Medical Audit

Presenter: Dr. Preeti Thaware

Frame work
1. What is audit? 2. What is medical audit? 3. Why audit? 4. Audit versus research 5. The quality cycle 6. Stages of medical audit

What is audit?
Evaluation of data, documents and resources to check performance of systems meets specified standards.
Audit in the wider sense is simply a tool to find out what you do now; this often to be compared with what you have done in the past, or what you think you may wish to do in the future.

.collecting data. . . .What is medical audit “A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change.identifying areas for improvement.making necessary changes .back round to defining new standards.” • An audit is a cyclical process -defining standards.

Maintain data quality . It does not involve experiments It uses data that already exists . Protect reputation of staff. host and sponsorer Protect current and future funding Improve quality.Why audit? • • • • • • • Maintain participant and staff safety.

are we doing the best thing in the best way? • • • • • Measures current practice against specific standards Never experimental Uses data in existence by virtue of practice May require ethical approval Aims to improve delivery of patient care .Audit:.

Research:.What is the best thing to do/the best way to do it • • • • • Provides sound basis for medical audit Involves experimental trials Uses detailed data collection Needs ethical approval and registration Aims to add to body of scientific knowledge .

Quality cycle Prevent future problems Identify problems Correct the problem Identify barrier .

Five stages of clinical audit .

Stage 1: Preparing for audit • • • • Involving users Selecting a topic Defining the purpose Planning .

including: -Letters containing comments or complaints -Critical incident reports -Individual patients’ stories or feedback from focus groups -Direct observation of care -Direct conversations . • Involving users: .sources of data • The concerns of users can be identified from various sources.genuine collaborators .Stage 1: Preparing for audit continue…….

starting point .Stage 1: Preparing for audit continue…….careful thought and planning There seems little point in trying to audit a rare condition. with a cheap intervention with a fairly superficial outcome . • Selecting a topic: .

or risk to staff or users?  Is there evidence of a serious quality problem? for example patient complaints or high complication rates?  Is there potential for involvement in a national audit project or pertinent to national policy initiatives?  Is the topic a priority for the organisation?  Is good evidence available to inform standards? for example systematic reviews or national clinical guidelines? .Stage 1: Preparing for audit continue……. Selecting a topic: • Tool for prioritise audit topics questions:  Is the topic concerned of high cost.

• Defining the purpose .purpose must be established before appropriate methods for audit can be considered.The following series of verbs may be useful in defining the aims of an audit to improve to enhance to increase to change to ensure .Once topic selected. purpose define then suitable audit method can be chosen.Stage 1: Preparing for audit continue……. . .

. • Planning: o Involve ALL the people concern.Stage 1: Preparing for audit continue……. o Time and resources o Access the evidence o Methodology o Pilot o Report and Action o Re-audit o Data collection instrument o All these should be documented.

Stage 2: Selection criteria • Defining criteria • Sources of evidence • Appraising the evidence .

. .Stage 2: Selection criteria continue……… • Definition of criteria: .an individual. a team.The choice depends on the topic and objectives of the audit. or an organisation .This can include assessment of the process and/or outcome of care .They should relate to important aspects of care and be measurable.

Stage 2: Selection criteria continue……… • Sources of evidence: . reference to levels achieved in audits undertaken by other professionals is useful. reviews of the evidence . good-quality guidelines . previously use criteria for same purpose .Systematic methods should be used . Measurement of outcome Can develop own standards. .

Stage 2: Selection criteria continue……… • Appraising the evidence: -Evidence needs to be evaluated to find out if it is valid. reliable and important o Aim /objectives o Methodology o Results /conclusions o Applicable to your patient group o Bias/ causes for concern .

Stage 3: Measuring level of performance  Planning data collection  Methods of data collection  Handling data .

M. 2.the data collected are precise .All children under 16 years diagnosed with asthma and registered with the primary healthcare team.Essential .Stage 3: Measuring level of performance continues…….G.S .User group to be included Examples 1. • Planning data collection: .I. All women receiving treatment for breast cancer in M.

Stage 3: Measuring level of performance continues…….Computer stored data.keep it simpleaand short. Interviews Focus Groups.Surveys . . • Methods of data collection: Do not try and collect too many items. Questionnaires.Case notes/Medical Records.How will this be done? -Compare performance against the criteria -Keep focused on the objective of the audit . Prospective recording of specific data .

. • Handling data: .Stage 3: Measuring level of performance continues…….ethical implications of and their responsibilities under the Data Protection Act (1998) when collecting data and presenting results.

Stage 4: Making improvements  Identifying barriers to change  Implementing change .

Low morale .Consensus not gained .. • Identifying barriers to change .Fear .Lack of understanding .Stage 4: Making improvements continues…….Pushing too hard .Poor communication .Culture .

systematic approach o identification of local barriers to change o support of teamwork o use of a variety of specific methods ..Stage 4: Making improvements continues……. • Implementing Change: .

Stage 5: Sustaining improvement  Monitoring and evaluation  Re-audit  Maintaining and reinforcing improvement .

Stage 5: Sustaining improvement continues……. • Monitoring and evaluation ..systematic approach to changing professional practice should include plans to: o monitor and evaluate the change o maintain and reinforce the change .

• Re-audit -Review evidence -Measure effectiveness -Decide how often to re-audit ..Stage 5: Sustaining improvement continues…….Ongoing process monitoring -Adverse incidents -Significant events audit .

integration of audit . .reinforcing or motivating factors built in by the management ..strong leadership . • Maintaining and reinforcing improvement .Stage 5: Sustaining improvement continues…….

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