Audit javed


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

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Audit javed

  1. 1. Javed Iqbal FCPS, FRCS Professor of SurgeryQuaid-e-Azam Medical College, Bahawalpur
  2. 2. ► CRICKET ► SURGERY► Batting ► Basic knowledge► Bowling ► Clinical methods► Fielding ► Technical skill► Preparation of pitch ► Communication skills► Overall fitness ► Ward administration ► Research
  3. 3. There is one thing missing in both
  4. 4. Scoring in cricketAnd Audit in surgery
  5. 5. Audit in surgery ~Keeping the record of the scores in cricket
  6. 6. Surgical practice without audit is Like playing cricket without keeping the records of scores
  7. 7. AUDITReview…Check…Inspection…Examination Assessment…Inventory
  8. 8. The main responsibility of a doctor To provide health care
  9. 9. Knowledge Training Experienc eAudit Outcome
  10. 10. History of Audit► Personal experience► Writings………Theodor Billroth in 1881► Ward rounds► Clinical meetings► Morbidity and Mortality meetings (INFORMAL AUDIT)
  11. 11. Informal audit is and use tobe an activity conducted by some Which are more enthusiastic
  12. 12. Subjective Objective
  13. 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. 14. 2Systemic approach to the review of clinical care tohighlight the opportunities for improvement
  15. 15. Medical Audit Clinical AuditAssessment of the Assessment of the total medical care provided care by the doctors
  16. 16. Informal audit is and use tobe an activity conducted by some, which are more enthusiastic
  17. 17. But now:The audit is considered to be part of job description of all involved in health care clinicians Managers
  18. 18. Subjective Objective
  19. 19. This is why, it is now part of the curriculum of final fellowship examination
  20. 20. 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
  21. 21. It is also a very powerful teaching tool
  22. 22. From where to start?
  23. 23. Attitude and motivation
  24. 24. Areas to be audited Structure Procedures Outcome
  25. 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. 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. 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 has potential to bring about change
  28. 28. Audit cycle Choose topic Set standardsIntervene to promote Collect the data the change Feed back the results
  29. 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. 30. METHODS An outline
  31. 31. 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
  32. 32. 2 Incidence review► Selection of a criteria or clinical scenario.All incidences are reported and then their frequency is matched with already available standards
  33. 33. 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
  34. 34. 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
  35. 35. 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.
  36. 36. 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”
  37. 37. 7 Global audit► Comparison of the data across different units, hospitals and regions.
  38. 38. 8 Out come studies
  39. 39. 9 National studies
  40. 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. 41. What minimum we can do?► Personal record keeping► Basic surgical audit► Out come assessment  Morbidity  Mortality  Patients satisfaction► Focused studies
  42. 42. Audit is the first step Not an end in itself
  43. 43. Surgical practice without audit is Like playing cricket without keeping the records of scores
  44. 44. Thank you