Waiting is a common phenomenon in the doctor's waiting room. The purpose of this audit is to assess patient waiting time and doctor consultation time in a primary healthcare clinic and to formulate strategies for improvement. This audit was conducted at a primary care clinic for 4 weeks using the universal sampling method. All patients who attended the clinic during this period was included in the study except for those who required more time to be seen such as those who were critically ill, aggressive or those who came for repeat medication or procedures only without needing to see the doctor. The time of arrival was captured using the queue management system (QMS) and then the patient was given a timing chit which had to be manually filled by the staff at every station. The waiting time for registration, pre-consultation, consultation, appointment, payment and pharmacy were recorded as well as consultation time. The data were entered into the statistical software SPSS version 17 for analysis. version 17. Results showed that more than half of the patients were registered within 15 minutes (53%) and the average total waiting time from registration to seeing a doctor was 41 minutes. Ninety-nine percentage of patients waited less than 30 minutes to get their medication. The average consultation time was 18.21 minutes. The problems identified in this audit were addressed and strategies formulated to improve the waiting and consultation time were carried out including increasing the number of staff at the registration counter, enforcing the staggered appointment system for follow-up patients and improving the queuing system for walk-in patients.
Citation: Quality of Diabetes Care at MOH Healthcare Facilities: SIQ Investigation Guideline, Fifth Edition. Putrajaya: Ministry of Health, Malaysia; 2011
Health technology assessment (HTA) has been continuously used for value-based healthcare decisions over the last decade. Healthcare databases represent an important source of information for HTA, which has seen a surge in use in Western countries. Although HTA agencies have been established in Asia-Pacific region, application and understanding of healthcare databases for HTA is rather limited. Thus, we reviewed existing databases to assess their potential for HTA in Thailand where HTA has been used officially and Japan where HTA is going to be officially introduced.
Matched MeSH terms: Medical Audit/methods; Medical Audit/statistics & numerical data
Malaysia has successfully reduced maternal mortality through several efforts which, in the broad sense, include (i) the overall socio-economic development of the country; (ii) strengthened health services; and (iii) specific efforts and initiatives for the reduction of maternal mortality, one of which is the audit of maternal deaths by the confidential enquiry into maternal deaths.
Citation: Ismail M, Haniff J, Wan Bebakar WM. Diabetes Registry Malaysia: report of an audit of diabetes control and management (January-December 2009). Kuala Lumpur: Clinical Research Centre, 2010
Citation: Mohd Ghazali RJ. A study on the adequacy of outpatient management of essential hypertension in MOH hospitals and health centres. Kuala Lumpur: Institute of Health Management, Ministry of Health, Malaysia; 2006
Diabetes is a chronic condition that is one of the major causes of illness, disability, and death in Malaysia. Cost in managing diabetes plus indirect cost of lost work, pain, and suffering have all increased. The optimal management of patients with diabetes require the tracking of patients over time to monitor the progression of the disease, compliance with treatment, and preventive care. Diabetes care can be improved by standardizing access to, and improving the use of, clinical information. Access to timely, accurate and well-organized electronic data will improve the quality of care for patients with diabetes. Clinical Research Center convened an expert workshop to forecast how physicians, hospitals and clinics will employ clinical information technology (IT) applications to diabetes care over the next year. Workshop participants included experts from research organizations, government, and the IT vendor. This is a summary of the workshop organised for the purpose of the Audit of Diabetes Control and Management (ADCM) project. We hope to identify the gaps, if any, that exists in delivering diabetes care and to improve the quality of care. In future, we hope to develop an expansion of this project for the Adult Diabetes Registry that will be implemented for the whole country.
Day-case surgery is preferred for adults, allowing post-operative fast recovery in family environment and support. Myringoplasty using the traditional method of underlay temporalis fascia or tragal perichondrium is usually performed as an in-patient. From 2003 to 2004, 22 myringoplasty procedures were performed in a dedicated day surgery unit at the Hospital Melaka. We report the retrospectively review of the outcome results of these procedures. None of the patients need admission overnight. There were no surgical or anesthetic complications noted and this series suggests that day-case surgery is a safe and desirable practice for patients undergoing myringoplasty. However, there should be the facility for admission if required.
An audit of hypertension management was done in October 2004 in nine general practice (GP) clinics. Two structure, ten process and two outcome indicators were assessed. Results showed that targets were achieved in only four indicators, i.e., weight recording (89%), BP monitoring (85.8%), follow-up interval not exceeding 6 months (87.9%) and mean diastolic BP (73.9%). The other indicators (hypertension registry, reminder mechanisms for defaulters, recording of smoking, height, fundoscopy, monitoring of lipid profile, blood sugar, ECG, renal function and achievement of target mean systolic pressure) showed adequacy percentages varying from 22.1 to 68.7. Out of the 1260 patients assessed, 743 (59%) achieved a mean BP < or = 140/90 (or < or = 130/80 mmHg with diabetes mellitus / renal insufficiency) in the last 3 recorded readings. There was a vast difference between individual clinics. Reasons for not achieving targets were discussed and remedial measures for implementation were recommended.
An audit on diabetic management was done in seven Perak general practice (GP) clinics in December 2001. The results showed inadequacies in nine out of eleven criteria assessed. Remedial measures were implemented. A second audit in March 2003, at the completion of the audit cycle, showed improvements in all the criteria used. All clinics established a diabetic register compared to 28.6% in the first audit and 57.1% of the clinics set up a reminder mechanism compared to 0% in the first audit. In the process of care, recording of weight, height, blood pressure; feet examination, fundoscopy, blood sugar monitoring and urine for albumin improved at the end of the audit cycle. In the only outcome criteria, the blood sugar control improved from 21.8% to 31.3%.
A 4-year-review was carried out on intraoperative frozen section consultations in Sultanah Aminah Hospital, Johor Bahru. Two hundred and fifteen specimens were received from 79 patients in the period between January 1999 and December 2002. An average of 2.72 specimens per patient was received. The overall diagnostic accuracy was high, 97.56%. The diagnoses were deferred in 4.65% of the specimens. False positive diagnoses were made in 3 specimens (1.46%) and false negative diagnoses in 2 specimens (0.98%). This gave an error rate of 2.44%. The main cause of error was incorrect interpretation of the pathologic findings. In the present study, frozen sections showed good sensitivity (97.98%) and specificity (97.16%). Despite its limitations, frozen section is still generally considered to be an accurate mode of intraoperative consultation to assist the surgeon in deciding the best therapeutic approach for his patient at the operating table. The use of frozen section with proper indications was cost-effective as it helped lower the number of reoperations. An audit of intraoperative frozen section from time to time serves as part of an ongoing quality assurance program and should be recommended where the service is available.
This paper reports the implementation, findings and feedback of the audit project of the general practice (GP) module carried out in the fifth year of the MBChB (Sheffield) twinning programme with the Perak College of Medicine. After training, each student with his/her GP tutor planned and conducted the audit. All 28 students (year 2002) satisfactorily completed their audit projects. Fifty percent did an audit of hypertension, 36% on diabetes, 7% on asthma and one each (3.5%) on upper respiratory tract infection and client satisfaction. It was the GP tutors first experience at audit in their clinics. The majority of indicators of care audited did not meet the set target standards.
Adequacy of diabetic management in 5 Perak outpatient departments was studied in April 1996. Two hundred diabetic patients' records were analysed. All doctors and 100 patients answered questionnaires on diabetes. Fifty five percent of doctors had adequate knowledge. Patients' knowledge varied between centres (13% to 80% adequacy). Most records had insufficient data to determine adequacy of early detection. Centres with screeners had adequate weight and blood pressure measurement. Overall control and monitoring of diabetes were inadequate. Referral of complications were delayed in 2 centres. Refresher courses for doctors, patient health education, protocols, screeners and physician visits are recommended.
Study site: Klinik kesihatan, outpatient clinics, hospitals, Perak, Malaysia
An audit of all perioperative deaths within seven days of surgery in 14 major public hospitals is presented. This study is part of a quality assurance programme examining the surgical and anaesthetic practices in these hospitals. During the study period from July 1992 till June 1994, 211,354 surgeries were performed and 715 deaths were reported out of which 699 were available for analysis. The data was obtained by confidential enquiry using predetermined questionnaires filled by participating surgeons and anaesthetists and analysed by a group of peers. The overall crude mortality rate was 0.34% and the majority of the deaths occurred in severely ill patients in whom the clinical management was satisfactory. Polytrauma including head, intra-abdominal and skeletal trauma accounted for 253 of the deaths (36.19%). The other causes were bowel obstruction with sepsis, burns, ischaemic limbs, congenital malformations in neonates and pregnancy-related hemorrhage. 62.52% of the deaths occurred within two days of surgery and 85.87% were related to emergency procedures. The review identified some shortfalls in perioperative care and these were lack of adequate critical care facilities, lack of supervision, unnecessary surgery in the moribund and inadequate preoperative optimisation. The results of the study have been forwarded to all participating hospitals for implementation of remedial measures.
This is a study of patients referred to the Scoliosis Service of Hospital Kuala Lumpur. Three hundred and thirty five (335) consecutive patients who were seen between 1985 and 2000 were reviewed to determine the presentation of scoliosis, the treatment received and the compliance to follow up. Data were determined by measuring the frontal spinal radiographs. Two hundred and ninety eight (298) patients met inclusion criteria. Idiopathic scoliosis accounted for 203 patients (68.1%), 31 (10.4%) were neuromuscular scoliosis; and 44 (14.8%) had congenital scoliosis. Twenty-five point five percent of patients had surgery, 10.4% were treated with brace, while the remaining 69.1% of patients were observed, or had no treatment at all. Congenital scoliosis patients had better compliance compared to idiopathic or neuromuscular scoliosis patients.
We report a cross-sectional descriptive study of 90 new long-stay patients (NLS) (i.e. those who had been resident for six months to three years in Permai Mental Hospital, Johor) and studied from April to June, 1995. The age of this sample ranged from 18 to 85 years. Two subgroups were observed (i.e. younger NLS patients aged 18 to 34 years and older NLS patients aged 35 to 85 years). Among the younger NLS patients, the commonest diagnosis was schizophrenia (51.2%), followed by mental retardation with related problems (24.4%). Sixty-one percent of these younger patients had a history of serious violence or dangerous behaviour. Older NLS patients were likely to have a diagnosis of schizophrenia (79.6%), followed by mood disorder (6.1%) and dementia (4.1%). Forty seven percent of these older group had history of danger to others and 57.1% were at moderate or severe risk of non-deliberate self-harm. Focusing on the schizophrenic patients, all of them had some form of psychopathology, either positive, negative or general symptoms and about one-fourth were assessed to pose a risk for aggression.
An audit of diabetes care was done in a hospital to assess its effectiveness. The results revealed that diabetic patients received less than adequate care. Only 9% of the patients achieved good glycaemic control; 39% had hypertriglyceridemia and 65% had undesirable weight gain while on treatment. The average duration of diabetes in this group of young diabetic patients under study was only 4.5 years, yet 12% of them had evidence of diabetic retinopathy. Few patients possessed adequate knowledge and skills of diabetes self-care. No patients could draw up and mix insulin adequately. Only one patient could self-inject insulin correctly. Few understood the nature of hypoglycaemia, hence few took adequate precaution against it. Patients had frequent hypoglycaemia; 61% had at least one episode per week and 56% of the diabetic drivers admitted to occurrence of hypoglycaemia while driving. No patient understood the principle of diabetic diet therapy, nor did they carry out regular home-monitoring of their diabetes. Good diabetes care requires organisation with supportive patient education. The less than adequate standard of care achieved by the hospital under study is probably explained by the absence of both.
Study site: Outpatient clinic, Hospital Mentakab, Pahang, Malaysia
We retrospectively analyzed all patients presenting with upper gastrointestinal bleeding to Seremban Hospital over a one-year period. A quarter of the oesophagogastro-duodenoscopies (OGD) performed were performed as emergency for upper gastrointestinal tract bleeding. Gastric ulcers and duodenal ulcers were the two most common findings. Our results suggest that there is a male preponderance of 2:1, the Chinese were more likely to be affected and the elderly (> 60 years) were at highest risk.
Comparative surgical audit to monitor quality of care should be performed with a risk-adjusted scoring system rather than using crude morbidity and mortality rates. A validated and widely applied risk adjusted scoring system, P-POSSUM (Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality) methodology, was applied to a prospective series of predominantly general surgical patients at the Sarawak General Hospital, Kuching over a six months period. The patients were grouped into four risk groups. The observed mortality rates were not significantly different from predicted rates, showing that the quality of surgical care was at par with typical western series. The simplicity and advantages of this scoring system over other auditing tools are discussed. The P-POSSUM methodology could form the basis of local comparative surgical audit for assessment and maintenance of quality care.