Waleed Th. Aletreby

Clinical Audit

Audit in the dictionary…

Definition

A quality improvement process that seeks to improve patient care and outcomes thorough systematic review of care, against explicit criteria and the implementation of change.

That is to say the performance is being reviewed (audited) to make sure that what should be done is being done.

And if not, it provides a framework for improvements to be made.

Clinical audit has been incorporated as an essential part of the clinical governance in many countries worldwide.

Since 1993 in UK for example.

WHY ?Clinical auditing as part of the clinical governance has many advantages and benefits to the organization:

To identify whether standards are being met, and evidence from research are being used in practice.

To identify baselines for development of standards. To reduce clinical risk. To ensure cost effective use of resources, and effectiveness

of a service. To highlight problems, and help in the solution. To improve team working and communication. To improve patient care and outcomes.

A little bit of history

One of first ever clinical audits was undertaken by Florence Nightingale during the Crimean War of 1853-1855.

She and her team of 38 nurses applied strict sanitary routines and standards of hygiene to the hospital and equipment.

Kept meticulous records of the mortality rates among the hospital patients.

Following these changes the mortality rates fell from 40% to 2%.

A question here …

Is Clinical Audit A research ?

THE DIFFERENCE IS SIMPLY

Research asks:

Are we singing the right song?

Audit asks:

Are we singing this song right?

THE CLINICAL AUDIT CYCLE

Choose Topic

In this stage the audit team will identify a problem, or an area of healthcare service

that is to be compared to standards.

When choosing a topic it is recommended to focus on areas where: Standards and guidelines exist, and there is

conclusive evidence about effective clinical practice.

Problems have been encountered in practice. There have been recommendations or complains

from the patients or public. There is high volume, high risk, or high cost. There is clear potential of improvement of service.

Audit topics fall into 3 categories:

1. The structure: resources and personnel available to enable healthcare professionals to perform their jobs (eg. Skills – provision of equipment).

2. The process: focuses on the amount, type, and appropriateness of clinical care (eg. Quality of CPR – antibiotics prescription).

3. The outcome: focuses on the result of an intervention (eg. Patient satisfaction – pain relief).

Choose Topic

Decisions regarding the overall purpose of the audit, either as what should happen as a result of the audit, or what question you want the

audit to answer, should be written as a series of statements or tasks that the audit will focus on. Collectively, these form the audit criteria.

A criterion is a measurable outcome of care. For example, ‘Patients in the ICU should receive GIT bleeding prophylaxis’.

A standard is the threshold of the expected compliance for each criterion (these are usually expressed as a percentage). For the above example an appropriate standard would be: ‘GIT bleeding prophylaxis received in 90% of cases’.

The audit team should start by collecting available standards and guidelines concerning the topic of the audit, from the best available and most updated sources, and agree on them among themselves.

Then they should formulate the standards as a series of statements or tasks that the audit will concentrate on.

Those statements will be the criteria of the audit.

Remember, Criteria of an audit should be:

S

M

A

R

T

Clear, not vague

Objectively

Realistic

To the topic

As well as Theoretically sound

Choose Topic

•Data collection sheets or questioners developed by the audit team.•The type of collected data taken in consideration.

Choose Topic

•Simple Statistical analysis based on the type of data collected.•Graphical presentation•Clinical Audit Facilitator.

Analysis stage, whereby the results of the data collection are compared with criteria and standards.

The end stage of analysis is concluding how well the standards were met and, if applicable, identifying reasons why the standards weren't met in all cases.

These reasons might be agreed to be acceptable, i.e. could be added to the exception criteria for the standard in future, or will suggest a focus for improvement measures.

In theory, any case where the standard was not met in 100% of cases suggests a potential for improvement in care.

In practice, where standard results were close to 100%, it might be agreed that any further improvement will be difficult to obtain.

And that other standards, with results further away from 100%, are the priority targets for action.

This decision will depend on the topic area, in some ‘life or death’ type cases, it will be important to achieve 100%, in other areas a much lower result might still be considered acceptable.

Choose Topic

Discuss your results…

Conclude if standards were met, and if not, because of what.

What needs to be done about that? Is the solution practical? Was the standard itself applicable ?

(perhaps exclusion criteria should be added).

Share your results…

Once the results of the audit have been published and discussed, it is time to formulate and action plan, that should include;

o What needs to be done or changed.o Who is going to do it.o When it is going to be done.o How it will be done.o Involve higher authorities.

Choose Topic

Closing the loop…

After an agreed time frame, the audit should be repeated.

The same methods and data analysis are used to ensure comparability.

The re-audit should demonstrate that the changes have been implemented and that improvements have been made.

This stage is critical to the successful outcome of the audit process as it verifies whether the changes implemented have had an effect.

So, are you…

Or ,are you…

Thank you all.Can’t wait to get started…