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Presenter-Dr. L.KarthiyayiniModerator- Dr. Abhishek RautMedical auditFramework Origin Definition of medical auditNeedfor medical auditDifference between clinical audit & researchStages of medical auditAudit cycleSuccessful clinical auditBarriers to clinical auditApplication

Origin Florence Nightingale and Ernest Codman in the late 1880s and early 1900s were the first to use a systematic form of clinical audit. Since the late 1990s clinical audit has been utilised as part of clinical governance and quality and safety strategies as a method monitoring and improving the quality of healthcare. It received special mentioned as an improvement strategy in the Bristol Royal Infirmary Inquiry in the UK.Definition The UKs National Institute for Health and Clinical Excellence (NICE) defines clinical audit as: a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the review of change. Aspects of the structure, process and outcome 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

Clinical audit is a cyclical process where individuals, teams or services: identify a clinical topic of interest or concernidentify sources of appropriate data which will assist in assessing the topic, including medical records and feedback from senior doctors, other clinicians and consumersreview the data against set criteria and standardsidentify areas for improvementimplement those improvements assess the impact of those improvements.Need for medical audit The main reason is that it helps to improve the quality of the service being offered to users.It identifies and promotes good practice and can lead to improvements in service delivery and outcomes for userscan provide the information we need to show others that our service is effective (and cost-effective) and thus ensure its developmentprovides opportunities for training and educationhelps to ensure better use of resources and so, increased efficiency.can improve working relationships, communication and liaison between staff, staff and service users, and between agencies.Difference between medical audit & research

Clinical audit Research 1 Aims to evaluate how close practice is to best practice & to identify ways of improving the quality of health care Aims to establish what is best practice2 Is specific & local to particular patient group results are not transferable to other settingsIs designed so that it can be replicated & so that its results can be generalised to other similar groups3 Aims to Improve servicesAims to generate new knowledge4Is usually led by service providersIs usually initiated by researchers5Is practice-basedIs theory driven6Is an ongoing processIs often a on-off study7Never involves allocating patients randomly to different treatment groupsMay involve allocating service users randomly to different groups8Never involves a placebo treatmentMay involve administration of a placebo9Never involves a completely new treatmentMay involve a completely new treatmentAdapted from Madden (1991) and Firth-Cozens (1993)7Stages of audit

STAGE-1:PREPARING FOR AUDIT

Involving stakeholders & including consumers, in the process Select a topic (based on cost, volume, risk to consumers, serious quality problem, complaints, available evidence, amenability to change, priority, policy directives or guidelines) Defining the purpose of the audit (improvement, enhancement, ensuring quality, or instigating change) Establishing or activating necessary structures (committees and meetings, feedback systems)Identifying skills and people needed to carry out audit Providing training to audit team as necessary (project management, audit method skills, change management skills, data collection and analysis and facilitation skills)

STAGE-2:SELECTING CRITERIA

Defining criteria & standards against which to assess the process & outcome of care Drawing criteria from existing guidelines or systematic reviews Prioritising criteria (based on the research evidence) Making criteria explicit and subjecting it to external peer review

STAGE:3-MEASURING PERFORMANCE LEVESIdentifying the data to be collected ,determining sample size, data sources, data extraction tools and techniques, reviewer training and method of analysis. STAGE-4:MAKING IMPROVEMENT Identifying the level and location of change (organisational, group, individual); the barriers to change establishing the environment for the audit and involving stakeholders.

STAGE:5-SUSTAINING IMPROVEMENTMonitoring and evaluating change Maintaining and reinforcing the change

Success of medical audit Successful clinical audit requires:a clearly defined issue or probleman ability to measure clinically relevant elements of care which clearly reflect that probleman ability to apply that measure in a rigorous and consistent way which best reflects patient carean ability to change care processes to drive any subsequent improvement in the chosen measuresufficient resources to ensure that the work can be undertaken appropriately and in a manner which ensures clinician engagement and supportclinical leadership.Barriers lack of clarity re purpose of audit (what are we trying to achieve?) audit must be framed around improving patient care and has no role as an investigational toolinconsistent approaches to data collection and managementinsufficient resources to support the audit processlack of expertise in audit project design and analysislack of planninglack of medical engagement and leadership poor professional culture and poor relationships between professional groups and agencies, and within audit teamsabsence of trust between senior doctors and managerslack of integration with other activities (including clinical governance processes) an inability of senior doctors to change or improve the care processes being measured.Application

In providing better quality of care to patients.Safety of patientsContinuing medical educationHelps in maintaining the clinical practice standards

References National Institute for Health and Clinical Excellence. Principles for best practice in clinical audit. Oxford: Radcliffe Medical Press, 2002. http://www.health.vic.gov.au/clinicalengagement/downloads/pasp/understanding_clinical_practice_toolkit.pdfClinical audit: a comprehensive review of the literature . Travaglia J, Debono, D. University of New South Wales. Centre for Clinical Governance Research in Health. 2009. http://clingov.med.unsw.edu.au Undertaking a clinical audit project: a step-by-step guide