Articles

Improving Inter-Hospital Transfer Documentation Through Standardisation and Accountability: A Quality Improvement Study in a Resource-Limited Sri Lankan Hospital

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Background: Incomplete transfer documentation contributes to communication failures, delayed clinical decision-making, and increased patient safety risks during inter-hospital transfers. These risks are amplified in resource-limited settings due to system inefficiencies, high workload, and lack of standardisation.¹–³

Objective: To improve the completeness, accuracy, and accountability of inter-hospital transfer documentation through structured system-level interventions.

Methods: A single-centre quality improvement study using Plan–Do–Study–Act (PDSA) cycles was conducted at Base Hospital Kinniya, Sri Lanka from January to June 2019 for a period of 6 months. A retrospective audit of 436 inter-hospital transfer forms was conducted using predefined criteria derived from Ministry of Health standards and stakeholder consensus. Two PDSA cycles were implemented: the first introduced staff training and a structured documentation seal; the second introduced a “probable diagnosis” field and a checking officer system. Key indicators included documentation of diagnosis, reason for transfer, vital signs, treatment given, and time of transfer. Descriptive statistics were used to analyse changes in documentation completeness.

Results: Baseline assessment demonstrated major deficiencies in documentation, including diagnosis (61.5%), treatment given (42.2%), time of transfer (14.7%), and oxygen saturation (26.6%). Following PDSA cycle 1, improvements were observed across all parameters. After PDSA cycle 2, near-complete compliance was achieved in most domains, including diagnosis (99.1%), heart rate (100%), blood pressure (100%), and time of transfer (98.6%). Treatment documentation improved to 94.9%, and oxygen saturation to 98.6%. Documentation verification reached 100% following introduction of a checking officer.

Conclusion: System-level interventions incorporating standardisation, training, and accountability significantly improved transfer documentation completeness. This low-cost, scalable approach is potentially applicable to similar resource-limited healthcare settings.

Analysis of The Preparedness of Public Accounting Firm in Implementing Quality Management Standar 1 (QMS 1) Based on IAPI Guidelines (Case study KAP Nexia KPS)

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Quality Management Standard 1 (QMS 1) is a standard established by the Indonesian Institute of Certified Public Accountants (IAPI) to serve as a framework ensuring that Public Accounting Firms (KAP) deliver services in compliance with predetermined quality standards. The implementation of QMS 1 plays a pivotal role in enhancing quality management practices and fostering public trust in the audit outcomes produced by KAP. This study aims to evaluate the preparedness of KAP in adopting QMS 1 in alignment with the guidelines issued by IAPI. The analysis focuses on critical areas, including the adoption of a risk-based approach, leadership, technological integration, human resource capabilities, and the adequacy of existing internal systems.

The readiness of KAP in implementing SMM 1 is highly dependent on the ability to integrate this standard into all aspects of the KAP organization. By following the guidelines issued by IAPI and overcoming existing challenges, KAP can improve the quality of audit services and meet market expectations for transparency and reliability of financial reports.

Audit Quality Evidence from Indonesia: A Systematic Literature Review

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The audit quality produced by the auditor can be a benchmark in their work. This research aims to uncover factors influencing audit quality, especially in Indonesia. Articles were obtained using Google Scholar, and the publication period was between 2018-2023. The systematic literature review method uses Scientific Procedures and Rationales for Systematic Literature Reviews (SPAR-4-SLR). The results show that 157 articles are accredited by SINTA (Science and Technology Index) and registered with GARUDA (Garba Rujukan Digital). This study identifies basic theory, independent variables, intervening/moderating variables, variable measurement indicators, population and samples, sampling methods, data sources, measurement scales, data processing, respondent information, and auditors. Finally, the implications of this research are to provide direction and guidance for future research regarding audit quality in Indonesia for academics and researchers, government and professional associations, and practicing auditors.