Education & Debate
نویسندگان
چکیده
Implicit in the idea of medical audit are two notions: the quantifying of medical practice in terms of treatment, procedures, outcomes, and complications; and the use of these data to exact some form of accountability. Therefore some sort of objective monitoring, or quality control, of practices or procedures is needed so that periods of suboptimal performance in relation to an agreed standard can be recognised and, ideally, remedied. Objective monitoring or quality control has been used for surveillance: methods have been developed to detect increases in rare events, such as birth malformations and to detect minimal epidemics. ' A review of the concepts and definitions of quality control procedures that are commonly used in clinical chemistry have also been presented.2 The use of the cumulative sum (cusum) has been suggested for both surveillance and quality control. Its use for examining sequential measures or for looking for changes over time has recently been described.3 It has also been used for plotting temperature charts for assessing antimicrobial treatment in neutropenic patients.4 Because the cusum shows changes over time it can be used by individual practitioners to monitor their own performance as a form of quality control to give proof of ongoing competence in a particular skill. It can also be used to show progress in mastering a new technique. One advantage of this sort of self assessment is that an acceptable level of attainment must be defined so that how well it is met can be quantified. It has been suggested, for instance, that the completion rate for colonoscopic examination should be above 90%.5 The cusum has been described as a useful graphical tool for discerning trends.3 For a series of observations XI, X2, . . . X,,, the cusum can be defined as
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