Javed Iqbal draws a comparison between cricket and surgery, noting that both are missing an important element of record keeping. For cricket, it is keeping score, while for surgery it is conducting audits. Without audits, surgical practice would be like playing cricket without keeping score. Audits are a systematic, critical review of clinical care that can help highlight opportunities for improvement. The main goals of audits are to evaluate current practices, identify areas for improvement, and implement changes to promote better patient outcomes and evidence-based healthcare.

1. Javed Iqbal
FCPS, FRCS
Professor of Surgery
Quaid-e-Azam Medical College,
Bahawalpur

6. ► CRICKET ► SURGERY
► Batting ► Basic knowledge
► Bowling ► Clinical methods
► Fielding ► Technical skill
► Preparation of pitch ► Communication skills
► Overall fitness ► Ward administration
► Research

7. There is one thing
missing in both

8. Scoring in cricket
And Audit in surgery

9. Audit in surgery
~
Keeping the record of the
scores in cricket

10. Surgical practice without
audit is
Like playing cricket without
keeping the records of scores

11. AUDIT
Review…Check…Inspection…Examination
Assessment…Inventory

12. The main responsibility
of a doctor
To provide health care

13. Knowledge Training
Experienc
e
Audit Outcome

14. History of Audit
► Personal experience
► Writings………Theodor Billroth in 1881
► Ward rounds
► Clinical meetings
► Morbidity and Mortality meetings
(INFORMAL AUDIT)

15. Informal audit is and use to
be an activity conducted by
some
Which are more
enthusiastic

16. Subjective
Objective

17. Definition
The systemic, critical analysis of the
quality of medical care, including the
procedures used for diagnosis, the use of
recourses and outcome of the quality of
life of the patient

18. 2
Systemic approach to the
review of clinical care to
highlight the opportunities
for improvement

19. Medical Audit Clinical Audit
Assessment of the Assessment of the total
medical care provided care
by the doctors

20. Informal audit is and use to
be an activity conducted by
some, which are more
enthusiastic

21. But now:
The audit is considered to be part of job
description of all involved in health care
clinicians Managers

22. Subjective
Objective

23. This is why, it is now part of
the curriculum of final
fellowship examination

24. 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

25. It is also a very powerful
teaching tool

26. From where to start?

27. Attitude and motivation

28. Areas to be audited
Structure
Procedures
Outcome

29. Structure
► The quantity and type of resources
Building, equipments, staff and organization
etc.
It is easy to measure but is not a very
good indicator of the quality of care

30. Procedure
► What is done to the patient
The 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

31. Out come
► It is the result of the clinical intervention and
represents the success or failure
Hospital stay, complications, Morbidity,
Mortality, return to normal activity and
patients satisfaction etc.
This is the best audit which has
potential to bring about change

32. Audit cycle
Choose topic
Set standards
Intervene to promote
Collect the data
the change
Feed back the results

33. 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?

34. METHODS
An outline

35. 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

36. 2 Incidence review
► Selection of a criteria or clinical scenario.
All incidences are reported and then their
frequency is matched with already available
standards

37. 3 Clinical record review
A 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

38. 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

39. 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.

40. 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”

41. 7 Global audit
► Comparison of the data across different
units, hospitals and regions.

42. 8
Out come studies

43. 9
National studies

44. 1. Basic Clinical Audit
2. Incidence review
3. Clinical record review
4. Criterion audit
5. Adverse occurrence screening
6. Focused audit study
7. Global audit
8. Out come studies
9. National studies

45. What minimum we can do?
► Personal record keeping
► Basic surgical audit
► Out come assessment
 Morbidity
 Mortality
 Patients satisfaction
► Focused studies

46. Audit is the first step
Not an end in itself

47. Surgical practice without
audit is
Like playing cricket without
keeping the records of scores

48. Thank you