This is why, it is now part of the curriculum of final fellowship examination
WHAT IS THE USE OF AN AUDIT?► It can bring about the change for improvement► It makes the practice evidence based► It can be used to formulate the departmental, institutional, national and international policies and protocol To improve the health care
Areas to be audited Structure Procedures Outcome
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
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
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 has potential to bring about change
Audit cycle Choose topic Set standardsIntervene to promote Collect the data the change Feed back the results
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?
1 Basic Clinical Audit► A report produced by a unit, department, institution after every 3 months► Type of patients, Diagnosis, Management offered, Complications, Mortality, Patients satisfaction etc. The results are compared with previous period, other departments or institution
2 Incidence review► Selection of a criteria or clinical scenario.All incidences are reported and then their frequency is matched with already available standards
3 Clinical record reviewA team of other unit reviews the randomly selected record of the patients. There might be more emphasis on record keeping skills than actual quality of the care of the patient
4 Criterion audit► It is more advanced and structured form of incident audit.► A standard criterion of an aspect of patient care is selected. The criterion should be such that even a non-technical auditor can get an unambiguous assessment from the patients chart.► If the criterion is not met, then further review is conducted► This has a potential to assess all aspects of patients care
5 Adverse occurrence screening► The auditors decide to shortlist the adverse happenings which should not take place and needs to avoided. e.g. Wound infections, burst abdomen, readmission within 24 hours of discharge, unplanned blood transfusions etc.► The frequency of them are than matched with standards.
6 Focused audit study► This is conducted on the basis of the outcome of another audit to find out the finer details.► This is closer to clinical research but it not intended to find new knowledge. Research finds “right thing to do” Audit finds “whether right thing has been done or not”
7 Global audit► Comparison of the data across different units, hospitals and regions.