The importance of a supportive environment in clinical audit

Ross, P. J.; Hubert, Jane; Saunders, Mike; Wong, Wai Lup

doi:10.1097/mnm.0000000000000161

Cited by 5 publications

(4 citation statements)

References 13 publications

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“…61 The structure of the current audit ensured adequate time and resources were available for the working group and other key stakeholders, in an environment supporting a learning culture. 64,65 The results of the current audit suggest that dystocia case management broadly improved through each audit phase, including a significant increase in the use and recording of neonatal monitoring via fetal heart rate assessment during ultrasonography. This is encouraging, as diagnostic imaging is reported as a critical tool for successful management of canine dystocia.…”

Section: Discussionmentioning

confidence: 96%

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Applying clinical audit for quality improvement in canine dystocia cases seen at a UK primary‐care emergency practice

et al. 2023

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Background: The paucity of published veterinary clinical audits suggests that clinical audit is an under-used tool for quality improvement (QI) in the veterinary profession. Therefore, a continuous QI process was designed and implemented at a UK multisite small animal emergency practice, focusing on audit of clinical management of canine dystocia. Methods: Data collection phases were undertaken in 2014, 2019 and 2021, with intervening knowledge dissemination activities. Nine variables relating to clinical management of canine dystocia were selected as audit criteria in the initial dataset, and 21 variables were measured in each subsequent phase. Results: Between 2014 and 2021, statistically significant increases (p < 0.05) were demonstrated in recording of bodyweight, use of diagnostic imaging, use of ultrasonography, recording of fetal heart rates, use of calcium gluconate, and use during caesarean section of intravenous fluid therapy, multimodal analgesia, full agonist opioids, paracetamol and local anaesthesia. Statistically significant decreases were demonstrated in median first quantity and median first dose of oxytocin, and in the use of NSAIDs during caesarean section. A clinical audit planning template was created for future audits. Limitations: Typical case presentation and management of canine dystocia cases may vary between dedicated emergency and non-emergency primarycare settings. Conclusion:This study demonstrates the feasibility of large-scale veterinary clinical audit and suggests that the application of the clinical audit process promotes learning within the veterinary team and improved clinical outcomes.

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Section: Discussionmentioning

confidence: 96%

“…Additionally, it has been reported that change in practice is positively influenced when the professional and organisational culture supports QI 61 . The structure of the current audit ensured adequate time and resources were available for the working group and other key stakeholders, in an environment supporting a learning culture 64,65 …”

Section: Discussionmentioning

confidence: 99%

Applying clinical audit for quality improvement in canine dystocia cases seen at a UK primary‐care emergency practice

et al. 2023

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“…The participants' report quality for each case was independently assessed by one of two dual-certified radiology and nuclear medicine physicians with >15 years of experience using a standard 5-point audit score used in routine clinical practice (18,19) (Table 3). Reports generated in both arms of the study (with and without AI) by a participant radiologist for a specific PET/CT case were scored for quality by the same assessor.…”

Section: Report Qualitymentioning

confidence: 99%

Comparative effectiveness of standard vs. AI-assisted PET/CT reading workflow for pre-treatment lymphoma staging: a multi-institutional reader study evaluation

Frood,

Willaime,

Miles

et al. 2024

Front. Nucl. Med.

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BackgroundFluorine-18 fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) is widely used for staging high-grade lymphoma, with the time to evaluate such studies varying depending on the complexity of the case. Integrating artificial intelligence (AI) within the reporting workflow has the potential to improve quality and efficiency. The aims of the present study were to evaluate the influence of an integrated research prototype segmentation tool implemented within diagnostic PET/CT reading software on the speed and quality of reporting with variable levels of experience, and to assess the effect of the AI-assisted workflow on reader confidence and whether this tool influenced reporting behaviour.MethodsNine blinded reporters (three trainees, three junior consultants and three senior consultants) from three UK centres participated in a two-part reader study. A total of 15 lymphoma staging PET/CT scans were evaluated twice: first, using a standard PET/CT reporting workflow; then, after a 6-week gap, with AI assistance incorporating pre-segmentation of disease sites within the reading software. An even split of PET/CT segmentations with gold standard (GS), false-positive (FP) over-contour or false-negative (FN) under-contour were provided. The read duration was calculated using file logs, while the report quality was independently assessed by two radiologists with >15 years of experience. Confidence in AI assistance and identification of disease was assessed via online questionnaires for each case.ResultsThere was a significant decrease in time between non-AI and AI-assisted reads (median 15.0 vs. 13.3 min, p < 0.001). Sub-analysis confirmed this was true for both junior (14.5 vs. 12.7 min, p = 0.03) and senior consultants (15.1 vs. 12.2 min, p = 0.03) but not for trainees (18.1 vs. 18.0 min, p = 0.2). There was no significant difference between report quality between reads. AI assistance provided a significant increase in confidence of disease identification (p < 0.001). This held true when splitting the data into FN, GS and FP. In 19/88 cases, participants did not identify either FP (31.8%) or FN (11.4%) segmentations. This was significantly greater for trainees (13/30, 43.3%) than for junior (3/28, 10.7%, p = 0.05) and senior consultants (3/30, 10.0%, p = 0.05).ConclusionsThe study findings indicate that an AI-assisted workflow achieves comparable performance to humans, demonstrating a marginal enhancement in reporting speed. Less experienced readers were more influenced by segmentation errors. An AI-assisted PET/CT reading workflow has the potential to increase reporting efficiency without adversely affecting quality, which could reduce costs and report turnaround times. These preliminary findings need to be confirmed in larger studies.

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“…Furthermore, these audits are opportunities to educate and train healthcare professionals. 4,5 This study emphasises the importance of clinical audits as a valuable part of practice in the developed world. Most of our undergraduate students need more knowledge and understanding about audits and the audit cycle.…”

Section: Introductionmentioning

confidence: 99%

Perceptions of Undergraduate Students Regarding the Inclusion of Clinical Audit in their Curriculum

Dilnawaz,

Kanwal,

Saeed

et al. 2023

PAFMJ

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Objective: To find out undergraduate students' perceptions regarding the inclusion of clinical audits in their curriculum. Study Design: Exploratory sequential mixed methods study. Place and Duration of study: Combined Military Hospital, Lahore Pakistan, from Dec 2022 to Mar 2023. Methodology: The first phase of the study comprised a quantitative research questionnaire regarding undergraduate students' perceptions about the inclusion of a clinical audit in their curriculum. These perceptions were explored in depth in the second phase with focus group discussions (FGD). Thirty students participated in the study, ten from the fourth year and twenty from the final year MBBS. Results: The study included 30 participants. The results showed that (24, 80%) of participants were able to develop skills as team members, (22, 73%) were able to identify audit topics, collect data, write audit reports and understand conflicts of interest, and (21, 70%) were able to write audit proposal and develop skill in life long audit learning. The key themes emerging from clinical audit focus group discussions (FGD) were better clinical care, patient safety, lack of understanding about audit by students and faculty and improper implementation mechanisms. Conclusion: In conclusion, a clinical audit promotes a safe, good-quality, and evidence-based environment for patient care. It also decreases the risk of clinical negligence and should be incorporated as an integral part of the undergraduate curriculum.

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The importance of a supportive environment in clinical audit

Cited by 5 publications

References 13 publications

Applying clinical audit for quality improvement in canine dystocia cases seen at a UK primary‐care emergency practice

Applying clinical audit for quality improvement in canine dystocia cases seen at a UK primary‐care emergency practice

Comparative effectiveness of standard vs. AI-assisted PET/CT reading workflow for pre-treatment lymphoma staging: a multi-institutional reader study evaluation

Perceptions of Undergraduate Students Regarding the Inclusion of Clinical Audit in their Curriculum

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