Javed Iqbal draws a comparison between cricket and surgery, noting that both are missing an important element of record keeping. For cricket, it is keeping score, while for surgery it is conducting audits. Without audits, surgical practice would be like playing cricket without keeping score. Audits are a systematic, critical review of clinical care that can help highlight opportunities for improvement. The main goals of audits are to evaluate current practices, identify areas for improvement, and implement changes to promote better patient outcomes and evidence-based healthcare.
14. History of Audit
► Personal experience
► Writings………Theodor Billroth in 1881
► Ward rounds
► Clinical meetings
► Morbidity and Mortality meetings
(INFORMAL AUDIT)
15. Informal audit is and use to
be an activity conducted by
some
Which are more
enthusiastic
17. Definition
The systemic, critical analysis of the
quality of medical care, including the
procedures used for diagnosis, the use of
recourses and outcome of the quality of
life of the patient
18. 2
Systemic approach to the
review of clinical care to
highlight the opportunities
for improvement
19. Medical Audit Clinical Audit
Assessment of the Assessment of the total
medical care provided care
by the doctors
20. Informal audit is and use to
be an activity conducted by
some, which are more
enthusiastic
21. But now:
The audit is considered to be part of job
description of all involved in health care
clinicians Managers
23. This is why, it is now part of
the curriculum of final
fellowship examination
24. WHAT IS THE USE OF AN AUDIT?
► It can bring about the change for
improvement
► It makes the practice evidence based
► It can be used to formulate the
departmental, institutional, national and
international policies and protocol
To improve the health care
28. Areas to be audited
Structure
Procedures
Outcome
29. Structure
► The quantity and type of resources
Building, equipments, staff and organization
etc.
It is easy to measure but is not a very
good indicator of the quality of care
30. Procedure
► What is done to the patient
The way operations are performed,
prescription of medications, investigations,
adequacy of notes, compliance to the set
protocols etc.
This area of patient care can be
changed by education
31. Out come
► It is the result of the clinical intervention and
represents the success or failure
Hospital stay, complications, Morbidity,
Mortality, return to normal activity and
patients satisfaction etc.
This is the best audit which has
potential to bring about change
32. Audit cycle
Choose topic
Set standards
Intervene to promote
Collect the data
the change
Feed back the results
33. Audit cycle
► What are we tiring to achieve?
► Are we achieving it?
► Why are we not achieving it?
► What can we do to make it better?
► Have we made it better?
35. 1 Basic Clinical Audit
► A report produced by a unit, department,
institution after every 3 months
► Type of patients, Diagnosis, Management
offered, Complications, Mortality, Patients
satisfaction etc.
The results are compared with
previous period, other
departments or institution
36. 2 Incidence review
► Selection of a criteria or clinical scenario.
All incidences are reported and then their
frequency is matched with already available
standards
37. 3 Clinical record review
A team of other unit reviews the randomly
selected record of the patients.
There might be more emphasis on
record keeping skills than actual
quality of the care of the patient
38. 4 Criterion audit
► It is more advanced and structured form of
incident audit.
► A standard criterion of an aspect of patient care is
selected. The criterion should be such that even a
non-technical auditor can get an unambiguous
assessment from the patients chart.
► If the criterion is not met, then further review is
conducted
► This has a potential to assess all aspects of
patients care
39. 5 Adverse occurrence screening
► The auditors decide to shortlist the adverse
happenings which should not take place
and needs to avoided. e.g. Wound
infections, burst abdomen, readmission
within 24 hours of discharge, unplanned
blood transfusions etc.
► The frequency of them are than matched
with standards.
40. 6 Focused audit study
► This is conducted on the basis of the
outcome of another audit to find out the finer
details.
► This is closer to clinical research but it not
intended to find new knowledge.
Research finds “right thing to do”
Audit finds “whether right thing has been
done or not”
41. 7 Global audit
► Comparison of the data across different
units, hospitals and regions.
44. 1. Basic Clinical Audit
2. Incidence review
3. Clinical record review
4. Criterion audit
5. Adverse occurrence screening
6. Focused audit study
7. Global audit
8. Out come studies
9. National studies
45. What minimum we can do?
► Personal record keeping
► Basic surgical audit
► Out come assessment
Morbidity
Mortality
Patients satisfaction
► Focused studies