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To assess the effectiveness of implementing audit recommendations in improving the service provided at a prolonged jaundice clinic in a district general hospital in the UK
  1. P Ramaswamy,
  2. E Unwin,
  3. G Marais
  1. Paediatrics, Croydon University Hospital, London, UK

Abstract

Jaundiced infants >14 days old are seen by ST 1–3 paediatric trainees with registrar and consultant support when necessary. Prior to the initial audit, patients were seen randomly with no set clinic times. Doctors clerked patients on a standard proforma and took blood samples. Results were discussed with seniors and acted upon as appropriate. Parents were telephoned with the results and a discharge letter was subsequently sent to the GP and parents. The initial audit showed that blood samples for liver function tests were frequently haemolysed and had to be repeated, causing anxiety and inconvenience to parents. Discharge letters were frequently not sent and reception staff had to field calls from annoyed parents enquiring about results. Documentation was inadequate and clinical activity was not being recorded. The following recommendations were made:

  • A formal prolonged jaundice clinic with appointment times was established

  • Blood sampling to be performed by a paediatric phlebotomist

  • A combined results and discharge template was designed

  • Modification of the clinic proforma to improve documentation

Method Retrospective analysis of medical notes of infants attending the prolonged jaundice clinic that is, audit of 28 infants over 3 months (September, October and November 2007) followed by re-audit of 124 infants over 11 months (July 2008 to June 2009).

Results The initial audit showed that 11 of 28 (39%) blood samples for liver function tests haemolysed and 12 of 28 (43%) discharge letters were not sent. The re-audit showed that only 7 of 124 (6%) blood samples haemolysed and only 3 of 124 (2%) discharge letters were not sent. Documentation in general had improved.

Conclusion The re-audit has showed that changes introduced following the initial audit led to decreased number of haemolysed blood samples and increased number of discharge letters sent to parents. Documentation was improved and clinical activity was captured. A parental satisfaction survey would be a useful addition to future re-audits of this service.

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