7/28/2019 125855783 Clinical Audit

1/19

Dr. Mukesh Sharma

Manager- Quality & Operations

7/28/2019 125855783 Clinical Audit

2/19

Audit- Process of reviewing of delivery of

care to identify deficiencies so that they

may be remedied

Clinical Audit- Peer review for evaluation of

medical care through retrospective and

concurrent analysis of medical record

7/28/2019 125855783 Clinical Audit

3/19

To improve the quality of healthcare

services to the patient

Clinical audit is not- A fault finding

A punitive action

An external quality control

7/28/2019 125855783 Clinical Audit

4/19

Measure Baseline

Review standard if

required

Evaluete Change

Assessment ofperformance against

standard

Measure practice

through data collection

and analysis

Set standards

Implement Change

Suggestchange Identify opportunity

for improvement

The Audit cycle

7/28/2019 125855783 Clinical Audit

5/19

Clinical Audit Committee/ Medical Record

and Audit Committee

Members Medical Administrator

Administrator

Representative from all discipline

Nursing Director

7/28/2019 125855783 Clinical Audit

6/19

Should be common (high risk/high cost)Have local clinical concern/wide variance

in clinical practice

Well defined and focusedExamples

Long/Short stay cases

Disease/operations

Groups (Vulnerable) Increase incidence of some disease

Post operative infections etc

7/28/2019 125855783 Clinical Audit

7/19

A) To be set prior to the studyB) 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 theirINR within recommended limits

C) Criteria should be well justified

7/28/2019 125855783 Clinical Audit

8/19

D) Target should be set at realistic level for defined patientgroups 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 onthat 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 withinrecommended level

E) Objective criteria are explicit-The problem with implicit criteria is that important deficienciesin care may be overlooked an rates may differ in theirassessment of the acceptability of management .

7/28/2019 125855783 Clinical Audit

9/19

Structure Process Outcome

Criteria Staffing of ICU BT during

surgery

Case fatality

Target Not < 1 per two

occupied beds

Not 20

percent of

average cases

Not to exceed

0.1 percent for

specified

procedures

7/28/2019 125855783 Clinical Audit

10/19

A. Simplest for the purposeB. Only essential data is collectedC. 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

7/28/2019 125855783 Clinical Audit

11/19

A) Deficiency of care recognizedB) Specific solutions are proposed . they

may not be possible every time

E.g. a study of the way cervical screening isorganized identified deficiencies but concluded

only that other schemes needed to be examined

C) Education impact is appreciated- Training

& education regarding outcome & probablesolutions

7/28/2019 125855783 Clinical Audit

12/19

A. Planned programme for change

B. All staff is involved

C. Active feed back

D. Audit is evaluated

7/28/2019 125855783 Clinical Audit

13/19

Professional Motives Social Motives Pragmatic Motives

Legal Motives

CPA Negligence Malpractice

To identify deficiencies

Educational needSelf-correction & Self-

regulation

To ensure safety of public

To present patient from

inappropriate or suboptimal

care

To reduce

patients suffering

7/28/2019 125855783 Clinical Audit

14/19

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?

7/28/2019 125855783 Clinical Audit

15/19

(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

7/28/2019 125855783 Clinical Audit

16/19

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

7/28/2019 125855783 Clinical Audit

17/19

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 timestudy 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 withconflict

Benefits outweigh disadvantage

7/28/2019 125855783 Clinical Audit

18/19

3. Review staff training programme Importance of planning

Benefits of pilot study

4. Emphasis audit facilitation5. Establish Confidentiality of finding

6. Ensure all relevant staff are involved

7. Establish evaluation programme

7/28/2019 125855783 Clinical Audit

19/19