الفهرس 
List of abbreviations
Medical auditOnly 14 pages are availabe for public view
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Abstract
Clinical audit is a quality improvement process that seeks to improve the patient care and outcomes through systematic review of care against explicit criteria and the implementation of change Aspects of the structures, processes and outcomes of care are selected and systematically evaluated against explicit criteria. where indicated, changes are implemented at an individual team, or service level and further monitoring is used to confirm improvement in healthcare delivery’.
the systematic critical analysis of the quality of medical care including the procedures used for diagnosis and treatment, the use of resources and the resulting outcome and quality of life for the patient.
- Prospective study was carried out in assuit university endoscopy unit in 2 months duration (from April to May 2012).
- The main aim was to study the role of auditing and assisting performance in the upper GIT endoscopy to obtain a safe endoscopy as diagnostic and therapeutic maneuvers.
- A prospective study was performed through medical audit 100 patients were included in this study 68 male and 32 female.
The indication of the upper GIT endoscopy in the studied groups there were50 urgent upper endoscopy, 46 elective upper endoscopy and 4 patients not indicated (not within the guidelines).
In our study haematemesis was the most frequent indication for an upper endoscopy (50%).
The most common causes of haematemsis in our study were bleeding varices (27%) and peptic ulcer (23%).
The most common inappropriate indication was dyspepsia in patients 45 years of age or younger who received no adequate treatment and experienced no alarm symptoms. Similar indication frequencies were reported in a large American national endoscopic database, in which EGD was most commonly performed to evaluate dyspepsia and/or abdominal pain (23.7%), dysphagia (20%), symptoms of gastroesophageal reflux without dysphagia (17%) and suspected upper gastrointestinal bleeding (16.3%).
The follow up of the all patients in our study after the endoscopy was done and there is 91%related to the upper endoscopy and 9% not related to the upper endoscopy associated with co morbidity as cardiac problems, renal insufficiency and bleeding tendency.
The duration of hospital admission, showing 75% of the patients were admitted in the hospital while 25%of the studied groups were outpatients and duration of hospital admission related to the upper endoscopy were 32%of the studied groups related to the endoscopy while 68% were not related to upper GIT endoscopy.
The cases of admission which not related to upper GIT endoscopy as hepatic encephalopathy control of ascites, hepatocellular carcinoma and other co morbidity.
The complications of the upper endoscopy and its type, the complications present in 8% of the studied groups and the type of the complications were (failure of control of upper GIT bleeding 37.5%, syncope in 37.5%, respiratory arrest 12.5% and myocardial infarction in 12.5%).Haematemesis occurs during the procedure due to failure in the management of the upper GIT bleeding.
Myocardial infarction related to inappropriate selection of the patients and bad preparation before the procedure.
Respiratory arrest occurs as a complication of general anesthesia.
The relation between the complication and the indication type of the upper endoscopy, showing 1% of the complications occur in not indicated patients, 4% occurs in elective upper endoscopy and 3%in urgent upper endoscopy.
Increase the percentage of the complications in elective upper endoscopy due to (bad preparation and general anesthesia).
The results of the relation between the suspected diagnosis before the upper endoscopy and the final diagnosis were 81% of the suspected diagnosis similar to the final diagnosis and 19% the suspected diagnosis different from the final diagnosis.
Conclusion
Medical audit of upper endoscopy is a quality improvement process that seeks to improve patient care and outcomes of the upper endoscopy through systematic review of care against explicit criteria and the review of change, development of professional education and self regulation, improvement of quality of patient care, increasing accountability, improvement of motivation and teamwork, aiding in the assessment of needs and as a stimulus to research.
Recommendations
We recommend according to the guidelines of NICE:
1. Appropriate selection for the patients before the upper endoscopy.
2. Proper preparation of the patient before upper endoscopy.
3. Close follow up of the patients after upper endoscopy.