Dr.

Mukesh Sharma Manager- Quality & Operations

 Audit-

Process of reviewing of delivery of care to identify deficiencies so that they may be remedied Audit- Peer review for evaluation of medical care through retrospective and concurrent analysis of medical record

Clinical

 To

improve the quality of healthcare services to the patient audit is not-

Clinical

A fault finding A punitive action An external quality control

The Audit cycle

Measure Baseline

Review standard if required

Set standards

Evaluete Change
Implement Change

Measure practice through data collection and analysis

Assessment of performance against standard

Suggest change

Identify opportunity for improvement

 Clinical

Audit Committee/ Medical Record and Audit Committee Members

Medical Administrator Administrator Representative from all discipline Nursing Director

 Should

be common (high risk/high cost) Have local clinical concern/wide variance in clinical practice Well defined and focused Examples

Long/Short stay cases Disease/operations Groups (Vulnerable) Increase incidence of some disease Post operative infections etc

A) To be set prior to the study B) Criteria to be based on objective measures

Criterion is an item of care or sure aspect of care that

can be used to assess quality. It is a written statement for example. All Patients requiring urgent appointment will be seen that day only. All patients with epilepsy should be seen once a year. All Patients on oral anticoagulants should have their INR within recommended limits

C) Criteria should be well justified

D) Target should be set at realistic level for defined patient groups and take into account local circumstances.
A target describes the level of care to be achieved for any particular

criteria . for example 98 percent of patients requesting for urgent appointment will be seen on that day 90 percent of patient s with epilepsy must be seen at least once a year 100 percent of patients on oral anticoagulants will have the INR within recommended level

E) Objective criteria are explicitThe problem with implicit criteria is that important deficiencies in care may be overlooked an rates may differ in their assessment of the acceptability of management .

Structure Criteria Staffing of ICU

Process BT during surgery

Outcome Case fatality

Target

Not < 1 per two occupied beds

Not <5 percent and not > 20 percent of average cases

Not to exceed 0.1 percent for specified procedures

A. B. C.

Simplest for the purpose Only essential data is collected Suitable sample size is to be selected

Random sampling generate Stratified samples Systematic sampling Cluster sampling

D.

Probability of bias is to be considered

Non-response to a survey Unavailability of certain type of case note Selective referral of ce4rtain types of patients Failure of patient to turn up for follow up

4. Tabulation of evaluation

A) Deficiency of care recognized B) Specific solutions are proposed . they may not be possible every time
E.g. a study of the way cervical screening is

organized identified deficiencies but concluded only that other schemes needed to be examined

C) Education impact is appreciated- Training & education regarding outcome & probable solutions

A. B. C. D.

Planned programme for change All staff is involved Active feed back Audit is evaluated

Professional Motives

Social Motives

Pragmatic Motives

To identify deficiencies Educational need Self-correction & Selfregulation

To ensure safety of public To present patient from inappropriate or suboptimal care

To reduce patients suffering

Legal Motives

CPA

Negligence

Malpractice

 What

do we do? Do we do what we think we do? What should we do ? Are we doing what we should be doing ? How can we improve what we do? How we improve?

(a)Professional benefits

Change in prescribing behavior Updation of clinical knowledge Increase in staff enthusiasm and satisfaction Teamwork

(b)Patient care and service delivery

Improvement inpatient care

Improved patient satisfaction

Better patient feedback

 Lack

of resources Lack of expertise in design and analysis Lack of an overall plan for audit Relationships problem Organisational impediments disputes between views of clinicians and mangers

1. Foster an environment for audit

Audit is a valued activiry Can augment both career and professional development Provision of protected time for audit Commitment from staff to provide a request and act on time study findings

2.Tackle the problems of multidisciplinary audit

Can be seen as threatening Exposing one mistakes to another Staff training in interpersonal skills and in dealing with

conflict Benefits outweigh disadvantage

3. Review staff training programme

Importance of planning Benefits of pilot study

4. Emphasis audit facilitation 5. Establish Confidentiality of finding 6. Ensure all relevant staff are involved 7. Establish evaluation programme