1. Khaing Zay Aung
2/7/2015

2. 1) Definition
2) Attitude to audit
3) Components of audit
4) Stages of single audit
5) A successful audit
6) Types of surgical audit
7) Audit committee
8) Functions of audit committee
9) Audit cycle

3.  'The systematic, critical analysis of the quality of
medical care, including the procedures used for
diagnosis and treatment, the use of resources, and the
resulting outcome and quality of life for the patient‘.

4.  An effective program of medical audit will also help to provide
reassurance to doctors, their patients, and managers that the best
quality of service is being achieved, having regard to the resources
available

5.  medical audit
 refers to the assessment by peer review of the medical care provided
by the medical profession to the patient.
 clinical audit
 refers to an assessment of the total care of the patient by nurses,
professions allied to medicine (such as physiotherapists) as well as
doctors.

6. 1. Audit must be seen as a systematic approach to the review of clinical
care to highlight opportunities for improvement and to provide a
mechanism for bringing them about.
Audit investigation is also suitable for resolving issues of contention or
local interest.

7. 2. The time spent on audit could be much better spent on other activities, such as
treating more patients.
3. There is, none the less, general agreement that a regular review of your own
practice against agreed standards of best practice can lead to improved care of
patients, who must be the principal beneficiaries of the process.

8. 4. Clinical audit improves patient care not only through direct changes in clinical
practice but also through indirect effects such as professional education and
team development.
5. An effective clinical audit programme can give the necessary reassurance to
patients, clinicians and managers that an agreed quality of service is being
given within available resources.

9. 6. Clinicians and managers share audit information within agreed rules of
confidentiality.
7. There is a growing need to base clinical practice on the knowledge obtained
from rigorous research into the effectiveness of healthcare interventions.

10. 8. The treatment offered to individual patient may need to be justified it as
accepted or evidence based practice if there is an adverse outcome.
9. An important part of the national research and development strategy is to make
information on research findings easily available to clinical and managerial staff,
both in printed form, such as Effective Health Care bulletins, and electronic
media

11.  (i) Audit of a structure
 this refers to the organisation and availability of resources to deliver
the surgical service
 It is not a good indicator of the quality of care but should be taken into
account in the assessment of process and outcome
 E.g - whether each ward, clinic has a fully equipped and operational
trolley available for emergency access

12.  (ii) Audit of a process
 this refers to the way in which the patient has been managed from
admission to discharge
 E.g. – regular review of a sample of case notes to check that the
information recorded on all patients admitted with H&M conforms to
agreed local guidelines

13.  (iii) Audit of an outcome
 This is the audit of surgical intervention
 Eg; systematic review of the incidence of wound sepsis in patients
undergoing emergency appendicectomy

14. 1. Primary data collection
 Normally performed by medical stuff or an audit officer using specific forms
1. Verification of primary data by confidential peer view
2. Subjection of data to analysis
3. Presentation of results
 Audit meetings should be held regularly and should be attended by all
members of the surgical team including representatives from the nursing stuffs

15.  Complete
 Honest and accurate
 Educational
 Confidential
 Objective
 Reproducible
 Cost-effective

16. 1. Unit based or morbidity and mortality meetings (M&Ms)
2. Local, hospital based audit
3. National / International comparative audit

17.  Most hospitals have their own audit committee
 Members from range of clinical background
 The chairman needs to be well motivated and prepared to devote time
on regular basis to the task
 The members should be representatives from GPs, nursing
professions, educational stuffs, doctors in training grades, clinicians
and audit stuffs.

18.  Coordinate and foster clinical audit for every doctors
 Determine existing practice of audit and assist clinicians in the
implementation of audit methods
 Monitor the results and conclusions of the audit process and check
validity of data and reporting
 Ensure that changes where indicated by the outcome of audit, are
implemented

19.  Ensure that the outcome of audit is perceived as educational
 Train and direct audit directors
 Ensure effective liaison with GP and management
 Maintain confidentiality
 Estimate funding required for audit
 Prepare annual report and forward programme

20.  Decide which area your clinical care you intend to scrutinized
 Then set the standard of practice
 Comparison made that between the observed practice with standard
 A decision can then be made as to whether practice need to change
 Finally change is implemented
 This process is known as “cycle of audit”
 The achievement of change is termed “closing the audit loop”

22.  Good surgery is 25 percent manipulative skill and 75 percent decision
making.
(American surgeon F. C. Spencer )

23. 1. Information
2. Joint decision making with the patient
3. Cost-effectiveness
4. Avoid obstacles to good decision making

24.  Relevant and reliable
 Facts to be borne in mine
 Facts that can be left out of consideration
 Facts that can be rejected as invalid or irrelevant
 No two patients are exactly the same and some factors may exclude
your patient from being comparable with the tightly selected patients
assessed in statstistical trials

25.  Surgeon should first decide what is the professional opinion that will
offer the patient after reviewing the possible methods of management,
with the benefits and risks
 In taking informed consent, avoid scientific terms that are likely to
confuse patients rather than instruct them
 Recognize the patients’ right to ask for the treatment that differs from
that advised by you but do not agree to treatment that is harmful,
ineffective or offends against the moral code

26.  Consider what treatment is best for the patient’s need
 In the mean time need to consider from the financial aspect
 Need to consider patients’ socioeconomic status

27.  Try not to attempt too many tasks at once
 But in an emergency, be willing to abandon a less important one and
undertake one that is urgent
 Measuring individual aspects separately does not provide a complete
picture. You must look at the patient as a whole

28. 1. Codified decisions
(codify….. organized into a system)
2. Personalized decisions

29.  Facts and experiences can be measured and then compared with
findings in other similar situations, it become possible to make
decisions for future guidance when faced with similar problems
 As a result of reviewing series of cases, various standardized methods of
management have been devised
 If the problem complies with previously assessed cases, a plan can be
developed so that succeeding problems can be dealt with according to
predetermined directions.

30. Codified decisions can be with
Algorithm
Protocol
Guidelines
Decision trees

31.  Many decisions are complex and cannot be made with standardized or
codified manner
 The condition may be complicated by cofactors or may have unusual
features
 The decision is unique and may be challenging or even controversial
 Some of the factors may be indefinable and difficult to weigh in the
balance. It is in such circumstances that opinions differ between
specialists because of individual selection of evidence and the
importance given to it.

32.  Personal experience, especially of rare problems is a powerful
influence on decisions, so that senior surgeons are usually trusted to
deal with them

33.  In conclusion, the decision making is critical importance for the patient
and also for the surgeon to manage a disease.
 There are many factors need to be consider in decision making.
 And the decision making comprises ¾ to become a good surgeon
rather than surgical skill.