An Overview of Clinical Audit in Practice By: Dr Ali Mahdi * Dr Ghadaq Enad * Dr Rema Elshein

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Clinical
Audit
Dr Ali Mahdi
Dr Ghadaq Enad
Dr Rema Elshein

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Objectives
Definition and History01
Audit VS Research02
Types of Audits03
Case Study05
Audit Cycle04

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Definition

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Definition
A quality improvement process that seeks to
improve patient care and outcomes thorough
systematic review of care, against explicit criteria
and the implementation of change.

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Definition
That is to say the performance is being reviewed (audited) to
make sure that what should be done is being done.
And if not, it provides a framework for improvements to be made.
Clinical audit has been incorporated as an essential part of the
clinical governance in many countries worldwide. It was first done
in the UK by Stephen Bolsen In 1989.Royal Infirmary

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Clinical Governance

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WHY?
Clinical auditing has many advantages and benefits to the organization:
To improve patient care and service quality.
To master problem-solving/leadership.
To improve team working and communication/career progress.
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2
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A little bit of history
One of first ever clinical audits was undertaken
by Florence Nightingale during the Crimean War of
1853-1855.
She and her team of 38 nurses applied strict sanitary
routines and standards of hygiene to the hospital and
equipment.
Kept meticulous records of the mortality rates
among the hospital patients.
Following these changes the mortality rates fell
from 40% to 2%.

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A little bit of history
Stephen Bolsin is a British anesthetist at the Bristol
Royal Infirmary.
In 1989, Bolsin identified that too many babies were
dying during heart surgery.
He spent the next six years confirming the high mortality
rates and attempting to improve the service.
This led to a fall in mortality rates for children's heart
surgery in Bristol from 30% to less than 5%.

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Audit Versus Research

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Audit Versus Research

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Audit Versus Research
A question here, is clinical audit a research?

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Audit Versus Research
The difference is simply
Research asks:
Are we singing the right song?
Clinical Audit asks:
Are we singing this song right?

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Types of Audit

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Types of Audits
Personal

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Types of Audits
Local
Personal

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Types of Audits
National
Local
Personal

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The Audit Cycle

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The Audit Cycle
Problem or
Objective
Identified
Audit
Cyce

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The Audit Cycle
Problem or
Objective
Identified
Audit
Cyce

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The Audit Cycle
Problem or
Objective
Identified
Audit
Cyce

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The Audit Cycle
Problem or
Objective
Identified
Audit
Cyce
Compare
to
Standards

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The Audit Cycle
Problem or
Objective
Identified
Audit
Cyce
Compare
to
Standards

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The Audit Cycle
Problem or
Objective
Identified
Audit
Cyce
Compare
to
Standards

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The Audit Cycle
Problem or
Objective
Identified
Audit
Cyce
Closed
Audit
Open
Audit
Compare
to
Standards

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Objective Identified
The Audit Cycle.... Explained
- Agree topic
- Initiation or Continuation
- Contact audit team

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Objective Identified
Standards
- Source of Standards
- Appraising the standards
- Agree topic
- Initiation or Continuation
- Contact audit team
The Audit Cycle.... Explained

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Objective Identified
Standards
- Source of Standards
- Appraising the standards
Data Collection
- Agree topic
- Initiation or Continuation
- Contact audit team
- Planning data collection
- Methods of data collection
- Data handling
The Audit Cycle.... Explained

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Objective Identified
Standards
- Source of Standards
- Appraising the standards
Data Collection
Compare to standards
- Agree topic
- Initiation or Continuation
- Contact audit team
- Planning data collection
- Methods of data collection
- Data handling
- Devise a spreadsheet
- Careful analysis
- double and triple check
The Audit Cycle.... Explained

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Objective Identified
Standards
- Source of Standards
- Appraising the standards
Data Collection
Compare to standards
- Agree topic
- Initiation or Continuation
- Contact audit team
- Planning data collection
- Methods of data collection
- Data handling
- Devise a spreadsheet
- Careful analysis
- double and triple check
- Understand the results
- Understand any issue
- Build an achievable plan
- Sell your plan to team
Plan & Implement
Changes
The Audit Cycle.... Explained

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The great coffee audit (Case Study)

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The great coffee audit (Case Study)
Objective Identified
The doctors feel that their
coffee isn’t hot enough
after slogging through
morning surgery

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The great coffee audit (Case Study)
Objective Identified
The doctors feel that their
coffee isn’t hot enough
after slogging through
morning surgery
Standards
The coffee shall be served
at a temperature of 85
90°C on 80% of occasions
and there will be 90%
satisfaction level
expressed by the docs

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The great coffee audit (Case Study)
Objective Identified
The doctors feel that their
coffee isn’t hot enough
after slogging through
morning surgery
Standards
The coffee shall be served
at a temperature of 85
90°C on 80% of occasions
and there will be 90%
satisfaction level
expressed by the docs
Data Collection
The junior receptionist shall
check the temperature of the
coffee daily for two weeks and
circulate a questionnaire to the
partners asking them to score a
coffee satisfaction level between
1 and 10. The practice manager
shall visit Tesco’s and interview
the manager about the
availability, costs, quality and
sell-by dates of the coffee
brands available

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The great coffee audit (Case Study)
Objective Identified
The doctors feel that their
coffee isn’t hot enough
after slogging through
morning surgery
Compare to standards
it was found that the
coffee temperature fell
below 37°C on at least
33% of occasions and
reached the standard on
only 10% of occasions.
The doctors scored the
coffee at an average 3/10.
The practice manager
reported the results of her
Tesco’s visit.
Standards
The coffee shall be served
at a temperature of 85
90°C on 80% of occasions
and there will be 90%
satisfaction level
expressed by the docs
Data Collection
The junior receptionist shall
check the temperature of the
coffee daily for two weeks and
circulate a questionnaire to the
partners asking them to score a
coffee satisfaction level between
1 and 10. The practice manager
shall visit Tesco’s and interview
the manager about the
availability, costs, quality and
sell-by dates of the coffee
brands available

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The great coffee audit (Case Study)
Objective Identified
The doctors feel that their
coffee isn’t hot enough
after slogging through
morning surgery
Compare to standards
it was found that the
coffee temperature fell
below 37°C on at least
33% of occasions and
reached the standard on
only 10% of occasions.
The doctors scored the
coffee at an average 3/10.
The practice manager
reported the results of her
Tesco’s visit.
Standards
The coffee shall be served
at a temperature of 85
90°C on 80% of occasions
and there will be 90%
satisfaction level
expressed by the docs
Data Collection
The junior receptionist shall
check the temperature of the
coffee daily for two weeks and
circulate a questionnaire to the
partners asking them to score a
coffee satisfaction level between
1 and 10. The practice manager
shall visit Tesco’s and interview
the manager about the
availability, costs, quality and
sell-by dates of the coffee
brands available
Plan & Implement
Changes
It was agreed to replace
the aged coffee maker
( after agreeing suitable
redundancy terms for the
senior receptionist) with a
shiny new machine from
Argos. As an additional
‘quality initiative’, cream
cakes would be served
after surgery.

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Clinical Audit proposal Form
https://bit.ly/auditnhs

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Thank You