Audit javed

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This presentation touches the basic concepts about surgical audit: Talk given to post gradate students of surgery

Text of Audit javed

  • 1. Javed Iqbal FCPS, FRCSProfessor of SurgeryQuaid-e-Azam Medical College, Bahawalpur

2. CRICKET SURGERY Batting Basic knowledge Bowling Clinical methods Fielding Technical skill Preparation of pitch Communication skills Overall fitness Ward administration Research 3. There is one thing missing in both 4. Scoring in cricketAnd Audit in surgery 5. Audit in surgery~Keeping the record of the scores in cricket 6. Surgical practice without audit isLike playing cricket without keeping the records of scores 7. AUDITReviewCheckInspectionExamination AssessmentInventory 8. The main responsibility of a doctorTo provide health care 9. KnowledgeTrainingExperienceAudit Outcome 10. History of Audit Personal experience WritingsTheodor Billrothin 1881 Ward rounds Clinical meetings Morbidity and Mortality meetings (INFORMAL AUDIT) 11. Informal audit is and use tobe an activity conducted by someWhich are moreenthusiastic 12. Subjective Objective 13. Definition The systemic, critical analysis of the quality of medical care, including theprocedures used for diagnosis, the use of recourses and outcome of the quality of life of the patient 14. 2Systemic approach to the review of clinical care tohighlight the opportunities for improvement 15. Medical Audit Clinical AuditAssessment of the Assessment of the totalmedical care provided careby the doctors 16. Informal audit is and use tobe an activity conducted by some, which are more enthusiastic 17. But now:The audit is considered to be part of job description of all involved in health care cliniciansManagers 18. Subjective Objective 19. This is why, it is now part of the curriculum of finalfellowship examination 20. WHAT IS THE USE OF AN AUDIT? It can bring about the change forimprovement It makes the practice evidence based It can be used to formulate thedepartmental, institutional, national andinternational policies and protocol To improve the health care 21. It is also a very powerfulteaching tool 22. From where to start? 23. Attitude and motivation 24. Areas to be audited StructureProcedures Outcome 25. Structure The quantity and type of resources Building, equipments, staff and organization etc.It is easy to measure but is not a verygood indicator of the quality of care 26. Procedure What is done to the patientThe way operations are performed, prescription of medications, investigations, adequacy of notes, compliance to the set protocols etc.This area of patient care can be changed by education 27. Out come It is the result of the clinical intervention and represents the success or failureHospital stay, complications, Morbidity, Mortality, return to normal activity and patients satisfaction etc.This is the best audit which haspotential to bring about change 28. Audit cycleChoose topicSet standardsIntervene to promote Collect the datathe changeFeed back the results 29. Audit cycle What are we tiring to achieve? Are we achieving it? Why are we not achieving it? What can we do to make it better? Have we made it better? 30. METHODS An outline 31. 1 Basic Clinical Audit A report produced by a unit, department,institution after every 3 months Type of patients, Diagnosis, Managementoffered, Complications, Mortality, Patientssatisfaction etc.The results are compared withprevious period, otherdepartments or institution 32. 2 Incidence review Selection of a criteria or clinical scenario.All incidences are reported and then theirfrequency is matched with already availablestandards 33. 3 Clinical record reviewA team of other unit reviews the randomlyselected record of the patients.There might be more emphasis on record keeping skills than actual quality of the care of the patient 34. 4Criterion audit It is more advanced and structured form ofincident audit. A standard criterion of an aspect of patient care isselected. The criterion should be such that even anon-technical auditor can get an unambiguousassessment from the patients chart. If the criterion is not met, then further review isconducted This has a potential to assess all aspects ofpatients care 35. 5 Adverse occurrence screening The auditors decide to shortlist the adversehappenings which should not take placeand needs to avoided. e.g. Woundinfections, burst abdomen, readmissionwithin 24 hours of discharge, unplannedblood transfusions etc. The frequency of them are than matchedwith standards. 36. 6 Focused audit study This is conducted on the basis of theoutcome of another audit to find out the finerdetails. This is closer to clinical research but it notintended to find new knowledge.Research finds right thing to do Audit finds whether right thing has been done or not 37. 7 Global audit Comparison of the data across different units, hospitals and regions. 38. 8Out come studies 39. 9National studies 40. 1. Basic Clinical Audit2. Incidence review3. Clinical record review4. Criterion audit5. Adverse occurrence screening6. Focused audit study7. Global audit8. Out come studies9. National studies 41. What minimum we can do? Personal record keeping Basic surgical audit Out come assessment Morbidity Mortality Patients satisfaction Focused studies 42. Audit is the first step Not an end in itself 43. Surgical practice without audit isLike playing cricket without keeping the records of scores 44. Thank you