CLINICAL AUDIT

Federal Ministry of Health of Ethiopia

 OUTLINE

• Introduction

• Definition of clinical audit

• Rational

• Stages of clinical audit

 HSTQ
Section I: Quality improvement guideline

Section II: Ethiopian quality structure

Section III: Clinical audit guideline

Section IV: Health service Quality standards  

 FMOH HSQD, NHQSC

RHB QU, RHQSC

Quality
structures
ZHD, WoHO QU, Quality officers

HOSPITALS QU, QC, QIT

HCs QC/HPMT, QIT

 QUALITY STANDARDS
• main pillars of the Quality Measurement systems
• a statement of expected level of quality and it states clearly the
• Inputs required to deliver a service – RESOURCES
• How things should be done – PROCESS
• What the output should be – OUTCOME
• Used in QI
• identify any quality gaps and then make plans to improve upon it.
 QUALITY STANDARDS
 REMARK /
QUALITY MEASURES SCORE VERIFICATION
CRITERIAS

 REMARK /
QUALITY MEASURES SCORE VERIFICATION
QUALITY CRITERIAS

STATEMENTS QUALITY MEASURES  REMARK /

SCORE VERIFICATION
CRITERIAS

 REMARK /
QUALITY MEASURES SCORE VERIFICATION
CRITERIAS

 REMARK /
QUALITY MEASURES SCORE VERIFICATION
CRITERIAS
 HEALTH SERVICE QUALITY STANDARDS

1. Infrastructure, equipments, drugs, supplies,

Quality statements guidelines, protocols, manuals
2. HR – numbers, competencies
Quality measures 3. Evidence based care
4. Communication
Score 5. CRC and patient centered care
6. Patient safety
Verification criteria 7. Data management
 Focus areas
1. Maternal Health (6)
2. Neonatal and Child Health (16)
3. Communicable Ds (18) (Malaria 2,HIV/AIDS 11, TB 6)
4. NCD (11)
5. CRC and Patient centeredness (6)
6. Patient Safety (5)
7. Surgical Service (6)
8. STG Adherence (3)
9. Nursing and midwifery (4)
10. Health care data quality (5)
11. Total Quality statements /standards = 80
Cont’d
• Assessment process comprises of gathering information from

• Staff interview

• Review of records

• Observation

• Interview with patients and attendants

 Cont’d
 Staff interview
 4 staffs interview then score 2 or 0 for each of them according to the criteria
 Chart Review
 10 charts of the previous month then score 1 or 0 for each chart according to
the criteria
 Client Interview
 5 clients interview then score 2 or 0 for each of them according to the criteria
 Observation
Cont’d
 CLINICAL AUDIT

• Used as QI method in every day practice

NOT NEW

• Audit practice against standards

• Clinical or non clinical
• Evidence based
Main purpose • Identify technical and administrative gaps
• action plan development and implementation
• move towards best practice through CQI
 CLINICAL AUDIT
• “The systematic critical analysis of the quality of clinical
care, including the procedures used for diagnosis and
treatment, the use of resources and the resulting outcome and
quality of life for the patient.”
US department of health Clinical audit, 1989
DEFINITION

• “A quality improvement process that seeks to improve patient care and

outcomes through systematic review of care against explicit standards
and the implementation of change.”
National institute for Clinical Excellence (NICE), 2002
 CLINICAL AUDIT

• Enable measurement of practice and standards

RATIONAL • assess and improve patient care
• Identifying and measuring areas of risk
undertaken • Create a culture of quality improvement and best practice
as a routine • educational for the participants (provide up to date
part of information with evidence based good practice)
everyday • Offers an opportunity for increased job satisfaction.
practice • Improve the quality, effectiveness and efficiency of
healthcare.
 CLINICAL AUDIT

THE FIVE STAGE

APPROACH

Each stage must be undertaken

to ensure that an audit is
systematic and successful
 Stage 1 – Planning for audit
successful clinical audit,
• Needs effective planning and preparation
….

• Involve all relevant stakeholders

Planning has three main • Determining the audit topic
steps • Planning the delivery of audit
• Who, when, how…
 Stage 1 – Planning for audit

• Involvement of ALL workers

• FRONTLINE TO MANAGEMNT
Invlolving all • 10% audit – involvement of service users
relevant stakeholders
is VITAL
All should understand the aim
It is for improvement, NOT BLAME
 Stage 1 – Planning for audit

• Donabedian (1966) classification system

Select the topic

• Resource is limited
PRIRORITIZE • Prioritize
• Severity
• Impact
• Feasibility
 Stage 1 – Planning for audit

• Understand purpose
Plan for
• Involve the right people with the right skill
auditing
• Training – roles of each player,….
 Stage 2 - Standard and quality measure selection

• Sources
• Guidelines – local or international
• Literature review
Identify the
standards • standard describes and defines the quality of care to be
and achieved
audit criteria • for each standard a quality statement and quality
against which the measures
audit will be
• A quality measure
conducted • gives the detail of what needs to be achieved for the
standard to be reached
• should be SMART
 Stage 3 – Measuring performance

1. data collection
2. data analysis
Four steps
3. drawing conclusion
4. presentation of results
 Stage 3 – Measuring performance

• Data types
• Categorical (nominal/ordinal)
• quantitative or numerical (discrete/continuous)

Data
• Data items - ADEQUATE AND NOT EXCESSIVE
collection • infringe compliance

• Source of data – need agreement

• Charts, interview, observation etc
 Stage 3 – Measuring performance
• Collection
• retrospective/ cross sectional / prospective

• Sampling
• not possible or necessary to gather data on all service users, events
Data or item
• Should be representative
collection • numerous sampling methods
• random sampling and convenience sampling are most
commonly used
• Sample size
• small enough to allow for speedy data collection but large enough
to be representative
 Stage 3 – Measuring performance

Data • convert a collection of facts (data) into useful information

analysis • Measure the level of compliance

• Set problem statements

Drawing
• identify the reasons why the standard was not met
conclusion
• Use Root cause identification methods
 Stage 3 – Measuring performance

• Maximize the impact of the clinical audit on the audience

• Generate discussion
Presentation of
• Stimulate and support action planning
results
To all relevant
stakeholders • Can be
• Visual presentation – posters, table, graph etc
• Written reports
• Verbal presentation
 Stage 4 – Making improvements

All audits should be accompanied by a quality improvement plan

Change
the most ‘Audit that simply measures but does not drive change to address
problems identified, is NOT GOOD AUDIT’
difficult part
of the audit
• PRIORITIZE problems
• Set the aim statement
• Develop change ideas
 Stage 5 – Sustaining improvements

• Re – auditing
• Further improve to reach the standard of interest
Audit cycle or exceed it
• Sustain the improvement
a continuous
process • Share findings – bulletins, journals, social medias,
seminars etc
• Scale up the practice
 Bisidimo Hospital HSTQ Assessment
Table 1: HSTQ assessment of Bisidimo Hos. Feb, 2017 G.C
No. Standard Total Score Hos. Score Hos. Quality Score
Expected (%)
1 Maternal Health 1404 1272 90.59
2 Neonatal & Child Health 985 914 92.79
3 Communicable Ds
 Malaria 126 125 99.2
 TB 400 388 97
 HIV/AIDS 774 707 91.34
4 NCD 895 730 81.56
5 STG Adherence 270 260 96.29
6 Surgical Service 659 600 91.04
7 Health Care Data Quality 905 766 84.64
8 CRC 187 163 87.1
9 Nursing & Midwifery 388 356 91.75
10 Patient Safety Quality 240 219 91.25
Cont’d
Table 2: NCD HSTQ assessment of Bisidimo Hos. Feb, 2017 G.C
No. Non Communicable Ds Standards Bis Hos. Score Standard

1 NCD 1 13 23

2 NCD 2 16 32

3 NCD 3 26 66

4 NCD 4 100 108

5 NCD 5 79 79

6 NCD 6 97 133

7 NCD 7 111 117

8 NCD 8 121 136

9 NCD 9 80 90

10 NCD 10 85 95

11 NCD 11 2 24
 Cont’d
Table 3 HCDQ HSTQ assessment of Bisidimo Hos. Feb, 2017 G.C
No. Health Care Data Quality Standard Bis Hos Score Standard
1 DQ 1 58 59
2 DQ 2 450 550
3 DQ 3 188 191
4 DQ 4 70 105
THANK YOU!