Factors associated with attributes of internal audit departments : a canonical analysis

This study explores internal audit (IA) practices in selected Ethiopian organizations to identify factors associated with attributes of IA departments. Analytical questionnaire survey responses of 188 IA directors and staff from Ethiopian government ministries, state-owned enterprises and private companies were used. Canonical analysis results show that IA proficiency, scope of IA work and quality of IA planning and execution are higher in organizations where organizational policy authorizing IA is clearly defined, organizational risk exposure is high and internal audit's linkage with external audit is strong. The findings suggest that in organizations that are exposed to high risk, management tends to appreciate IA's assistance in managing risk and thus strengthens IA. Results also suggest the importance of internal and external audit linkages and IA charter (or similar organizational policy) to strengthen IA. The study provides further evidence of differences in IA attributes between public and private sector entities.

Complexities of medicines safety: communicating about managing medicines at transition points of care across emergency departments and medical wards

To explore how health professionals, patients and family members communicate about managing medicines across transition points of care in two Australian public hospitals.

'Hands-on' assessment: a useful strategy for improving patient safety in emergency departments

BACKGROUND: Patient assessment is an essential nursing intervention that reduces the incidence and impact of errors and preventable adverse events in emergency departments (EDs). This paper reports on a key finding of the ED nurse component of a larger study investigating how registered nurses manage 'discontinuities' or 'gaps' in patient care. METHODS: The larger study was undertaken as a naturalistic inquiry using a qualitative exploratory descriptive approach. Data were collected from a criterion-based purposeful sample of 71 nurses, of which 19 were ED nurses, and analysed using content and thematic analysis strategies. RESULTS: The component of the study reported here revealed that ED nurses used 'hands-on', head-to-toe assessment to manage gaps in patient care. Examination of the data revealed three key dimensions of patient assessment in the ED: (i) assessment is the 'bread and butter' of emergency nursing; (ii) 'hands-on' assessment techniques are irreplaceable and, (iii) patient assessment is undervalued in EDs. CONCLUSIONS: The findings of this study reaffirm the role of 'hands-on' observation and assessment in creating safety in EDs. Further research and inquiry is needed to determine how health care systems can provide the conditions for ensuring that 'hands-on' assessment occurs.

Analysis of quality indicators of central sterile supply departments at accredited public hospitals

O objetivo do estudo foi descrever e analisar os indicadores de qualidade de Centros de Material e Esterilização de hospitais públicos acreditados do Estado de São Paulo e sua gestão pelos responsáveis do setor. Trata-se de um estudo de casos múltiplos, onde são apresentados os dados interligados de três hospitais acreditados num relatório de casos cruzados. Os dados foram coletados por entrevista semiestruturada com o responsável e por visita técnica com análise documental. Os resultados constatam a dificuldade dos responsáveis em pontuar os indicadores específicos do setor e os referidos foram os de produção e pesquisa de satisfação do cliente que não retratam a qualidade efetiva do serviço, pois são fragmentados, sem consolidação de resultados na busca de melhorias, o que sugere baixa especificidade e baixa sensibilidade dos critérios da Organização Nacional de Acreditação à realidade deste setor.

A Study of Interdisciplinary Research Needs: Results from Input of Faculty in Six Engineering Departments in Prioritizing Serial Subscriptions

Baldwin, Virginia (2003) "A Study of Interdisciplinary Research Needs: Results from Input of Faculty in Six Engineering Departments in Prioritizing Serial Subscriptions," American Society for Engineering Education Conference, June 23, 2003, Nashville, TN,

Describing some of the Dimensions that comprise the Profile of the Faculty Staff of Statistics Departments in Brazil

Statistics is a required course in virtually all undergraduate programs in Brazilian universities. In addition, undergraduate programs in Statistics are offered in many public universities. However, despite the importance of this science, there are no systematic studies in the national literature regarding the characterization of the faculty staff, which is responsible for the teaching of statistics in the country. In this context, this paper presents a description of the faculty members of undergraduate courses in Statistics. This description was based on a descriptive sample, related to aspects of their education and scientific production. A prediction of future demand for PhDs in Statistics to fill the vacancies is also provided based on the retirement of faculty members in undergraduate courses in Statistics in the country.

Outcome and patients' satisfaction after functional treatment of acute lateral ankle injuries at emergency departments versus family doctor offices

BACKGROUND: In some Western countries, more and more patients seek initial treatment even for minor injuries at emergency units of hospitals. The initial evaluation and treatment as well as aftercare of these patients require large amounts of personnel and logistical resources, which are limited and costly, especially if compared to treatment by a general practitioner. In this study, we investigated whether outsourcing from our level 1 trauma center to a general practitioner has an influence on patient satisfaction and compliance. METHODS: This prospective, randomized study, included n = 100 patients who suffered from a lateral ankle ligament injury grade I-II (16, 17). After radiological exclusion of osseous lesions, the patients received early functional treatment and were shown physical therapy exercises to be done at home, without immobilization or the use of stabilizing ortheses. The patients were randomly assigned into two groups of 50 patients each: Group A (ER): Follow-up and final examination in the hospital's emergency unit. Group B (GP): Follow-up by general practitioner, final examination at hospital's emergency unit. The patients were surveyed regarding their satisfaction with the treatment and outcome of the treatment. RESULTS: Female and male patients were equally represented in both groups. The age of the patients ranged from 16 - 64 years, with a mean age of 34 years (ER) and 35 years (GP). 98% (n = 98) of all patients were satisfied with their treatment, and 93% (n = 93) were satisfied with the outcome. For these parameters no significant difference between the two groups could be noted (p = 0.7406 and 0.7631 respectively). 39% of all patients acquired stabilizing ortheses like ankle braces (Aircast, Malleoloc etc.) on their own initiative. There was a not significant tendency for more self-acquired ortheses in the group treated by general practicioners (p = 0,2669). CONCLUSION: Patients who first present at the ER with a lateral ankle ligament injury grade I-II can be referred to a general practitioner for follow-up treatment without affecting patient satisfaction regarding treatment and treatment outcome.

Quality in emergency departments: a study on 3,285,440 admissions

INTRODUCTION: A multi-centre study has been conducted, during 2005, by means of a questionnaire posted on the Italian Society of Emergency Medicine (SIMEU) web page. Our intention was to carry out an organisational and functional analysis of Italian Emergency Departments (ED) in order to pick out some macro-indicators of the activities performed. Participation was good, in that 69 ED (3,285,440 admissions to emergency services) responded to the questionnaire. METHODS: The study was based on 18 questions: 3 regarding the personnel of the ED, 2 regarding organisational and functional aspects, 5 on the activity of the ED, 7 on triage and 1 on the assessment of the quality perceived by the users of the ED. RESULTS AND CONCLUSION: The replies revealed that 91.30% of the ED were equipped with data-processing software, which, in 96.83% of cases, tracked the entire itinerary of the patient. About 48,000 patients/year used the ED: 76.72% were discharged and 18.31% were hospitalised. Observation Units were active in 81.16% of the ED examined. Triage programmes were in place in 92.75% of ED: in 75.81% of these, triage was performed throughout the entire itinerary of the patient; in 16.13% it was performed only symptom-based, and in 8.06% only on-call. Of the patients arriving at the ED, 24.19% were assigned a non-urgent triage code, 60.01% a urgent code, 14.30% a emergent code and 1.49% a life-threatening code. Waiting times were: 52.39 min for non-urgent patients, 40.26 min for urgent, 12.08 for emergent, and 1.19 for life-threatening patients.

State of Emergency Medicine in Switzerland: a national profile of emergency departments in 2006

BACKGROUND Emergency departments (EDs) are an essential component of any developed health care system. There is, however, no national description of EDs in Switzerland. Our objective was to establish the number and location of EDs, patient visits and flow, medical staff and organization, and capabilities in 2006, as a benchmark before emergency medicine became a subspecialty in Switzerland. METHODS In 2007, we started to create an inventory of all hospital-based EDs with a preliminary list from the Swiss Society of Emergency and Rescue Medicine that was improved with input from ED physicians nationwide. EDs were eligible if they offered acute care 24 h per day, 7 days per week. Our goal was to have 2006 data from at least 80% of all EDs. The survey was initiated in 2007 and the 80% threshold reached in 2012. RESULTS In 2006, Switzerland had a total of 138 hospital-based EDs. The number of ED visits was 1.475 million visits or 20 visits per 100 inhabitants. The median number of visits was 8,806 per year; 25% of EDs admitted 5,000 patients or less, 31% 5,001-10,000 patients, 26% 10,001-20,000 patients, and 17% >20,000 patients per year. Crowding was reported by 84% of EDs with >20,000 visits/year. Residents with limited experience provided care for 77% of visits. Imaging was not immediately available for all patients: standard X-ray within 15 min (70%), non-contrast head CT scan within 15 min (38%), and focused sonography for trauma (70%); 67% of EDs had an intensive care unit within the hospital, and 87% had an operating room always available. CONCLUSIONS Swiss EDs were significant providers of health care in 2006. Crowding, physicians with limited experience, and the heterogeneity of emergency care capabilities were likely threats to the ubiquitous and consistent delivery of quality emergency care, particularly for time-sensitive conditions. Our survey establishes a benchmark to better understand future improvements in Swiss emergency care.

Can geriatric approaches support the care of old patients in emergency departments? A review from a Swiss ED

In the coming decades, old patients will account for an increasing proportion of emergency department (ED) visits. During or after their stay in the ED, they more frequently suffer adverse outcomes than younger patients. There is evidence that specific age-centred approaches improve the outcomes. We therefore reviewed specific conditions needing particular attention in older ED patients, such as cognitive disorders and delirium, impaired mobility and falls, as well as problems related to the activities of daily living, disability, poly-pharmacy, adverse drug effects, co-morbidity and atypical presentation. We also propose steps to further improve the quality of care in older ED patients by using appropriate age-centred management.