances within 1 week and mortality) to evaluate. Based on locally available guidance, we formulated six criteria to audit with a standard set at 100% for each. A team of emergency medicine residents collected data that was anonymized on an Excel spreadsheet ( Microsoft Excel,  Microsoft Corporation. (2018). Basic descriptive statistics were used to collate results. About 93 patients (77.5%) were 16 years and above, and 27 patients (22.5%) were below 16 years. There was a slight preponderance of males (64 patients, 53.3%) than females (56 patients, 46.6%). The majority of LAMA cases presented in the evening and night (97 patients, 80.8%). About 57 (47.5%) patients had an ED length of stay of 3 hours or more. The average ED length of stay for these patients was 3.4 hours. About 73 patients (60.3%) were insured. Out of 120 patients, only 12 (10%) had a mental capacity assessment documented. The commonest reason for signing LAMA was a social reason in 45 (37.5%) cases. In the remaining cases, the causes were a combination of family, financial, waiting, or other/undocumented reasons). When faced with a decision to LAMA, the involvement of a Public Relationship Officer (PRO) was only documented to be consulted in seven (5.8%) cases. About 14 cases were re-attended within 1 week (11.6%) and no mortalities were reported in any of the reattendances. LAMA is a not-so-rare phenomenon often occurring in EDs, and often a cause of trepidation for healthcare workers. Treating this as an aberrant behavior on the part of the patient, or laying the responsibility for this action on the healthcare provider is primitive, counter-productive, and not patient-centric. Familiarity with local guidelines around this contentious area is essential. Revised nomenclature like 'premature discharge' may be less stigmatizing for the patient. Where possible, a harm reduction approach should be used and frontline healthcare workers must be prepared with an escalation plan. In the United Arab Emirates, familiarity with Wadeema's Law as a child protection measure is essential., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alhajeri et al.)

Objective: To develop a reference standard based on US Food and Drug Administration and stakeholder guidance for pharmaceutical companies' policies on diversity in clinical trials and to assess these policies., Design: Development of a reference standard and structured audit for clinical trial diversity policies., Setting: 50 pharmaceutical companies selected from the top 500 by their market capitalizations in 2021 (the 25 largest companies and 25 non-large companies, randomly selected from the remaining 475 companies)., Population: Data from pharmaceutical company websites and annual reports. Policy guidance from the Pharmaceutical Research and Manufacturers of America, International Federation of Pharmaceutical Manufacturers and Associations, Biotechnology Industry Organization, International Committee of Medical Journal Editors, the US Food and Drug Administration, European Medicines Agency, and World Health Organization, up to 15 May 2023., Main Outcome Measures: Multicomponent measure based on distinct themes derived from FDA and stakeholder guidance., Results: Reviewing FDA and stakeholder guidance identified 14 distinct themes recommended for improving diversity in clinical trials, which were built into a reference standard: (1) enrollment targets that reflect the prevalence of targeted conditions in populations, (2) broad eligibility criteria for trials, (3) diversity in the workforce, (4) identification and remedy of barriers to trial recruitment and retention, (5) incorporation of patient input into trial design, (6) health literacy, (7) multidimensional approaches to diversity, (8) sites with diverse providers and patient populations, (9) data collection after product approval, (10) diverse enrollment in every country where trials are conducted, (11) diverse enrollment should be a focus for all phases of clinical trials, not just later stage or pivotal trials, (12) varied trial design, (13) expanded access, and (14) public reporting of the personal characteristics of participants in trials. Applying this reference standard, 48% (24/50) of companies had no public policy on diversity in clinical trials; among those with policies, content varied widely. Large companies were more likely to have a public policy than non-large companies (21/25, 84% v 5/25, 20%, P<0.001). Large companies most frequently committed to using epidemiological based trial enrollment targets representing the prevalence of indicated conditions in various populations (n=15, 71%), dealing with barriers to trial recruitment (n=15, 71%), and improving patient awareness of trial opportunities (n=14, 67%). The location of the company was not associated with having a public diversity policy (P=0.17). The average company policy had five of the 14 commitments (36%, range 0-8) recommended in FDA and stakeholder guidance., Conclusions: The findings of the study showed that many pharmaceutical companies did not have public policies on diversity in clinical trials, although policies were more common in large than non-large companies. Policies that were publicly available varied widely and lacked important commitments recommended by stakeholder guidance. The results of the study suggest that corporate policies can be better leveraged to promote representation and fair inclusion in research, and implementation of FDA and stakeholder guidance., Competing Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: no support from any organization for the submitted work; JM serves as a board member of Bioethics International and as an advisor for Galatea Bio, and receives grant funding from the the US Food and Drug Administration (FDA) and Arnold Ventures outside the submitted work; RR reports receiving consultancy fees from ReAct Action on Antibiotic Resistance Strategic Policy Program, grants from the Stavros Niarchos Foundations for a project on public research and development, grants from the FDA outside the submitted work, and serving in volunteer unpaid positions on the board for the non-profit organization Universities Allied for Essential Medicines, North America and as chair of the Doctors for America FDA Task Force; CG reports receiving grants from Johnson & Johnson and the National Comprehensive Cancer Network (AstraZeneca), and personal fees from Genentech outside the submitted work; JS reports receiving grants from National Institutes of Health (NIH) during the conduct of the study; JSR reports receiving grants from the FDA, Johnson & Johnson, Medical Devices Innovation Consortium, Agency for Healthcare Research and Quality, National Heart, Lung, and Blood Institute, and Arnold Ventures, and having been an expert witness at the request of relator’s attorney, the Greene Law Firm, in a qui tam lawsuit alleging violations of the False Claims Act and Anti-Kickback Statute against Biogen that was settled in September 2022; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Infective endocarditis (IE) has a high mortality rate in developing countries including Malaysia. This clinical audit aims to identify the shortcomings in the diagnosis and management of IE patients in a local tertiary centre to implement changes for improvement., Materials and Methods: This retrospective audit had two cycles - the first includes all IE patients in Sarawak Heart Centre, Malaysia from January 2020 to December 2022 with different parameters (blood culture, echocardiogram, the appropriateness of antibiotics and surgery) assessed against Malaysian Clinical Practice Guideline (CPG); and reaudit from July 2023 to December 2023. Interventions before re-audit include presentation at different hospital levels and continuing medical education., Results: Fifty patients were recruited (37 in the first cycle, 13 in the second cycle). The median age was 48.5 years with male predominance. Valve prosthesis (12.0%) and rheumatic heart disease (10.0%) were the commonest predisposing factors. Native mitral (44.0%) and aortic valves (28.0%) were most commonly involved. Twenty-eight (56.0%) patients were culture-positive. In the first cycle, most parameters (culture technique 0.0%, vegetation measured 54.1%, empirical 5.4%, culture-guided 29.7% antibiotics therapy, indicated surgery 0.0%) did not achieve the expected standard except timeliness of echocardiograms and blood culture incubation period. After initial interventions, all parameters showed statistically significant improvement (culture technique p<0.001, echocardiography p<0.001, empirical p<0.001, culture-guided p=0.021, surgery p<0.001) during the re-audit., Conclusion: Compliance with clinical practice guidelines (CPG) on IE management was suboptimal during the first audit but improved after interventions. Hence, regular continuing medical education (CME) is essential, and a written hospital protocol may be useful. Regular audits alongside multidisciplinary teamwork are crucial efforts.

Introduction: The implications of shorter scan time and lower tube voltage in the dual-source CT coronary angiography (CTCA) scan protocol necessitate the adaptation of contrast media (CM) injection parameters. This audit evaluates the coronary arteries' vascular attenuation and image quality by comparing the personalised patient protocol technology (P3T) contrast injection software with standard injection protocol. The secondary aim is to determine the relationship between CM volume and the patient's weight., Methodology: A Siemens Somatom Definition Force CT Unit was used to scan 30 sets of patients between August 2020 and October 2020. Patients were selected retrospectively and separated into Standard Injection and P3T injection protocols. An experienced radiologist blinded to the groups reviewed the coronary vessels' contrast enhancement and image quality., Results: Overall, the mean HU of all the main coronary artery vessels obtained from P3T injection software reached above 350 HU and was diagnostically sufficient. The mean attenuation at the proximal region of RCA in the 80-99 kg weight category was significantly higher in the P3T injection software than the standard injection protocol (p < 0.001). The CM volume proposed by P3T injection software for 40-59 kg was approximately 57 ± 5 mls, while 75 ml was used for the standard injection protocol., Conclusion: P3T injection software in CTCA resulted in an adequate diagnostic attenuation of coronary arteries (>350HU) in all weight groups, most effectively in the higher weight group, while maintaining diagnostic image quality. Further, the P3T software reduces CM volumes in lower-weight patients., Implications: P3T software enables reducing CM volume in lower-weight patients while improving vascular enhancement in CTCA scans in higher-weight patients., Competing Interests: Conflict of interest statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Intravenous patient-controlled analgesia (PCA) is valuable for delivering opioids in a flexible and timely manner. Although it is designed to offer personalized analgesia driven by the patients themselves, users often report insufficient pain relief, which can be addressed by optimizing its settings and multimodal analgesia. We adopted a systematic approach to modify PCA protocols by utilizing a serial audit process based on institutional PCA data. This review retrospectively examined the process, encompassing data from 13,230 patients who had used PCA devices. The two modifications to the fentanyl-based PCA protocols resulted in three distinct phases. In the first phase, high opioid consumption and unintended PCA withdrawal were the common issues. These were addressed in the second phase by omitting the routine use of basal infusion. However, this led to increased delivery-to-demand ratios, mitigated in the third phase by increasing the bolus dose from 15 μg to 20 μg. These serial protocol changes have produced varied outcomes across different surgical departments, underscoring the need for careful and gradual adjustments and thorough impact assessments. Drawing insights from this audit process, we incorporated findings from the literature on PCA settings and multimodal analgesic approaches. This review underscores the significance of iterative feedback and refinement of analgesic protocols to achieve optimal postoperative pain management. Additionally, it discusses critical considerations regarding the postoperative audit processes.

Diabetes-related foot complications, including neuropathic plantar forefoot ulcers, are a significant contributor to morbidity and increased healthcare costs. This retrospective clinical audit examines the characteristics of people accessing pedorthics services who are at risk of neuropathic plantar forefoot ulcer (re)occurrence and the pathways and funding models used to access these services. A clinical record audit was conducted on all patients accessing a pedorthics service who had diabetes and neuropathy with a history of plantar forefoot ulceration. The data included demographics, diabetes and neuropathy duration, main forefoot pathology and other comorbidity, footwear and insole interventions, and health fund access status. A total of 70 patient records were accessed, and relevant data was extracted. The mean age of participants was 64.69 (standard deviation (SD) 11.78) years; 61% were male and 39% female. Duration of diabetes ranged from one to 35 years, with a mean of 14.09 years (SD 6.58). The mean duration of neuropathy was 8.56 (SD 4.16) years. The most common forefoot conditions were bony prominences at 71% (n = 50), rigid flat foot and limited joint mobility (53%, n = 37), and hallux abductovalgus at 47% (n = 33). All participants had hyperkeratosis; 34% (n = 24) had forefoot amputation, and around 34% (n = 24) had a history of digital amputation. Various publicly funded packages and private health insurance were accessed. This study investigates the sociodemographic and medical profiles of individuals with diabetes-related foot complexities prone to neuropathic plantar forefoot ulcers. It is the first to examine patients receiving pedorthic services, informing practitioner surveys and preventive care strategies. Understanding patient characteristics aids in optimising multidisciplinary care and reducing ulcer incidence. Further studies are warranted to explore the field to establish an effective multidisciplinary care approach between medical professionals, podiatrists and pedorthists to optimise patient outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ahmed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Increased therapy time and task-specific practice can improve functional recovery post stroke. This observational study aimed to determine whether the clinical implementation of circuit training increases therapy time and improves function in stroke rehabilitation., Methods: In a retrospective clinical audit, medical records of 110 people (mean age 78.7, standard deviation 13.0, 49.1% male, 57.3% severe stroke) admitted to a stroke inpatient rehabilitation ward were evaluated to determine the differences between pre (Individual Therapy (IT), n = 55) and post (Circuit Class Therapy (CCT), n = 55) service change implementation. The primary outcome was the amount of time spent in physiotherapy daily (minutes). Secondary outcomes included the Functional Independence Measure (FIM) score and length of stay (LOS)., Results: The CCT Group spent significantly more time in physiotherapy daily during their rehabilitation LOS compared to the IT Group (mean difference 8.45 (95% CI 5.99 to 10.90) mins, p < 0.001). No significant between-group differences were observed for FIM scores or LOS (p ≥ 0.066)., Conclusion: This study suggests that the clinical implementation of CCT can significantly increase therapy time by close to 9 minutes per session, with functional gains that are equivalent to usual care. This was achieved with a patient-to-staff ratio of 3:1, compared to the 1:1 ratio in IT, concurring with existing evidence in support of CCT as an alternative service delivery model for inpatient stroke rehabilitation.

Abstract Introduction Preliminary image evaluation (PIE) is a mechanism whereby radiographers provide a preliminary evaluation of whether pathology is present in their radiographs, typically acquired within the emergency department (ED). PIE provides referrers with a timely communication of pathology prior to the availability of a radiology report. The purpose of this study was to determine the most common radiographer PIE false‐negative interpretations. Methods Each month over a two‐year period, 100 PIEs of adult and paediatric patients were randomly reviewed in a metropolitan hospital ED. The radiographer’s PIE was compared with the radiologist’s report and categorised into basic quality indicators; true positive, true negative, false positive and false negative. The anatomical regions which most commonly indicated a false‐negative interpretation were further analysed. Results 2402 cases were reviewed which resulted in an overall PIE accuracy of 88.7%. Wrists, hands, phalanges (upper), ankles, feet and phalanges (lower) reporting the highest false‐negative or false‐negative/true‐positive interpretations (60/116). Of the 60 false‐negative PIEs, 68 pathologies were identified. 41.1% (28/68) of the pathology not identified were in the phalanges. Within these regions, examinations with multiple injuries commonly reported false negatives (17/60). Conclusions This study demonstrated the most common false‐negative radiographer PIEs were within the upper and lower distal extremities. Specifically, the phalanges and examinations demonstrating multiple injuries reported high levels of misinterpretation. The misinterpretation in multi‐injury examinations could be attributed to ‘Subsequent Search Miss (SSM)’ error. These results provide valuable insights into areas of emphasis when providing image interpretation education.

Introduction: This audit was performed to monitor the diagnosis and management of chronic kidney disease (CKD) according to the clinical practice guidelines (CPGs) of CKD 2018 in a primary care clinic. Methods: Patients who attended the clinic from April to June 2019 and fulfilled the diagnosis of CKD were included in this study, except for those diagnosed with a urinary tract infection, pregnant women and those on dialysis. These criteria were set based on the CPGs. The standards were set following discussions with the clinic team members with reference to local guidelines, the 2017 United Kingdom National CKD audit and other relevant studies. Results: A total of 384 medical records were included in this audit. Overall, 5 out of 20 criteria for processes and 3 of 8 clinical outcomes for CKD care did not meet the set standards. These included the following: documentation of CKD classification based on albumin category (43.8%); CKD advice (19.0%); dietitian referral (9.1%); nephrologist referral (45.5%); haemoglobin level monitoring (65.7%); overall blood pressure (BP) control (45.3%); BP readings for diabetic kidney disease (DKD) and non-DKD with > 1 g/day of proteinuria (≤ 130/80 mmHg, 37.0%); eGFR reduction of < 25% over the past year (77.2%). Identified problems included the absence of a CKD registry, eGFR and albuminuria reports, and a dedicated team, among other factors. Conclusions: Overall, 8 out of 28 criteria did not meet the standards of CKD care set for this audit. The problems identified in this audit have been addressed. Moreover, strategies have also been formulated to improve the diagnosis and management of CKD in this clinic.

Abstract Background Secondary use of data via integrated health information technology is fundamental to many healthcare policies and processes worldwide. However, repurposing data can be problematic and little research has been undertaken into the everyday practicalities of inter-system data sharing that helps explain why this is so, especially within (as opposed to between) organisations. In response, this article reports one of the most detailed empirical examinations undertaken to date of the work involved in repurposing healthcare data for National Clinical Audits. Methods Fifty-four semi-structured, qualitative interviews were carried out with staff in five English National Health Service hospitals about their audit work, including 20 staff involved substantively with audit data collection. In addition, ethnographic observations took place on wards, in ‘back offices’ and meetings (102 h). Findings were analysed thematically and synthesised in narratives. Results Although data were available within hospital applications for secondary use in some audit fields, which could, in theory, have been auto-populated, in practice staff regularly negotiated multiple, unintegrated systems to generate audit records. This work was complex and skilful, and involved cross-checking and double data entry, often using paper forms, to assure data quality and inform quality improvements. Conclusions If technology is to facilitate the secondary use of healthcare data, the skilled but largely hidden labour of those who collect and recontextualise those data must be recognised. Their detailed understandings of what it takes to produce high quality data in specific contexts should inform the further development of integrated systems within organisations.

As the complexity of emergency care increases, current research methods to improve care are often unable to capture all aspects of everyday clinical practice. Video recordings can visualize clinical care in an objective way. They can be used as a tool to assess care and to reflect on care with the caregivers themselves. Although the use of video recordings to reflect on medical interventions (video-reflection) has increased over the years, it is still not used on a regular basis. However, video-reflection proved to be of educational value and can improve teams’ management and performance. It has a positive effect on guideline adherence, documentation, clinical care and teamwork. Recordings can also be used for video-reflexivity. Here, caregivers review recordings together to reflect on their everyday practice from new perspectives with regard to context and conduct in general. Although video-reflection in emergency care has proven to be valuable, certain preconditions have to be met and obstacles need to be overcome. These include gaining trust of the caregivers, having a proper consent-procedure, maintaining confidentiality and adequate use of technical equipment. To implement the lessons learned from video-reflection in a sustainable way and to continuously improve care, it should be integrated in regular simulation training or education. This narrative review will describe the development of video recording in emergency care and how video-reflection can improve patient care and safety in new ways. On our own department, the NICU at the LUMC, video-reflection has already been implemented and we want to further expand this. We will describe the use of video-reflection in our own unit. Based on the results of this narrative review we will propose options for future research to increase the value of video-reflection.

Introduction: Iliac vein obstructions account for 2%–3% of all lower limb deep vein thromboses (DVT). Delayed diagnosis can lead to a higher risk of limb ischemia in the acute setting and post‐thrombotic syndrome in the chronic setting. The purpose of this audit was to determine whether sonographers were taking and interpreting waveforms correctly at the common femoral vein (CFV). Methods: A retrospective audit was performed of all the DVT patients (n = 375) over the course of 3 months. Changes in phasicity during Valsalva, respiration or augmentation of the spectral waveform at the CFV was recorded. Results: Within the cohort group of 375 examinations assessed. Only 277 (74%) patients had spectral traces taken at the level of the CFV. 29 (10%) patients had persistent monophasic waveforms that did not change significantly when a Valsalva manoeuvre was performed, eight patients (2%) had confirmed iliofemoral vein obstruction with either ultrasound or computed tomography venogram. Conclusion: The audit results show that spectral traces at the CFV are not always being taken or assessed effectively in clinical practice for various reasons; highlighting a potential clinical risk. With a combination of education, improved department protocols and workflow strategies, the standard of sonography should be improved. [ABSTRACT FROM AUTHOR]

Objectives: (1) Systematically review the literature on computerized audit and feedback (e-A&F) systems in healthcare. (2) Compare features of current systems against e-A&F best practices. (3) Generate hypotheses on how e-A&F systems may impact patient care and outcomes.Methods: We searched MEDLINE (Ovid), EMBASE (Ovid), and CINAHL (Ebsco) databases to December 31, 2020. Two reviewers independently performed selection, extraction, and quality appraisal (Mixed Methods Appraisal Tool). System features were compared with 18 best practices derived from Clinical Performance Feedback Intervention Theory. We then used realist concepts to generate hypotheses on mechanisms of e-A&F impact. Results are reported in accordance with the PRISMA statement.Results: Our search yielded 4301 unique articles. We included 88 studies evaluating 65 e-A&F systems, spanning a diverse range of clinical areas, including medical, surgical, general practice, etc. Systems adopted a median of 8 best practices (interquartile range 6-10), with 32 systems providing near real-time feedback data and 20 systems incorporating action planning. High-confidence hypotheses suggested that favorable e-A&F systems prompted specific actions, particularly enabled by timely and role-specific feedback (including patient lists and individual performance data) and embedded action plans, in order to improve system usage, care quality, and patient outcomes.Conclusions: e-A&F systems continue to be developed for many clinical applications. Yet, several systems still lack basic features recommended by best practice, such as timely feedback and action planning. Systems should focus on actionability, by providing real-time data for feedback that is specific to user roles, with embedded action plans.Protocol Registration: PROSPERO CRD42016048695. [ABSTRACT FROM AUTHOR]

Inappropriate antibiotic prescribing in dentistry has been widely reported but local studies are scarce. We aimed to evaluate antibiotic prescribing practices among dental officers in a public dental primary care clinic against current guidelines: specifically assessing the number, appropriateness, accuracy of prescriptions, type of antibiotics prescribed and repeated prescribing of the same type of antibiotics within a specific duration. A retrospective audit consisting of two cycles (1st cycle: July to September 2018, 2nd cycle: July to September 2019) was carried out by manually collecting relevant data of patients (aged 18 and above) who were prescribed antibiotics from carbon copies of prescription books. Between each cycle, various interventions such as education through a continuous professional development (CPD) session, presentation of preliminary findings and making guidelines more accessible to dental officers were implemented. When the 1st and 2nd cycles were compared, the number of antibiotic prescriptions issued reduced from 194 to 136 (-30.0%) whereas the percentage of appropriate prescriptions increased slightly by 4.1%. Inaccurate prescriptions in terms of dosage and duration decreased (-0.5% and -13.7%, respectively) whilst drug form and frequency of intake increased (+15.7% and +0.7%, respectively). Repeated prescribing of the same antibiotics by the same officer within a period of ≤6 weeks no longer occurred. Amoxicillin and metronidazole were most commonly prescribed in both cycles. Overall, the antibiotic prescribing practices did not closely adhere to current guidelines. However, clinical audit in conjunction with targeted interventions resulted in improvement in the antibiotic prescribing patterns. Thus, further intervention and re-audit is necessary. [ABSTRACT FROM AUTHOR]

Background: Insight into and understanding of content and comprehensiveness in nursing documentation is important to secure continuity and high-quality care planning in long-term dementia care. The accuracy of nursing documentation is vital in areas where residents have difficulties in communicating needs and preferences. This study described the content and comprehensiveness of nursing documentation for residents living with dementia in nursing homes. Methods: We used a retrospective chart review to describe content and comprehensiveness in the nursing documentation. Person-centered content related to identity, comfort, inclusion, attachment, and occupation was identified, using an extraction tool derived from person-centered care literature. The five-point Comprehensiveness in the Nursing Documentation scale was used to describe the comprehensiveness of the nursing documentation in relation to the nursing process. Results: The residents' life stories were identified in 16% of the reviewed records. There were variations in the identified nursing diagnoses related to person-centered information, across all the five categories. There were variations in comprehensiveness within all five categories, and inclusion and occupation had the least comprehensive information. Conclusion: Findings from this study highlights challenges in documenting person-centered information in a comprehensive way. To improve nursing documentation of residents living with dementia in nursing homes, nurses need to include residents' perspectives and experiences in their planning and evaluation of care. [ABSTRACT FROM AUTHOR]

Background: Optimizing the monitoring of peripheral venous catheters is essential. We developed a nursing record system at bedside (Patient Smart Reader) to track peripheral venous catheter acts. Aims: The aim of the present study was to improve peripheral venous catheter monitoring. To improve the quality of monitoring, we aimed to increase the usage of the nursing record system at the bedside. Methods: We developed a 'commitment intervention' course based on a binding communication paradigm. The corresponding effect on monitoring was analysed using a p‐chart and time series analysis. Findings Nurses observed a significant improvement in compliance with catheter monitoring over time (shifts after shifts), ranging from 27.6% (CI = [25.3; 30.0]) compliance before the commitment intervention to 47.4% (CI = [45.0; 49.9]) compliance after training. The commitment intervention increased the chances of carrying out monitoring through the tool for acts related to peripheral venous catheters by a factor of 2.42 (odds ratio) (CI = [1.88; 3.11]). Conclusion: Binding communication provides an effective method for changing nurses' behaviours in terms of safe care. The determinants of engagement (individual vs collective) can be indicators for defining future communication and training strategies in care centers for all health care workers. [ABSTRACT FROM AUTHOR]

Background: Respiratory failure is a common cause of in-hospital mortality. Its correct diagnosis along with the determination of underlying cause/s and appropriate treatment is important. Objective: Objective of the resent study was to audit the management of Respiratory Failure at Pulmonology unit. Methodology: This was an observational study conducted at the Pulmonology department of a tertiary care Hospital from 1st august to 31st October 2021. Medical records of all patients admitted with SpO2 < 92% were retrieved. Parameters of interest were the diagnosis of Respiratory failure, ABGs analysis, and proper oxygen prescription. BTS guidelines (2017) were considered as standard for comparison. Data were entered into SPSS 19. Percentages were calculated for diagnosis, type of respiratory failure, ABGs Analysis, documentation of Oxygen prescription, target SpO2, and delivery device. Mean and Std. deviation was calculated for age and mean sSpO2. The results were presented as graphs. Results: A total of 100 patients' charts were reviewed. The mean age of patients was 48.8 (±19) years and among these, 45% were males. The initial SpO2 ranged from 45 to 91%. ABGs were taken in 87% of patients and the majority (64%) had type 1 Respiratory Failure. The correct diagnosis was mentioned in 82% of patients' charts. Oxygen was prescribed to 96% but the exact flow and target SpO2 were mentioned only in 33%. Conclusion: Overall, the study identifies significant deficiencies in both oxygen prescription practices and diagnostic documentation in the management of respiratory conditions within the healthcare setting. Addressing these issues is crucial for improving patient outcomes and ensuring appropriate respiratory care delivery. [ABSTRACT FROM AUTHOR]

Background: Healthcare workers are encouraged annually to get vaccinated against influenza. This year in view of COVID-19 pandemic, attitudes of HCWs towards vaccination are particularly important. A cross-sectional study was completed to understand how to best encourage and facilitate the vaccination of HCWs based on the previous years' findings. Methods: An online survey was disseminated to all hospital staff via electronic channels. The clinical audit sphinx software was used for data collection and analysis. Results: The total number of responses was n = 728, almost double the rate from 2018 (N = 393). A total of 78% (N = 551) of participants were vaccinated last year. A total of 94% (N = 677) of participants reported their intention to be vaccinated this year. The main barriers listed were being unable to find time (32%, N = 36), side effects (30%, N = 33) and thinking that it does not work (21%, N = 23). The most popular suggestions for how to increase uptake were more mobile immunisation clinics (72%, N = 517) and more information on the vaccine (50%, N = 360). A total of 82% of participants (N = 590) agreed that healthcare workers should be vaccinated, with 56% (N = 405) agreeing that it should be mandatory. Of the participants who were not vaccinated last year (N = 159), 40% (N = 63) agreed that COVID-19 had changed their opinion on influenza immunisation with a further 11% (N = 18) strongly agreeing. Discussion: In light of the increasing number of survey participants, more staff were interested in flu vaccination this year than ever before. The COVID-19 pandemic has had some influence on staff's likelihood to be vaccinated. Feasibility of immunisation and education posed the largest barriers to HCW vaccination. [ABSTRACT FROM AUTHOR]

Abstract Background Prosthetic joint infections (PJI) are one of the most serious complication of arthroplasty. The management of PJI needs a multidisciplinary collaboration between orthopaedic surgeon, infectious disease specialist and microbiologist. In France, the management of PJI is organized around reference centres (CRIOACs). Our main objective was to perform an audit through a questionnaire survey based on clinical cases, to evaluate how French physicians manage PJI. Eligible participants were all physicians involved in care of patients presenting a PJI. Physicians could answer individually, or collectively during a multidisciplinary team meeting dedicated to PJI. The survey consisted as three questionnaires organized in a total of six clinical cases. Results Answers from the CRIOACs to the three questionnaires were 92, 77, and 53%. Between 32 and 39% of respondents did not administer antibiotic prophylaxis despite positive S. aureus pre-operative documentation. One-stage exchange strategy was widely preferred in all clinical cases, with no difference between CRIOACs and other centres. Rifampicin was prescribed for S. aureus PJI, in a situation with (90–92%) or without any prosthesis (70%). There was no consensus for the total antibiotic regimen duration, with prescriptions from six to 12 weeks for a majority of respondents. Conclusions Surgical strategy for the management of PJI was homogenous with a preference for a one-stage exchange strategy. Medical management was more heterogenous, which reflects the heterogeneity of those infections and difficulties to perform studies with strong conclusions.

Abstract A clinical audit of hospitals in Thailand was conducted to assess compliance with the national hypertension treatment guidelines and determine hypertension control rates across facilities of different sizes. Stratified random sampling was used to select sixteen hospitals of different sizes from four provinces. These included community (120 beds) hospitals. Among new cases, the audit determined whether (i) the recommended baseline laboratory assessment was completed, (ii) the initial choice of medication was appropriate based on the patient's cardiovascular risk, and (iii) patients received medication adjustments when indicated. The hypertension control rates at six months and at the last visit were recorded. Among the 1406 patients, about 75% had their baseline glucose and kidney function assessed. Nearly 30% (n = 425/1406) of patients were indicated for dual therapy but only 43% of them (n = 182/425) received this. During treatment, 28% (198/1406) required adjustments in medication but this was not done. The control of hypertension at six months after treatment initiation was 53% varying between 51% in community and 56% in large hospitals (p

OBJECTIVE To assess hospital surgical-site infection (SSI) identification and reporting following colon surgery and abdominal hysterectomy via a statewide external validation METHODS Infection preventionists (IPs) from the California Department of Public Health (CDPH) performed on-site SSI validation for surgical procedures performed in hospitals that voluntarily participated. Validation involved chart review of SSI cases previously reported by hospitals plus review of patient records flagged for review by claims codes suggestive of SSI. We assessed the sensitivity of traditional surveillance and the added benefit of claims-based surveillance. We also evaluated the positive predictive value of claims-based surveillance (ie, workload efficiency). RESULTS Upon validation review, CDPH IPs identified 239 SSIs following colon surgery at 42 hospitals and 76 SSIs following abdominal hysterectomy at 34 hospitals. For colon surgery, traditional surveillance had a sensitivity of 50% (47% for deep incisional or organ/space [DI/OS] SSI), compared to 84% (88% for DI/OS SSI) for claims-based surveillance. For abdominal hysterectomy, traditional surveillance had a sensitivity of 68% (67% for DI/OS SSI) compared to 74% (78% for DI/OS SSI) for claims-based surveillance. Claims-based surveillance was also efficient, with 1 SSI identified for every 2 patients flagged for review who had undergone abdominal hysterectomy and for every 2.6 patients flagged for review who had undergone colon surgery. Overall, CDPH identified previously unreported SSIs in 74% of validation hospitals performing colon surgery and 35% of validation hospitals performing abdominal hysterectomy. CONCLUSIONS Claims-based surveillance is a standardized approach that hospitals can use to augment traditional surveillance methods and health departments can use for external validation. Infect Control Hosp Epidemiol 2017;38:1091-1097.