title: Clinical audit system as a quality improvement tool in the management of breast cancer.
abstract: BACKGROUND
  Quality improvement is recognized as a major factor that can transform healthcare management. This study is a clinical audit that aims at analysing treatment time as a quality indicator and explores the role of setting a target treatment time on reducing treatment delays.
  
  
  METHODS
  All newly diagnosed patients with breast cancer between September 2011 and August 2013 were included in the study. Clinical care pathway for breast cancer patients was standardized and the timeliness of care at each step of the pathway was calculated. Data collection was spread over three phases, baseline, audit cycle I, and audit cycle II. Each cycle was preceded by a quality improvement intervention, and followed by analysis.
  
  
  RESULTS
  A total of 334 patients with breast cancer were included in the audit. The overall time from first visit to initiation of treatment was 66.3 days during the baseline period. This improved to 40.4 and 28.5 days at the end of Audit cycle I and II, respectively. The idealized target time of 28 days for initiating treatment was achieved in 5, 23.5, and 65.2% of patients in the baseline period, Audit cycle I, and Audit Cycle II, respectively. There was improvement noted across all steps of the clinical care pathway.
  
  
  CONCLUSIONS
  This study confirms that audit is a powerful tool in quality improvement programs and helps achieve timely care. Gains achieved through an audit process may not be sustainable unless underlying patient factors and resource deficits are addressed.
authors.affiliation: Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
authors.forename: Chellappa
authors.initials: C
authors.lastname: Vijayakumar
authors.affiliation: Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India. Electronic address: nkmaroju@gmail.com.
authors.forename: Nanda Kishore
authors.initials: NK
authors.lastname: Maroju
authors.affiliation: Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
authors.forename: Krishnamachari
authors.initials: K
authors.lastname: Srinivasan
authors.affiliation: Department of Radiotherapy, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
authors.forename: K Satyanarayana
authors.initials: KS
authors.lastname: Reddy
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000628:therapy*; D054869:Clinical Audit / Q000379:methods*; D019091:Critical Pathways; D003625:Data Collection; D019468:Disease Management; D005260:Female; D006801:Humans; D058996:Quality Improvement; D013997:Time Factors
keywords: Audit; Breast cancer; Quality improvement; Target time; Tracking