An audit of occupational medicine consultation records

Abstract

There is a need to develop and test methods of audit of the consultation process in occupational medicine and to draw conclusions from the findings. An external audit was carried out on 313 randomly selected consultation records from the occupational health services of three health boards over a 26-month period. Additionally, nine months after the date of the first externally audited sample, a prospective internal audit was commenced within one board. In 58 of the consultations selected (19 per cent), audit was not possible mainly because records could not be found. In an appreciable proportion of the rest, there were shortcomings in the referral record or in the consultation record. The consultation records of 'career' occupational physicians were better than those of 'non-career' physicians, especially in recording specific diagnoses (91 per cent vs. 67 per cent; P < 0.0001) and in conclusions regarding occupational implications (86 per cent vs. 74 per cent; P < 0.0001). Multivariate regressions showed a highly significant improvement associated with prospective internal audit in one item, namely the record of occupational implications. However, the magnitude of this difference before and after audit was smaller than the independent difference arising from the career status of the physicians. The value of medical audit in improving quality of care and education in occupational medicine is discussed.

Evaluation research in occupational health services: general principles and a systematic review of empirical studies.

“…71 In an external audit of occupational medical consultation records, Agius et al used a set of quality criteria to judge the medical consultation process. 74 Because the "career" occupational physicians had significantly better scores than the "non-career" occupational physicians (usually part time general practitioners), the authors stress the importance of further training of physicians practising occupational medicine. Behrens and Müller evaluated the self reported compliance of company doctors with the workplace related activities as required by the German law on work security.…”

“…Some of the studies on process are the result of medical audit from quality assurance procedures, in particular in occupational health departments within the National Health Service (NHS) in the United Kingdom. 74 75 78 The study of Braddick et al shows a distinct variance in comprehensiveness of pre-employment examination procedures in diVerent departments with slightly higher rejection or restriction rates in the OHSs which examine more comprehensively. 75 Whitaker and Aw confirmed the variation in examining practice, but they found no significant diVerence in rejection rates between various assessment methods.…”

“…The study by Agius et al also included an attempt to "audit the audit"; it evaluated the possible benefit of audit on the medical consultation process and found it as yet to be only of minor significance. 74 Quality assurance procedures were also used by Udasin et al in evaluating the periodic occupational health surveillance practice. 81 By auditing medical records of 17 diVerent occupational health facilities and comparing them against performance standards, they studied the quality of medical surveillance programmes for hazardous waste workers.…”

Development and evaluation of a quality assessment instrument for occupational physicians.

“…The method is objective with explicit criteria for quality assessment and the agreement between raters was good. This explicit method is an alternative for a medical audit as described by Agius et al [8][9][10] They presented no guidelines, explicit indicators, or criteria. So, it is diYcult to discuss the method they used and to compare the results of their studies with others.…”

“…Some studies, especially from the United Kingdom, Finland, and the United States, refer to this topic. [8][9][10][11][12][13] However, a clear basis for the definition of good quality practice is often lacking, [8][9][10] or the emphasis is on procedures instead of the content of care. 11 14 Therefore, we decided to develop and evaluate a method for defining and measuring the quality of the occupational physician's contribution to occupational rehabilitation.…”