Audit of the Douglas Hocking Research Institute bone bank : ten years of non-irradiated bone graft

Background:  An audit performed in the use of non-irradiated femoral head bone graft at the Geelong Hospital over a 10-year period. While it is thought the non-irradiated bone graft provides a better structural construct there is theoretical increased risk of infection transmission.

Methods:  We performed a retrospective review of prospectively collected data in the use of non-irradiated bone allograft used from the Geelong Hospital Douglas Hosking Research Institute bone bank over a 10-year period. The review was performed using data collected from the bone bank and correlating it with the patient’s medical record. All complications, including infections, related to the use of the allograft were recorded.

Results:  We found that over the 10 years to 2004 that 811 femoral heads were donated, with 555 being used over 362 procedures in 316 patients. We identified a total of nine deep infections, of which seven were in joint replacements. Overall this was a 2.5% deep infection rate, which was lowered to 1.4% if the previously infected joints that were operated on were excluded.

Conclusion:  The use of non-irradiated femoral head bone graft was safe in a regional setting.

Internal audit attributes and external audit's reliance on internal audit : implications for audit fees

This study aims to examine two aspects of internal audit quality, namely internal audit competency and internal audit contribution to financial statement audits. Consistent with the substitution view, this study predicts a negative relationship between the competency aspects of internal audit (the tenure of the existence of internal audit in the organization, internal audit staff expertise in IT and computer skills, training hours, internal audit staff professional certifications in accounting and auditing, and internal audit staff experience in auditing) and audit fees. Second, this study tests whether the contribution of internal auditors to financial statement audit reduces audit fees. The data analysis is based on a cross-sectional regression model with observations of 73 public-listed firms in Malaysia, which include publicly available data matched with survey responses from their internal and external auditors. The results of the study suggest that the competency of internal audit, namely the tenure of the existence of internal audit in the organization, training, internal audit staff prior experience in auditing and accounting, and certifications are associated with lower audit fees. Our findings for both aspects of internal audit quality (competency and internal audit contribution) lend support to the substitution view for explaining the links between internal audit quality and audit fees.

Factors affecting capital program performance audit findings

Complex capital programs require specialized management techniques, in order to address the volatility, cost overruns, significant delays in completion, and failures with which such programs are typically associated. The need is greater than ever for careful oversight, especially for programs that expend public monies.

Audit is commonly a statutory or governance requirement on such programs, but traditional performance audit techniques and standards may be insufficient for certain types of programs and industries, providing a mere illusion of oversight adequacy instead of the assurance that is needed. In order to most appropriately define the performance audit scope, phrase the solicitation for services, select the audit team, and provide support to the auditors during the engagement, public and private sector entity auditees need to understand the factors that impact performance audit results and effectiveness. The question becomes one of how performance audit can be improved, and stakeholders satisfied regarding program achievements, accountability for resource use, transparency in operations, and risk management.

The author considered program complexity, governance, project controls, the history and evolution of the audit function, stakeholder expectations, assurance, and obstacles to audit, and used this information in conjunction with data from a large sample of 775 audit reports from complex construction programs, to derive questions and conclusions about performance audit results and effectiveness, and comparisons to expenditure audit results. The ultimate goal was to define key components in the execution of performance audits, based on theconclusions of the analysis, in order to improve performance audit findings and thus their applicability and usefulness.

While this study focused on program performance audit, it was also related to the field of program management. Although the data population was concentrated in the area of construction programs, conclusions from this research may also be applied to other complex, multifaceted or phased activities such as projects and programs in other industries (manufacturing, information technology), and also pursuits such as major event planning, company launch, mergers, and large program implementations or rollouts.

The research results clearly demonstrated that different types of findings were generated by different audit scopes. The author observed that typical audit findings focused on routine procedural, accounting, and controls errors. On average, contract expenditure audits questioned only 2.65% of expenditures, and performance audits of large complex programs questioned only 0.03% of expenditures. The majority (72.56%) of the performance audits in the sample yielded no findings or questioned costs.

There were significant positive correlations between: the number of expenditures tested and the number of qualitative findings, inclusion of construction experts on the audit team and the percentage of expenditures questioned, inclusion of construction experts on the audit team and the number of qualitative findings, broader audit scope and the percentage of expenditures questioned, and broader audit scope and the number of qualitative findings. Of these, auditor expertise and audit scope were the driving factors.

There were significant negative correlations between the application of agreed-upon procedures and the percentage of expenditures questioned, and the application of agreed upon-procedures and the number of qualitative findings. It was determined that the significant negative correlation between the application of audit standards and the number of qualitative findings was due to other factors, such as the application of agreed-upon procedures and the lack of construction experts on the audit team.

Other findings, resulting from review of the data, were unrelated to the research questions yet of considerable importance to industry. An extremely high percentage (81%) of the “performance audits” instead applied a very limited set of agreed-upon-procedures (AUP) in the engagement, According to the American Institute of Certified Public Accountants (CPAs), AUP engagements could not be classified as audits. Thus, it was inappropriate for the accounting firms to apply AUP engagements in lieu of a performance audit, and it was especially egregious for them to state in their report that the engagements were conducted in accordance with audit standards, as AUP engagements and the specific audit standards were by their very nature mutually exclusive.