{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T04:44:20Z","timestamp":1788583460882,"version":"build-2803163510"},"reference-count":19,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T00:00:00Z","timestamp":1738022400000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Qual"],"accepted":{"date-parts":[[2024,12,17]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>The increasing emphasis on risk management and quality assessment in hospital management necessitates strict adherence to government and international standards. Those standards are particularly important, and certification requirements further underscore this need. The objective of this paper is to outline the application of the INTegrated Audit Model in a Comprehensive Cancer Center. This model represents a revised version of Tracer Methodology, for audit surveys, aimed at aligning audit activities with UNI EN ISO 9001:2015 and Joint Commission Standards for quality, patient safety and clinical risk management.<\/jats:p>\n               <jats:p>Using the INTegrated Audit Model, a total of 7 tracers were conducted, and 31 units underwent auditing during the period spanning from 2022 to 2023. Each audit inquiry was documented, categorised and cross-referenced with International Organization for Standardization (ISO) and Joint Commission International (JCI) standards. Areas exhibiting the highest incidence of non-conformities and observations were systematically linked to relevant standards. Subsequently, a comprehensive analysis was conducted on the ensuing findings.<\/jats:p>\n               <jats:p>The INTegrated Audit Model allowed for systematic data collection across clinical pathways, revealing prevalent issues and areas for improvement in patient care. By aligning identified topics with ISO and JCI standards, compliance with international guidelines was assessed, offering units insight into their current status and areas for enhancement.<\/jats:p>\n               <jats:p>Overall, both auditees and auditors expressed satisfaction with the methodology and continuous training, highlighting its effectiveness in fostering collaboration, improving time management and promoting adherence to accreditation standards.<\/jats:p>\n               <jats:p>The study highlights the effectiveness of the methodology in monitoring unit activities and adherence to clinical pathways and international standards applied to an oncological setting. Audits conducted with this approach provided a thorough assessment of critical areas impacting patient care and clinical governance, contributing to a comprehensive understanding of service delivery.<\/jats:p>","DOI":"10.1136\/bmjoq-2024-003012","type":"journal-article","created":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T11:50:41Z","timestamp":1738065041000},"page":"e003012","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Enhancing patient safety and risk management through clinical pathways in oncology"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7104-3951","authenticated-orcid":false,"given":"Marco","family":"Milanesi","sequence":"first","affiliation":[{"name":"Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Fiorito","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2346-2704","authenticated-orcid":false,"given":"Lara","family":"Caloccia","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Guglielmetti","sequence":"additional","affiliation":[{"name":"University of Milan, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Giganti","sequence":"additional","affiliation":[{"name":"University of Milan, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara Elisa","family":"Andreasi","sequence":"additional","affiliation":[{"name":"University of Milan, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Triarico","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,1,28]]},"reference":[{"key":"2025083114313032000_14.1.e003012.1","first-page":"427","article-title":"Guidelines for overcoming hospital managerial challenges: a systematic literature review","volume":"9","author":"Crema","year":"2013","journal-title":"Ther Clin Risk Manag"},{"key":"2025083114313032000_14.1.e003012.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2023-016686"},{"key":"2025083114313032000_14.1.e003012.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2015-003955"},{"key":"2025083114313032000_14.1.e003012.4","unstructured":"Joint Commission International . Joint Commission International Standards for Hospitals, 7th Edition. 2021. Available: https:\/\/www.jointcommissioninternational.org\/standards"},{"key":"2025083114313032000_14.1.e003012.5","unstructured":"ISO . Quality management systems: requirements (ISO 9001:2015). 2015 Available: https:\/\/www.iso.org\/standard\/62085.html"},{"key":"2025083114313032000_14.1.e003012.6","doi-asserted-by":"publisher","DOI":"10.5527\/wjn.v3.i4.249"},{"key":"2025083114313032000_14.1.e003012.7","unstructured":"NHS England . Clinical audit. 2024. Available: https:\/\/www.england.nhs.uk\/clinaudit"},{"key":"2025083114313032000_14.1.e003012.8","doi-asserted-by":"crossref","unstructured":"Haxby E , Hunter D , Jaggar S . An introduction to clinical governance and patient safety. Oxford University Press, 2010:105\u201312.Available: https:\/\/doi.org\/10.1093\/acprof:oso\/9780199558612.001.0001","DOI":"10.1093\/acprof:oso\/9780199558612.001.0001"},{"key":"2025083114313032000_14.1.e003012.9","first-page":"48","article-title":"Clinical auditing to improve patient outcomes","volume":"23","author":"Yorston","year":"2010","journal-title":"Community Eye Health"},{"key":"2025083114313032000_14.1.e003012.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.m213","article-title":"Revitalising audit and feedback to improve patient care","volume":"368","author":"Foy","year":"2020","journal-title":"BMJ"},{"key":"2025083114313032000_14.1.e003012.11","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.aucc.2017.04.002","article-title":"Clinical audits to improve critical care: Part 2: Analyse, benchmark and feedback","volume":"31","author":"Ray-Barruel","year":"2018","journal-title":"Aust Crit Care"},{"key":"2025083114313032000_14.1.e003012.12","unstructured":"Joint Commission International . Tracer methodology fact sheet. 2023. Available: https:\/\/www.jointcommission.org\/resources\/news-and-multimedia\/fact-sheets\/facts-about-tracer-methodology"},{"key":"2025083114313032000_14.1.e003012.13","unstructured":"Ministero della Salute . Raccomandazione per la corretta identificazione dei pazienti, del sito chirurgico e della procedura, n. 3. 2008."},{"key":"2025083114313032000_14.1.e003012.14","unstructured":"Ministero della Salute . Raccomandazione per la prevenzione della reazione trasfusionale. Ministero della Salute, n.5. 2020."},{"key":"2025083114313032000_14.1.e003012.15","unstructured":"Ministero della Salute . Raccomandazione per la prevenzione e la gestione delle cadute del paziente nelle strutture sanitarie. n. 13. 2011."},{"key":"2025083114313032000_14.1.e003012.16","unstructured":"AGENAS . Raccomandazioni per la prevenzione di eventi sentinella. 2022. Available: https:\/\/raccomandazioni.agenas.it"},{"key":"2025083114313032000_14.1.e003012.17","unstructured":"AGENAS . Programma Nazionale Esiti: Fondazione IRCCS Istituto Nazionale dei tumori - Milano (MI). Indicatore - Volumi. 2023."},{"key":"2025083114313032000_14.1.e003012.18","unstructured":"AGENAS . Focus della mobilit\u00e0 per patologie oncologiche, Portale Statistico. 2022."},{"key":"2025083114313032000_14.1.e003012.19","unstructured":"Milanesi M , Guglielmetti C , Fiorito R , et al . I PDT come strumento a supporto di audit interni associati al monitoraggio delle raccomandazioni ministeriali, in Forum Risk Management 2023, 18\u00b0 edizione. Arezzo, Italy, 2023."}],"container-title":["BMJ Open Quality"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjoq-2024-003012","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T21:31:41Z","timestamp":1756675901000},"score":1,"resource":{"primary":{"URL":"https:\/\/qir.bmj.com\/lookup\/doi\/10.1136\/bmjoq-2024-003012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,28]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/bmjoq-2024-003012"],"URL":"https:\/\/doi.org\/10.1136\/bmjoq-2024-003012","relation":{},"ISSN":["2399-6641"],"issn-type":[{"value":"2399-6641","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}