This document discusses clinical audit, including:
1) The purpose of clinical audit is to improve patient care, promote professional education, and ensure efficient use of resources. It involves measuring current practice against explicit standards and implementing changes.
2) Clinical audit should have clearly defined boundaries and not be confused with research, resource management, or contract monitoring which have different aims.
3) Effective clinical audit requires support from leaders and staff to define topics, methods, resources, and ensure participation across disciplines. Barriers to implementation must be addressed.
4) Common audit methods include screening for adverse patient events, monitoring clinical indicators, and in-depth review of agreed topics using criteria to extract data from patient records. The goal is to
Clinical audit is a quality improvement process that systematically reviews and compares current clinical practice to standards of best practice in order to improve patient care and outcomes. It involves measuring actual practice against agreed standards, identifying any gaps, and implementing changes to close those gaps. The clinical audit cycle includes identifying a topic, setting standards, collecting data on current practice, comparing this to standards, implementing changes, and re-auditing to ensure improvements are sustained. Clinical audit aims to improve services for patients, support lifelong learning for healthcare professionals, and help meet national quality standards.
Florence Nightingale undertook the first clinical audit during the Crimean War by reviewing conditions in British hospitals and identifying issues like contaminated water and inadequate sanitation. She implemented changes that reduced the death rate of British soldiers from 40% to 2% within six months. Clinical audits now systematically compare current practices to standards to improve patient care and outcomes. They highlight both deficiencies and best practices, promote evidence-based changes, and reinforce quality improvement as a core part of healthcare systems and professional responsibilities. The audit cycle involves identifying issues, setting criteria and standards, collecting data, identifying areas for improvement, implementing changes, and re-auditing to continue enhancing care.
Clinical audit involves systematically analyzing medical care quality by measuring current practices against standards to identify areas for improvement. It aims to improve patient care delivery, unlike research which seeks to establish best practices. The audit cycle includes identifying an objective, setting criteria/standards, collecting data, identifying areas for improvement, implementing changes, and re-auditing. The five stages of clinical audit are preparing, selecting criteria, measuring performance, making improvements, and sustaining gains.
This document outlines the clinical audit process. It defines audit as reviewing, monitoring, and evaluating care against agreed standards to improve patient outcomes, use of resources, education, and staff reflection. Research aims to discover new information rather than evaluate existing care. The audit cycle involves identifying issues, setting criteria, measuring current practice, analyzing data against criteria, implementing changes, and re-auditing. Types of audits include structure, process, and outcome audits. Steps of the audit cycle are also demonstrated through an example audit on postoperative wound infections.
This document provides an overview of clinical audit, including:
- The definition and purpose of clinical audit as evaluating care against criteria to implement improvements.
- The history of audit beginning in ancient times and early examples from Florence Nightingale.
- The five stages of the audit cycle: preparing, setting criteria, measuring performance, making improvements, and sustaining changes.
- Key aspects like defining measurable criteria and standards, collecting and analyzing data, identifying barriers, and monitoring ongoing performance.
Clinical audit is presented as a tool to systematically review quality of care and ensure best practices are implemented to improve patient outcomes.
The document discusses creating effective clinical audits. It defines clinical audit as a quality improvement process that systematically reviews patient care against criteria to improve outcomes. The importance of clinical audits is described as helping to improve quality of care, reduce errors and costs, develop guidelines, and enhance education. Key differences between clinical audits and research are provided. The six stages of the clinical audit cycle are outlined as choosing a topic, setting standards, collecting data, analyzing performance against standards, implementing changes if needed, and re-evaluating to sustain improvements.
This document outlines the clinical audit process which involves systematically reviewing patient care against criteria to improve outcomes. It discusses selecting an audit topic focused on processes related to common conditions or procedures. Best practice standards are identified from guidelines and literature. The audit process involves forming a team, setting aims and standards, collecting and analyzing quantitative and qualitative data from a sample, implementing changes, and re-auditing to confirm improvements. Data collection involves designing a questionnaire and obtaining department approval and ethics approval.
Clinical audit is a quality improvement process that systematically reviews and compares current clinical practice to standards of best practice in order to improve patient care and outcomes. It involves measuring actual practice against agreed standards, identifying any gaps, and implementing changes to close those gaps. The clinical audit cycle includes identifying a topic, setting standards, collecting data on current practice, comparing this to standards, implementing changes, and re-auditing to ensure improvements are sustained. Clinical audit aims to improve services for patients, support lifelong learning for healthcare professionals, and help meet national quality standards.
Florence Nightingale undertook the first clinical audit during the Crimean War by reviewing conditions in British hospitals and identifying issues like contaminated water and inadequate sanitation. She implemented changes that reduced the death rate of British soldiers from 40% to 2% within six months. Clinical audits now systematically compare current practices to standards to improve patient care and outcomes. They highlight both deficiencies and best practices, promote evidence-based changes, and reinforce quality improvement as a core part of healthcare systems and professional responsibilities. The audit cycle involves identifying issues, setting criteria and standards, collecting data, identifying areas for improvement, implementing changes, and re-auditing to continue enhancing care.
Clinical audit involves systematically analyzing medical care quality by measuring current practices against standards to identify areas for improvement. It aims to improve patient care delivery, unlike research which seeks to establish best practices. The audit cycle includes identifying an objective, setting criteria/standards, collecting data, identifying areas for improvement, implementing changes, and re-auditing. The five stages of clinical audit are preparing, selecting criteria, measuring performance, making improvements, and sustaining gains.
This document outlines the clinical audit process. It defines audit as reviewing, monitoring, and evaluating care against agreed standards to improve patient outcomes, use of resources, education, and staff reflection. Research aims to discover new information rather than evaluate existing care. The audit cycle involves identifying issues, setting criteria, measuring current practice, analyzing data against criteria, implementing changes, and re-auditing. Types of audits include structure, process, and outcome audits. Steps of the audit cycle are also demonstrated through an example audit on postoperative wound infections.
This document provides an overview of clinical audit, including:
- The definition and purpose of clinical audit as evaluating care against criteria to implement improvements.
- The history of audit beginning in ancient times and early examples from Florence Nightingale.
- The five stages of the audit cycle: preparing, setting criteria, measuring performance, making improvements, and sustaining changes.
- Key aspects like defining measurable criteria and standards, collecting and analyzing data, identifying barriers, and monitoring ongoing performance.
Clinical audit is presented as a tool to systematically review quality of care and ensure best practices are implemented to improve patient outcomes.
The document discusses creating effective clinical audits. It defines clinical audit as a quality improvement process that systematically reviews patient care against criteria to improve outcomes. The importance of clinical audits is described as helping to improve quality of care, reduce errors and costs, develop guidelines, and enhance education. Key differences between clinical audits and research are provided. The six stages of the clinical audit cycle are outlined as choosing a topic, setting standards, collecting data, analyzing performance against standards, implementing changes if needed, and re-evaluating to sustain improvements.
This document outlines the clinical audit process which involves systematically reviewing patient care against criteria to improve outcomes. It discusses selecting an audit topic focused on processes related to common conditions or procedures. Best practice standards are identified from guidelines and literature. The audit process involves forming a team, setting aims and standards, collecting and analyzing quantitative and qualitative data from a sample, implementing changes, and re-auditing to confirm improvements. Data collection involves designing a questionnaire and obtaining department approval and ethics approval.
The document discusses quality improvement in hospitals. It notes that quality improvement (QI) requires sustained leadership, extensive training, robust measurement systems, and a culture receptive to change. It outlines six dimensions of healthcare quality: safety, effectiveness, appropriateness, access, patient satisfaction, and efficiency. Efficiency in healthcare involves deriving maximum benefit from available resources through technical and allocative efficiency. Common causes of medical errors include communication problems, inadequate information flow, human factors, and organizational issues. Many methods can be used to detect adverse events, both passive and active surveillance. Improvement starts with identifying an area for improvement through asking questions. Models for quality improvement include PDCA, Lean, Six Sigma, and change management. Measurement is key to
This document discusses the process of clinical auditing. It begins by defining clinical auditing as a quality improvement process that systematically reviews patient care against criteria to implement changes that improve outcomes. It then outlines the key stages of clinical auditing: choosing a topic by identifying an area for improvement; establishing criteria and standards; collecting and analyzing data; identifying if standards were met and reasons for any gaps; developing an action plan; and re-auditing to assess if improvements were achieved. The goals of clinical auditing are to ensure best practices are followed, reduce risks, and improve patient care.
The document outlines the key components and structure that should be followed when writing a clinical audit report. It provides examples of templates that divide the report into sections including: introduction, methods, results, discussion, conclusions, recommendations, and quality improvement plan. The report aims to be clear, concise, and follow a logical progression by using plain English and structured formatting like IMRAD. Visual aids like tables and graphs should be used where possible to clearly present results.
This document discusses clinical audits, including definitions, history, types of audits, and the audit cycle. It defines a clinical audit as a quality improvement process that systematically reviews care against criteria to implement changes. The first known clinical audit was conducted by Florence Nightingale during the Crimean War. Key points made include that audits seek to improve patient care and outcomes, while research examines whether the right processes are being followed. The document also provides a case study example of "The Great Coffee Audit" to illustrate how an audit was conducted to address doctors' dissatisfaction with the temperature of their coffee.
This document discusses medical audits and provides information on various types of audits including internal and external audits, managerial/organizational audits, medical/clinical audits, and financial audits. It explains the need for audits to maintain safety, quality, reputation and funding. The document outlines the six stages of clinical audits including preparing, selecting criteria, measuring performance, making improvements, sustaining improvements, and re-auditing. Methods used in audits like direct observation, checklists, documentation reviews, questionnaires and interviews are also mentioned.
This document provides an outline and overview of clinical pathways. It begins with the history and origins of clinical pathways in the 1980s. It then defines clinical pathways as multidisciplinary tools to standardize and optimize care for specific patients based on evidence. The document discusses why pathways are used, including to improve quality of care, maximize efficiency, reduce variability, and support clinical effectiveness. It also covers potential issues, benefits, components of pathways, and how pathways are developed through a multidisciplinary process.
Clinical Audit is a method of confirming the quality of clinical services and identify the need for improvement. A skill hospital administrator should learn and practice.
Clinical Audits and Process Improvement in HospitalsLallu Joseph
How to conduct a clinical audit, differences between research and clinical audit, medical audit, History of audit, benefits of audit, standard, criteria, benchmarks, compare performance, examples of clinical audit, audit cycle, types of audit, NABH, JCI, QAPI, PDCA, Hospital accreditation,
Implementation of quality improvement program in hospitalsLallu Joseph
A quality improvement program in hospitals aims to continuously monitor and improve quality through systematic activities organized by the hospital. The document outlines the steps to implement a quality improvement program which includes selecting a quality improvement project, assembling a team, developing aim and measure statements, identifying change ideas by analyzing current processes, testing changes, and sustaining improvements. The goal is to improve patient outcomes, clinical and managerial processes, and safety through engaging staff and using a systematic approach of planning, testing, and measuring changes.
Medical audit is a systematic evaluation of medical care to improve patient outcomes. It involves reviewing medical records against criteria to identify areas for improvement. The key aspects that can be audited include structure, processes, and outcomes of care. Medical audit aims to ensure best possible care, evidence-based practice, and implementation of initiatives. It benefits patients through reduced suffering and ensures safety. Hospitals should establish medical audit committees and collect data to facilitate the audit process. Audits help practitioners identify weaknesses and make corrections to enhance quality of care.
The document discusses clinical audit, which involves systematically analyzing healthcare quality, procedures, resource use, and patient outcomes and life quality. It describes the clinical audit cycle of defining standards, collecting data on performance, comparing performance to standards, implementing changes if needed, and monitoring additional data. The goals of clinical audits are to improve healthcare quality, efficiency, standards, and patient outcomes and satisfaction. Common methods used in clinical audits include reviewing medical records, incidents of adverse patient reactions, diagnostic investigations, and therapeutic practices. Challenges of auditing primary care include difficulties setting standards, measuring outcomes, accounting for patient views, and causing anxiety for some doctors.
Joint Commission International provides accreditation services to improve safety and quality of care internationally. It has accredited over 236 organizations in 35 countries. Accreditation involves evaluating organizations against established standards to ensure structures and processes are in place to deliver good patient outcomes and continuous quality improvement. Evidence shows accreditation reduces risks to patients and sets principles that are now standard in healthcare worldwide.
This document discusses the FOCUS-PDCA methodology for continuous process improvement. It describes the FOCUS steps as finding a process for improvement, organizing a team, clarifying the current process, understanding causes of variation, and selecting potential improvements. The PDCA cycle is then described as planning an improvement, doing it, checking the results, and acting to hold gains or continue improving. Cause-and-effect diagrams are introduced as a tool to determine major categories of influences on a process. The document provides detailed questions to consider for each step of the FOCUS methodology and each phase of the PDCA cycle to systematically improve processes.
The document provides a comparison of quality indicators between the 4th and 3rd editions of the NABH standards. It summarizes the key changes made to various quality indicators for monitoring access to care, care of patients, medication management, infection control, CQI processes, and other areas. For most indicators, the definitions and formulas for calculation remain the same between the editions, while some new indicators were added and the frequency of data collection was standardized in the 4th edition.
This document provides an overview of NABH (National Accreditation Board for Hospitals & Healthcare Providers) implementation. It discusses that NABH implementation is simple and does not require medical expertise. The document outlines the 10 NABH chapters covering patient care and organizational standards. It summarizes the objectives and scope of each chapter, including Access, Assessment, and Continuity of Care; Care of Patients; Management of Medication; Patient Rights and Education; Hospital Infection Control; and others. Implementation involves preparing manuals, conducting self-assessments, addressing non-conformities, and undergoing certification and surveillance visits.
An introductory overview of the basic concepts of Healthcare Quality, a starter for beginners.
Prepared in 2014 for the new staff of the Quality Management Department in King Saud University Medical City in Riyadh as a part of their capacity building plan.
Acknowledgments:
*Dr. Magdy Gamal Yousef, MBBCh, MS, CPHQ - for his contribution in the scientific content
**Ms. Maram Baksh, MS, CPHQ - for the design of the full HCQ capacity building plan in KSUMC
We all understand why improvement and a focus on excellence are important, so what we need is a method to use to help with our improvement efforts.FOCUS-PDCA is an improvement methodology that many organizations use to guide their improvement efforts. It’s simply a formalized process for improvement.
This document provides an overview of clinical audits in the NHS community pharmacy setting. It defines a clinical audit as a quality improvement process that systematically reviews care against criteria to implement changes that improve outcomes. The key aspects of an audit are described as the audit cycle of defining standards, assessing practice, comparing to standards, and reassessing with changes. Examples of audit topics are provided and the process explains steps of choosing a topic, collecting data, assessing performance, analyzing findings, and sharing results. Future directions for audits and resources are also mentioned.
This document discusses food and waterborne illnesses and how to prevent contamination. It provides examples of major foodborne illness outbreaks and lists many types of waterborne illnesses and their causes. It emphasizes the importance of handwashing, cooking food thoroughly, separating raw and cooked foods, and chilling and reheating foods properly to avoid foodborne illness when at home, work or deployed.
The document discusses quality improvement in hospitals. It notes that quality improvement (QI) requires sustained leadership, extensive training, robust measurement systems, and a culture receptive to change. It outlines six dimensions of healthcare quality: safety, effectiveness, appropriateness, access, patient satisfaction, and efficiency. Efficiency in healthcare involves deriving maximum benefit from available resources through technical and allocative efficiency. Common causes of medical errors include communication problems, inadequate information flow, human factors, and organizational issues. Many methods can be used to detect adverse events, both passive and active surveillance. Improvement starts with identifying an area for improvement through asking questions. Models for quality improvement include PDCA, Lean, Six Sigma, and change management. Measurement is key to
This document discusses the process of clinical auditing. It begins by defining clinical auditing as a quality improvement process that systematically reviews patient care against criteria to implement changes that improve outcomes. It then outlines the key stages of clinical auditing: choosing a topic by identifying an area for improvement; establishing criteria and standards; collecting and analyzing data; identifying if standards were met and reasons for any gaps; developing an action plan; and re-auditing to assess if improvements were achieved. The goals of clinical auditing are to ensure best practices are followed, reduce risks, and improve patient care.
The document outlines the key components and structure that should be followed when writing a clinical audit report. It provides examples of templates that divide the report into sections including: introduction, methods, results, discussion, conclusions, recommendations, and quality improvement plan. The report aims to be clear, concise, and follow a logical progression by using plain English and structured formatting like IMRAD. Visual aids like tables and graphs should be used where possible to clearly present results.
This document discusses clinical audits, including definitions, history, types of audits, and the audit cycle. It defines a clinical audit as a quality improvement process that systematically reviews care against criteria to implement changes. The first known clinical audit was conducted by Florence Nightingale during the Crimean War. Key points made include that audits seek to improve patient care and outcomes, while research examines whether the right processes are being followed. The document also provides a case study example of "The Great Coffee Audit" to illustrate how an audit was conducted to address doctors' dissatisfaction with the temperature of their coffee.
This document discusses medical audits and provides information on various types of audits including internal and external audits, managerial/organizational audits, medical/clinical audits, and financial audits. It explains the need for audits to maintain safety, quality, reputation and funding. The document outlines the six stages of clinical audits including preparing, selecting criteria, measuring performance, making improvements, sustaining improvements, and re-auditing. Methods used in audits like direct observation, checklists, documentation reviews, questionnaires and interviews are also mentioned.
This document provides an outline and overview of clinical pathways. It begins with the history and origins of clinical pathways in the 1980s. It then defines clinical pathways as multidisciplinary tools to standardize and optimize care for specific patients based on evidence. The document discusses why pathways are used, including to improve quality of care, maximize efficiency, reduce variability, and support clinical effectiveness. It also covers potential issues, benefits, components of pathways, and how pathways are developed through a multidisciplinary process.
Clinical Audit is a method of confirming the quality of clinical services and identify the need for improvement. A skill hospital administrator should learn and practice.
Clinical Audits and Process Improvement in HospitalsLallu Joseph
How to conduct a clinical audit, differences between research and clinical audit, medical audit, History of audit, benefits of audit, standard, criteria, benchmarks, compare performance, examples of clinical audit, audit cycle, types of audit, NABH, JCI, QAPI, PDCA, Hospital accreditation,
Implementation of quality improvement program in hospitalsLallu Joseph
A quality improvement program in hospitals aims to continuously monitor and improve quality through systematic activities organized by the hospital. The document outlines the steps to implement a quality improvement program which includes selecting a quality improvement project, assembling a team, developing aim and measure statements, identifying change ideas by analyzing current processes, testing changes, and sustaining improvements. The goal is to improve patient outcomes, clinical and managerial processes, and safety through engaging staff and using a systematic approach of planning, testing, and measuring changes.
Medical audit is a systematic evaluation of medical care to improve patient outcomes. It involves reviewing medical records against criteria to identify areas for improvement. The key aspects that can be audited include structure, processes, and outcomes of care. Medical audit aims to ensure best possible care, evidence-based practice, and implementation of initiatives. It benefits patients through reduced suffering and ensures safety. Hospitals should establish medical audit committees and collect data to facilitate the audit process. Audits help practitioners identify weaknesses and make corrections to enhance quality of care.
The document discusses clinical audit, which involves systematically analyzing healthcare quality, procedures, resource use, and patient outcomes and life quality. It describes the clinical audit cycle of defining standards, collecting data on performance, comparing performance to standards, implementing changes if needed, and monitoring additional data. The goals of clinical audits are to improve healthcare quality, efficiency, standards, and patient outcomes and satisfaction. Common methods used in clinical audits include reviewing medical records, incidents of adverse patient reactions, diagnostic investigations, and therapeutic practices. Challenges of auditing primary care include difficulties setting standards, measuring outcomes, accounting for patient views, and causing anxiety for some doctors.
Joint Commission International provides accreditation services to improve safety and quality of care internationally. It has accredited over 236 organizations in 35 countries. Accreditation involves evaluating organizations against established standards to ensure structures and processes are in place to deliver good patient outcomes and continuous quality improvement. Evidence shows accreditation reduces risks to patients and sets principles that are now standard in healthcare worldwide.
This document discusses the FOCUS-PDCA methodology for continuous process improvement. It describes the FOCUS steps as finding a process for improvement, organizing a team, clarifying the current process, understanding causes of variation, and selecting potential improvements. The PDCA cycle is then described as planning an improvement, doing it, checking the results, and acting to hold gains or continue improving. Cause-and-effect diagrams are introduced as a tool to determine major categories of influences on a process. The document provides detailed questions to consider for each step of the FOCUS methodology and each phase of the PDCA cycle to systematically improve processes.
The document provides a comparison of quality indicators between the 4th and 3rd editions of the NABH standards. It summarizes the key changes made to various quality indicators for monitoring access to care, care of patients, medication management, infection control, CQI processes, and other areas. For most indicators, the definitions and formulas for calculation remain the same between the editions, while some new indicators were added and the frequency of data collection was standardized in the 4th edition.
This document provides an overview of NABH (National Accreditation Board for Hospitals & Healthcare Providers) implementation. It discusses that NABH implementation is simple and does not require medical expertise. The document outlines the 10 NABH chapters covering patient care and organizational standards. It summarizes the objectives and scope of each chapter, including Access, Assessment, and Continuity of Care; Care of Patients; Management of Medication; Patient Rights and Education; Hospital Infection Control; and others. Implementation involves preparing manuals, conducting self-assessments, addressing non-conformities, and undergoing certification and surveillance visits.
An introductory overview of the basic concepts of Healthcare Quality, a starter for beginners.
Prepared in 2014 for the new staff of the Quality Management Department in King Saud University Medical City in Riyadh as a part of their capacity building plan.
Acknowledgments:
*Dr. Magdy Gamal Yousef, MBBCh, MS, CPHQ - for his contribution in the scientific content
**Ms. Maram Baksh, MS, CPHQ - for the design of the full HCQ capacity building plan in KSUMC
We all understand why improvement and a focus on excellence are important, so what we need is a method to use to help with our improvement efforts.FOCUS-PDCA is an improvement methodology that many organizations use to guide their improvement efforts. It’s simply a formalized process for improvement.
This document provides an overview of clinical audits in the NHS community pharmacy setting. It defines a clinical audit as a quality improvement process that systematically reviews care against criteria to implement changes that improve outcomes. The key aspects of an audit are described as the audit cycle of defining standards, assessing practice, comparing to standards, and reassessing with changes. Examples of audit topics are provided and the process explains steps of choosing a topic, collecting data, assessing performance, analyzing findings, and sharing results. Future directions for audits and resources are also mentioned.
This document discusses food and waterborne illnesses and how to prevent contamination. It provides examples of major foodborne illness outbreaks and lists many types of waterborne illnesses and their causes. It emphasizes the importance of handwashing, cooking food thoroughly, separating raw and cooked foods, and chilling and reheating foods properly to avoid foodborne illness when at home, work or deployed.
The document provides guidelines for psychological assessment reports for Veterans Affairs Canada clients. It outlines that reports should include only relevant information and indicate sources. Personal information is protected by privacy laws and clients have rights to access and challenge their information. The report format includes sections on informed consent, reason for referral, assessment methods, background, symptoms, diagnosis, risk assessment, recommendations, and prognosis. It aims to provide thorough and comprehensive evaluations to help clients.
This module is for use by community educators. Its appropriate for teaching groups of consumers or those that cook for others such as religous institutions. The guidelines within are for consumers, not for commercial food servce.
This module is intended for community educators to teach their clients about cross-contamination. It is appropriate for general consumers and anyone that cooks for groups including religous institutions. It is not meant for commercial food service.
Food borne diseases are illnesses caused by consuming contaminated food or drink and affect the gastrointestinal tract. They can be communicable through direct or indirect contact, parasites, or airborne means. Common food borne diseases include infectious diseases like typhoid or hepatitis transmitted via microorganisms in food. Food poisoning occurs when toxins or bacteria in food make someone ill. Proper food handling and hygiene can help control food borne illnesses.
Foodborne diseases are caused by consuming contaminated food or drink. Over 250 foodborne diseases have been described, mostly caused by bacteria, viruses and parasites. The most common foodborne diseases are caused by Campylobacter, Salmonella, E. coli O157:H7, and noroviruses. Raw foods of animal origin pose the highest risk of contamination. Proper cooking and cleaning can help prevent foodborne illnesses. Thorough investigation is needed to identify the contaminated source during outbreaks to prevent future illnesses.
Jane, age 9 years 7 months, was referred for a psychological evaluation by her mother who was concerned about Jane's reading fluency and comprehension difficulties. Jane appeared comfortable during assessments but struggled with reading aloud and decoding words. Test results and teacher reports indicated issues with reading. Jane's medical and family history were unremarkable, though she reported being bullied at school which upset her. The psychological evaluation was conducted to better understand Jane's challenges and provide recommendations to support her reading development.
Food-borne diseases, rather than food poisoning or ptomaine poisoning, is a more accurate term to describe illness caused by consuming contaminated food. Food-borne diseases can be caused by living organisms like bacteria, parasites, and viruses entering the body through food (food-borne infections) or toxic substances in food like bacterial toxins (food poisoning/intoxication). Common types of food-borne diseases include those caused by Salmonella, Shigella, Staphylococcus, Clostridium botulinum, and various parasites. Thorough cooking and proper food handling/storage can help prevent the spread of food-borne illnesses.
ACS adult safeguarding case study convertedJosie Winter
1) An independent clinical company was hired to investigate a large number of safeguarding concerns raised about a private healthcare provider relating to nursing care issues.
2) They conducted root cause analyses of each case and found recurring issues with training, documentation, communication, leadership and clinical effectiveness.
3) To address these issues, they provided development sessions for nurses, reassessed competencies, updated policies and procedures, and implemented mandatory refresh training covering key clinical topics for all staff.
This document discusses medical audits, including definitions, components, stages, and types of audits. It provides information on the audit cycle and the roles and functions of an audit committee. Some key points include:
- Medical audits systematically analyze quality of care, procedures, resource use, and patient outcomes and quality of life.
- Audits can help provide reassurance that best quality services are being provided given available resources.
- The audit cycle involves setting standards, comparing practice to standards, implementing changes if needed, and closing the audit loop.
- An audit committee coordinates audits, ensures changes are made, and maintains confidentiality.
The document provides an overview of the Joint Commission International (JCI) accreditation process for hospitals. It describes what accreditation is, the benefits of accreditation, and the accreditation timeline. The standards are organized around important hospital functions and apply to the entire organization as well as individual departments. There are sections that address requirements for maintaining accreditation, patient-centered functions, organizational functions that support patient care, and how standards, intents and measurable elements are used in the accreditation and survey process.
The document provides an overview of the Joint Commission International (JCI) accreditation process for hospitals. It describes what accreditation is, its benefits, and timeline. The standards are organized around important hospital functions and patient care. During an on-site survey, surveyors use various methods like document review, interviews, patient tracers, and facility tours to evaluate hospitals' compliance with JCI standards. Scoring guidelines are provided to assess standards as fully met, partially met, not met, or not applicable.
This document discusses clinical audits in anaesthesia. It defines clinical audits as quality improvement processes that systematically review care against criteria to improve outcomes. The document outlines the history of audits dating back to Florence Nightingale. It describes different types of audits including clinical, critical event, outcome, training, and survey audits. The audit cycle is also explained as preparing criteria, measuring performance, implementing improvements, and sustaining changes. Barriers to audits are a lack of resources, expertise, and leadership. Audits aim to improve standards but challenges include support, time constraints, and obtaining consent.
Quality circles originated in Japan after World War II and were inspired by W. Edwards Deming. Quality circles involve voluntary small groups of 6-12 employees who meet regularly to identify improvements in their work area. In healthcare, quality circles are used to (1) identify outstanding features of care, (2) identify obstacles to change, and (3) identify the need for more research. Examples of using quality circles in healthcare include reducing hospital-acquired infections, improving job satisfaction, and enhancing communication.
Quality assurance is a system to monitor outcomes of nursing care and activities to ensure they meet established standards. It involves setting standards, assessing actual performance, planning improvements, and taking corrective actions. Quality assurance is important to improve patient care quality, decrease costs, and meet professional, legal and social responsibilities. It requires establishing criteria and evaluating care structures, processes and outcomes. Nurses play a key role by developing quality assurance programs, implementing standards, monitoring performance, and evaluating changes to continually improve nursing services.
The document discusses the importance of evaluating mental health professionals through regular professional evaluations. These evaluations help identify areas for improvement, discuss difficult practices, and establish support to prevent burnout. Clinical supervisors are responsible for assessing supervisees to identify issues that need attention in order to further develop their quality of care.
This document discusses quality improvement and patient safety in anesthesia. It defines key terms like quality improvement, continuous quality improvement and differentiates it from traditional quality assurance. It outlines frameworks for improvement like the Model for Improvement and discusses tools used for quality improvement like Lean methodology, Six Sigma and PDSA cycles. It discusses important measures for quality improvement like process, outcome and balancing measures. Methods for analyzing and displaying quality improvement data like control charts and dashboards are described. Sources of quality improvement information and the importance of incident reporting are also summarized.
Clinical pathways are multidisciplinary plans that embed evidence-based best practices into patient care to improve outcomes and efficiency. They originated from process mapping in engineering and were later adapted for healthcare. Clinical pathways standardize care for common conditions while allowing flexibility for individual patients. When combined with clinical practice guidelines, pathways can reinforce evidence-based practices and support clinical decision making. However, pathways must be carefully implemented and evaluated to ensure they do not discourage personalized care or reduce quality.
This document outlines the process of clinical audit, which involves comparing aspects of patient care against explicit criteria to improve outcomes. It discusses establishing structure, measuring processes, and evaluating outcomes. The document also describes the audit cycle of preparing, selecting criteria, measuring performance, making improvements, and sustaining them over time. Clinical audit is presented as a way for healthcare professionals and organizations to critically examine practices and ensure patients receive optimal care.
CLINICAL PATHWAY and CLINICAL PRACTICE GUIDELINESMary Ann Adiong
This document discusses clinical pathways and clinical practice guidelines. It defines clinical pathways as multidisciplinary plans of best clinical practices for specific patient groups. Clinical pathways help improve quality of care, reduce variation, and enhance communication. The document outlines the components and development process of clinical pathways, including establishing multidisciplinary teams, collecting data, and monitoring variances. It also discusses how clinical practice guidelines are evidence-based statements that optimize patient care through systematic reviews and benefit-harm assessments.
This document discusses quality control in healthcare. It defines quality healthcare and how it is measured using indicators of structure, process, and outcomes. Evidence shows the need to improve quality through reducing errors and inappropriate care. Quality can be achieved by either building or inspecting it, using quality assurance or quality improvement approaches. Factors influencing quality include provider skills, system structure, resources, and education. Tools to improve quality include education, guidelines, and peer review. A comprehensive strategy is needed using incentives, data monitoring, patient empowerment, standards, and information systems to support continuous quality development.
This document discusses the development of therapeutic guidelines. It defines therapeutic guidelines as clinical practice guidelines written for prescribers to provide treatment recommendations based on current evidence. The document outlines the need for guidelines to improve patient care quality and consistency while controlling healthcare costs. It describes the composition of guideline development groups and the multi-step process involved, including identifying the problem and literature, obtaining expert opinions, reviewing evidence, and disseminating the completed guidelines. Potential limitations of guidelines like complexity and physician acceptance are also discussed.
Quality assurance and accredition, nursing standardsMahmoud Shaqria
The document discusses several key concepts related to quality assurance in nursing, including definitions of quality assurance, accreditation, nursing standards, nursing audit, and total quality management. It outlines the objectives, components, principles, and processes involved in quality assurance programs. Factors affecting quality assurance are also examined. Accreditation is defined and its purpose and preparation strategies are outlined. The definition, purpose, types, and use of nursing standards and nursing audits are provided. Total quality management is defined and its components, principles, and emphasis on continuous improvement are described.
Standards and audit for quality assurancerohini154
Standards and nursing audit are important tools for quality management in nursing. Standards provide agreed upon levels of excellence and measurable performance. Nursing audit involves systematically evaluating nursing care against standards by analyzing nursing records. This helps identify strengths and weaknesses to improve care quality. Standards and audits satisfy the public trust that nursing continuously seeks better health outcomes. Audits are done retrospectively by reviewing records or concurrently by observing care. They require criteria, data collection, analysis, and using results to modify care and education as needed. Standards and audits thus help ensure nursing provides the highest quality care possible.
This document provides instructions for students to submit their semester and specialization to receive fully solved assignments on the topic of Quality Management in Health Care. It includes 5 questions related to medical audits, hospital accreditation, quality assurance programs, quality components in healthcare, and developing a service strategy. Students are asked to answer any 5 questions, with each question worth 10 marks.
HS410 Unit 6 Quality Management - DiscussionDiscussionThi.docxAlysonDuongtw
HS410 Unit 6: Quality Management - Discussion
Discussion
This is a graded Discussion
. Please refer to the Discussion Board Grading Rubric in Course Home / Grading Rubrics.
Respond to all of the following questions and be sure to respond to two of your other classmates’ postings:
1.
What are the steps in the quality improvement model and how is benchmarking involved?
2. What are the stages in which data quality errors found in a health record most commonly occur?
3. What is the definition of risk management?
4. What are the parts of an effective risk management program?
5. What is utilization review and why is it important in healthcare?
6. What is the process of utilization review?
Please paper should be 400-500 words and in an essay format, strictly on topic, original with real scholar references to support your answers.
NO PHARGIARISM PLEASE!
This is the Chapter reading for this assignment:
Read Chapter 7 in
Today’s Health Information Management
.
INTRODUCTION
Quality health care “means doing the right thing at the right time, in the right way, for the right person, and getting the best possible results.”1 The term quality, by definition, can mean excellence, status, or grade; thus, it can be measured and quantified. The patient, and perhaps the patient's family, may interpret quality health care differently from the way that health care providers interpret it. Therefore, it is important to determine—if possible—what is “right” and what is “wrong” with regard to quality health care. The study and analysis of health care are important to maintain a level of quality that is satisfactory to all parties involved. As a result of the current focus on patient safety, and in an attempt to reduce deaths and complications, providing the best quality health care while maintaining cost controls has become a challenge to all involved. Current quality initiatives are multifaceted and include government-directed, private sectorsupported, and consumer-driven projects.
This chapter explores the historical development of health care quality including a review of the important pioneers and the tools they developed. Their work has been studied, refined, and widely used in a variety of applications related to performance-improvement activities. Risk management is discussed, with emphasis on the importance of coordination with quality activities. The evolution of utilization management is also reviewed, with a focus on its relationship to quality management.
In addition, this chapter explores current trends in data collection and storage, and their application to improvements in quality care and patient safety. Current events are identified that influence and provide direction to legislative support and funding. This chapter also provides multiple tips and tools for both personal and institutional use.
DATA QUALITY
Data quality refers to the high grade, superiority, or excellence of data. Data quality is intertwined with the concept of.
New microsoft office power point presentationEmani Aparna
Therapeutic guidelines are clinical practice guidelines that focus on treatment recommendations. They are developed by healthcare providers through a systematic process involving a literature review, obtaining expert opinions, developing recommendations, and assessing quality of evidence. Therapeutic guidelines provide standardized treatment protocols to improve patient outcomes and reduce healthcare costs. They are published in medical databases, websites of organizations like the American Heart Association, and government sources.
This document summarizes an initiative by Duke Medicine's Private Diagnostic Clinic to improve patient access and appointment availability across several departments. It discusses:
1. FTI Consulting partnering with Duke to develop new governance structures and use analytics to increase appointments.
2. Two key elements of the project - a new appointment management framework and an "Access Algorithm" tool to measure and score access.
3. Recommendations to consolidate resources into a new "Access Practices Team" to oversee scheduling and hold departments accountable to access standards.
4. The "Access Algorithm" used 12 metrics like lag times, no-show rates, and utilization to score and compare access across specialties and identify areas for
The document discusses the benefits of exercise for both physical and mental health. It notes that regular exercise can reduce the risk of diseases like heart disease and diabetes, improve mood, and reduce feelings of stress and anxiety. Staying active also helps maintain a healthy weight and keeps muscles, bones and joints healthy as we age.
The document discusses several key trends in the future of healthcare, including:
1) Healthcare is shifting from a focus on illness and disease to a focus on overall health and wellness, with an emphasis on prevention, proactive intervention, and sustaining well-being.
2) Technology and data will transform healthcare delivery, with more services shifting to the home and community through telemedicine. Hospitals will focus less on acute care.
3) The healthcare system must become more sustainable, personalized, and consumer-driven to address rising costs and focus on outcomes that matter to patients. Quality, safety, and access will need significant improvement.
This document discusses fundamentals of management. It outlines that management involves four key functions: planning, organizing, leading, and controlling. Planning involves setting goals and strategies to achieve them. Organizing establishes the organizational structure and roles. Leading motivates employees. Controlling monitors progress and ensures goals are met. Effective management requires technical, human, and conceptual skills as well as the motivation to lead others. Common manager mistakes include being insensitive, not delegating adequately, and inability to think strategically. The document emphasizes that competitive advantage lies in having committed employees.
MEDICAL EDUCATION: TEACHING & LEARNING METHODSS A Tabish
The document discusses various teaching methods used in medical education, including lectures, small group learning, problem/case-based learning, e-learning/computer-assisted instruction, self-instruction modules, and experiential learning through site visits and rotations. For each method, the document outlines strengths, weaknesses, and applications. It provides examples of how different methods can be used to effectively teach public health concepts and principles.
Healthcare Technology & Medical InnovationsS A Tabish
The document discusses how technology has changed and impacted healthcare. It covers several key areas:
1) Technology has transformed how clinicians perform their jobs and expanded options for medical treatments through improvements in networking and computers.
2) As demands on healthcare organizations increase, technology solutions are helping to improve performance, increase collaboration, manage costs, streamline processes, automate tasks and improve workflows.
3) Technologies like AI, blockchain, cloud computing, telehealth, and interoperability solutions are further helping to improve patient care, experiences and outcomes while reducing costs.
The document discusses future trends in healthcare, including:
1) Healthcare is shifting from treatment of illness to prevention and promotion of wellness. Data and technology will help identify health issues earlier and manage well-being.
2) Digital health, growing consumerism, and rising costs are driving transformation of healthcare systems to become more personalized, transparent, and focused on value over volume.
3) Future healthcare will increasingly occur outside of hospitals, with more care delivered at home through telemedicine and personalized chronic disease management programs.
The document discusses electronic medical records (EMRs), defining them as digital versions of patients' paper medical charts that contain their medical history, diagnoses, treatments, test results, and other clinical data. EMRs allow authorized medical providers to securely access a patient's comprehensive medical record electronically. The document also outlines the key components, functions, and benefits of EMR systems, such as automating workflows, integrating with other healthcare IT systems, and facilitating data sharing across providers to support comprehensive patient care.
This document provides an overview of emergency medicine as a clinical specialty and medical education topic. It discusses the goals of health systems to provide quality care for all, with emergency care and primary health care as key components. Emergency medicine is described as being at the interface between community and hospital care. The document outlines the scope of emergency medicine, including its multidisciplinary nature and focus on undifferentiated patient problems. Specific skills taught include resuscitation, procedures, toxicology, trauma management and approaches to common complaints. The roles of the emergency department and clerkships in medical education are also summarized.
1. Leadership involves creating positive change through vision and strategy while empowering others and making adaptive decisions. A leader takes initiative to accomplish the company's vision and inspires others to follow.
2. Management involves controlling organizations and groups to achieve objectives by planning, organizing, and ensuring day-to-day operations are performed as expected. A manager executes tasks regularly with subordinates.
3. While managers focus on goals and processes, leaders are concerned with guiding change through vision and influencing people. Leaders align people behind a vision, whereas managers assign work to achieve goals. Both roles are important for business success.
The document discusses disaster management and provides definitions and classifications of different types of disasters including natural disasters like earthquakes, floods, hurricanes, and tsunamis as well as man-made disasters like technological accidents and conflicts. It outlines the goals of emergency preparedness to reduce loss of life, damage, and impact during disasters and describes disaster planning, mitigation, and management processes. Key aspects like activating disaster plans, establishing response teams, and national policy-making are summarized.
This document discusses quality assurance in medical education. It defines quality assurance as the policies, standards, systems and processes used to maintain and improve the quality of medical education. It states quality assurance includes evaluating the curriculum, teaching methods, assessment methods, and involves institutional monitoring through course evaluations, peer evaluations and assessments. The goal of quality assurance is to produce medical graduates that are competent and able to perform their jobs safely and effectively according to predetermined quality standards.
This document discusses health-related quality of life (HRQoL), which refers to how a person perceives their physical and mental health over time and how illnesses affect daily functioning. It provides reasons for measuring HRQoL, including making patients feel better and improving functionality. HRQoL is measured using questionnaires that assess physical, psychological, and social domains. Choosing the appropriate HRQoL measure depends on the study purpose, with generic measures used for population surveys and disease-specific measures used in clinical trials. Valid and reliable HRQoL instruments are important for evaluating the effects of interventions and conditions on patients' lives.
This document discusses medical equipment planning and management. It emphasizes the importance of having complete and up-to-date medical equipment inventories, assessing equipment needs based on factors like clinical effectiveness and cost, and developing a planning cycle that includes acquisition and disposition of equipment. Effective equipment management can improve patient outcomes, contain costs, and ensure equipment is functioning properly. It requires considering the full lifecycle and risks associated with medical equipment.
1. HOSPITALS TODAY JK-PRACTITIONER
CLINICAL AUDIT
Sved Amin Tabish MD. FAMS. FlMSA. FRIPH
For a variety of reasons -professional, public and
political-most countries now seek to establish visible systems
for managing quality in health care. The motives, the settings
and the details may vary, but the general challenges facing
the enthusiasts are remarkably common.
‘Audit’ should include measurement of current practice,
and definition of explicit standards and implementing
changes which benefit patients; ‘clinical’ should imply
patient-centred and involving more than one clinical
profession (the experience of the patient is the unifying
factor).
Purpose
Decide why you want audit. Is it primarily for public
accountability, for management control, for contract
monitoring, or for professional self-development? Many
clinicians accept audit as an educational activity, led by the
profession but reported in general terms to managers. The
putpose of unidisciplinary audit has been stated as:
+ To improve the quality of patient care
+ To &rther professional education and training
+ To promote the effective use of resources.
Multidisciplinary audit concerns not only the clincial
practice within individual professions but also demonstrates
the contributions made by each and the organizational links
between them. Audit in many units thus reflects the clinical
directorate and health care team structure and includes a
further objective, ‘to define and monitor standards for the
provision and organisation of clincial services.’ Moving to
multidisciplinary clincial audit thus also implies a greater
involvement of managers, both providers and pruchasers.
Limitations
Fix the boundaries of audit. It relates to but is not the
same as several other activities which have different aims,
accountability or funding. In particular, audit should not be
confused with the following:
Research
This aims to identify general truths about health, disease
and the technology for intervention (what is the best
practice?); audit is about ensuring compliance with best
JK-Practitioner 2001; 8(4): 270 - 275
practice and a culture of constant evaluation and
improvement ofpatient care (do you apply the best practice?)
Resource Management
Good clinical practice is usually also efficient but
controlling resources is not the prime goal of audit. Even
so, resource management and audit share not only methods
and potentially f?uil.ful topics, but also the need for accurate,
complete and timely clinical data.
Contract Monitoring
Clinicians should be involved in setting and committed
to Wfilling quality clauses in service contracts, but data
generated by audit should not be assumed to be appropnate
for monitoring them, nor should audit staff be diverted to
collecting data solely for contract monitoring. Chnicians and
managers must agree on the responsibilities for collecting,
interpreting and exchanging clinical data for different
purposes.
Organization
Peer Group
For the purpose of audit, the appropriate ‘peer group’
depends on what is the topic under review. Clinical audit is
a method of formally questioning the interacting areas of
concern amongst different professions and parts of the
service. Its strength is that it takes the perspective of the
recipient, of the service and identifies the coordination of:
care. Staff should be reassured that clinical audit does not
signal the end of unidisciplinary audit. Exclusive meetings
by single professions or levels of seniority remain appropriate
for certain issues. To permit this flexibility, disciplines and
specialities need to share regular meeting times and to set a
programme of ,topics, may be six months or more in advance.
Structure
Define the local leaders and pathways. Plan for evolution
at a pace which is sensitive to the willingness of indlvldual
specialities, disciplines and units. Identify contact clinicians
in each and define how they relate to the committee structure,
to ‘quality assurance’ and to management.
Many units set a meeting once a month for medical audit,
and some have extended this to all clinical staff to enable
From the Department of Hospital Administration, SKIMS, Soura. Srinagar, Kashmir, India (Tabish)
Received May 2001 Accepted July 2001
Correspondence: Dr. Syed Amin Tabish MD, FAMS, FIMSA, FRIPH Sr, Consultant & Medical Administrator SKIMS Soura, Srinagar, Kashmir-
190011.
Vol. 8 No. 4, October - December 2001
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their paticipation and to minimize disruption to services.
This requtres a clear management commitment not only to
audit in nursing, medical and the principal therapy
professions (clinical psychology, physiotherapy,.
occupational and speech therapy), but also in those such as
dietetics, pharmacy and otthoptics.
Policies I
Take stock of existing local agreements, for example, on
confidentiality, data validation, attendance records, reportmg
and sharing of information. Are they acceptable or adaptable
to all? :
A p p r o a c h e s
Principles I
Define the starting point. Are disciplines and team
members starting from the same point, for example, sharing
a level of understanding and definitions of terminology and
willing to acknowledge alternative viewpoints on quality,
to discuss professional overlaps, to recognize differing
models of patients care and and to acknowledge each other’s
skills? f j
Topic selection
Define priorities for audit. Define the basis on which
the team might set priorities for selecting audit topics, for
example, high volume, risk, cost or wide variation or an
area of local concern. The method of selecting topics should
incorporate all members of the group and be sensitive to the
legihniate interests of managers and the organization as a
whole. It should also be able to respond to relevant external
initiatives such as ‘consumer’ demands and national audit
proJects. i I
Methods
Identify available sources of advice and provide practical
guidance on appropriate methods. Define general
characteristics, for example, objective, quantified, standards-
based, repeatable. How is effective methodology to be
monitored and promoted?
Resources
Fix the amount of time to be devoted to audit. Allow for
duration and frequency of formal meetings as well as the
time set aside for their preparation and follow-up. In some
services, this has been assessed at half a day per month or 5
percent of clincial time.
Identify and develop sources of information for audit. Ln
particular:
I
a. Are clinical records accessible? Do they include
information on what patients are told, outcomes, etc?
b. Are statistics on case mix, complications, procedures and
treatments accurate, up-to-date and readily available to
clinicians for audit?
c. Are facilities available to all clinical staff to access
literature on clinical practice, and on audit, for example,
journals, newsletters, and annual reports?
Catalogue the uni-or multidisciplinary networks for
sharing methods, results and traming at regional and national
level. Are clinicians aware of these and have access to them?
Identify staff available to support chmcal audit. Clarify
their function, accountability and finnding. Who determines
the allocation to audit suppOrt time, and on what criteria?
Are the support staff sufficient in numbers and skill mix to
service the audit needs ofall clinical groups? Do Information
staffgive time to audit? Is there clerical and technical help?
Define responsibility and funding for training. This
should include audit staff, clinicians and managers.
Recognize the need for behavioural as well as technical
skills. What facilities are available locally, regionally or
nationally?
Identify the source and application ofexisting funds. How
is money provided for clinical audit, for example, nursing
and professions allied to medicine, hospital medical and
dental, primary health care, project grants, and any local
topup f?om general allocations.
Methods of Clinical Audit
Audit should involve the objective peer review ofpattems
of care, be sensitive to the expectations of patients and other
clinical disciplines and be based on scientific evidence of
good medical practice. To this end, cases for review can be
selected randomly or by pre-agreed criteria. Patterns of
practice, quantified where possible, can be compared wth
explicit guidelines and these guidelines, though agreed
locally, should be consistent with regional and. national
advice and with the body of scientific knowledge.
No single approach is universally applicable. Indeed, by
using a variety of methods, an audit group is more likely to
maintain flexibility, innovation and interest. Some methods
screen 100 per cent of cases for pre-defined events, which
are then subjected individually to peer review. Others-the
majority -focus on a limited sample of cases with a common
characteristic (such as a symptom, investigation, treahiient,
or complication).
Adverse patient Events
. ‘:” I_
Adverse patient events or ‘occurrence’ screening
involves the systematic identification and analysis of events
during a patient’s treatment which may indicate some lapse
in the quality of care. Screening criteria, aimed at
recognizing a particular occurrence, are defined by the
participating clinicians, but may be applied to individual
clinical records by non-medical assistants. For each criterion
there is a detailed definition of the occurrence-c 1t is intended
I
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3. JK-PRACTITIONER
to Idehtify, together with notes of known exceptions,
gmdellnes 011 use, examples, and details of the information
reqmred about each occurence. Fmdmgs are analysed by
the peer group to determlne causes and effects. This
information may be used to plan changes in patient
management.
It can be apphed across the hospital, or within a speciality
and is amenable to computer scanning if a comprehensive
database is available. It may be used for concurrent or
retrospechve screening of individual cases, or as a means of
identifying trends of suboptimal care. This technique is a
valuable tool in risk management But it is labour intensive
on :I conhnuous basis and its concentration on failures rather
than successes is not appealing to clinicians as a
comprehensive audit system.
Generic (whole hospital) criteria include the following:
+ Admission because of adverse results or complications
of out-patient management
+ ReadmIssion for complicatiuons or incomplete
management of problems on a previous admission.
+ Unplanned removal, injury or repair oforgan or structure
during surgery/invasive procedure.
+ Unplanned return to theatre.
+ Pnthologyihistology report varies significantly from
preoperativeiantetnortem diagnosis.
+ Cardiac or respiratory arrest.
+ Cardiovascular accidents or acute myocardial infarction
within 48 hours of surgical procedure, or pulmonary
etnbolus at any hme postoperatively.
+ Unexpected transfer to higher dependency unit.
+ Neurological deficit 011 discharge not present on
admission.
+ Unexpected death.
+ E,ldence of patient/family dissatisfaction.
TradItional morbidity and mortality meetings are
mechanisms for reviewing higIll>, selected adverse events
locally; confidential enquiries into maternal, perinatal, and
perioperative deaths, eclampsia and suicides while under
treatment are the equivalent at national level.
Clinic& Indicators
.J more comprehensive approach involves the monitoring
of routinely generated data within a speicality, in order to
identify excephons or trends which may merit detailed adhoc
re,iew. Ideally, each indcator would reflect an agreed policy
objective, be routinely and accurately captured and be
readily accessible.
Routine presentation of such data to clinicians, though
initially painful, does improve quality and usage. A general
model might Include measures, with relevant comparisons
01 er time or place, of
a. Workload: numerical description of cases, for example,
by type, source, site, age.
b. Access: measures of availability, for example, treatment
rates, waiting times, non-attendance rates, elective
admissions deferred by hospital.
c. Appropriateness: for example, operations out of hours,
readmissions, children in adult wards, patients admitted
after day case procedure.
d. Outcome: patients discharged home, in-patient deaths,
complications.
e. information: measures of quality (tnay be by sample
study), for example, cases with final diagnosis coded
within 1 week of discharge, records missing at time of
clinical visit/admission, concordance of parallel data
systems.
f. Efficiency: clinic/theatre sessions cancelled, length of
stay (selected ddagnosesiprocedures), new/old patient
iatio, pharmac cost per ward/clinic, investigations
requested, day cases as percentage of all planned
procedures.
Most of these are available from existing data but need
to be collected and refined.
Topic Review
Analysis of an agreed topic may be carried out by
prospective study or by retrospective analysis of patient
records. The latter often reveals inadequacies in recording
but is a valuable exercise in providing a baseline for
comparison in a later, prospective study. Both approaches
involve a systematic review of a large enough sample of
similar cases in order to identify, quantify and con pare local
patterns of practice.
The concept is applicable to surgical and non-surgical
specialities, is objective, yields quantitative data and is
repeatable but is very labour intensive, For this reason, the
clinicians may define explicit criteria by which an assistant
can extract key information from large numbers of medical
records. The steps in this ‘criterion-based’ audit are
represented in Table 80.1.
@bJa 80.1: Criterion-based Audit
Clinicians Audit Assislanl
Steps
1. Define topic.
2 Define criteria for analysis
3 Defrne sample SIZB, dates, etc.
4.
5
6.
7.
8. Discuss findings and exceptions.
9. Define action and fhre policy.
10 Repeat audit agarnsi criieria.
fdentify case: for analysis.
Frnd indivtdual medrcal records
Abstract data against criteria.
Tabulate aggregated data.
The topic should be of general interest and of high
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volume, risk of cost. Or it should be a subject of wide local
variation or other concern. It may be a symptom, diagnosis,
investigation, treatment, outcome or just a clinical problem.
The snnpler and more common the topic, the easier it is to
collect data and repeat the audit before junior staff initially
involved in the work move on.
Discusuon on the criteria and sample details should
involve the audit assistant to minimize later problems of
interpretation. Typically, the criteria should form abou a
dozen self-explanatory queshons, with a numerical or a yes/
no answer which can be gleaned from the record.
The purpose of these criteria is not to act as a protocol
for clinical management but to establish current patterns
and to help identify records which may merit individual
review. Local groups may develop different ideas and these
may represent the lowest common denominator on which
&,reement is achievable. For a particular inpatient diagnosis,
these may be under headings such as:
1 !
+ Referral: for example, delay before seen by junior/
consultant.
+ History for example, specified symptom(s) recorded.
+ Examination: for example, specified sign(s) recorded.
+ Investigation: for example, specified test(s) reported.
+ Treatment: for example, specified drugs (type, dosage,
route( given.
+ Follow-up: for example, discharged asymptomatic within
agreed time from ward/from clinic.
+ Communication: for example, summary to General
Practitioner within ‘n’ days.
It is wise at this stage to test the criteria on a very small
sample of records, say five, to check that there is a realistic
chance of finding the required information.
The assistant then has the often challenging task of
finding an accurate, up to date, listing of patients who had
the specified diagnosis and were treated by the doctors
concerned within the defined time scale. The next task is to
find the records themselves, and not to bias the sample by
giving up on the ones that are missing.
Abstracting of the records, once found, can take I O-30
minutes per case, depending on the number and complexity
of the criteria. Multiplied by, say, twenty cases for each of
three or four firms involved, this occupies many hours of
work.
The results have to be tabulated and presented (ideally
with the help of a computer spreadsheet and graphics
package) to the chnicians. They must satisfy themselves
that the findings are accurate.
Discussion tends to turn to the choice of criteria to the
interpretation of results and to agreement on action.
The audit can be repeated, using the same or modified
criteria after an agreed hme in order to measure the impact
of the changes on patient care.
Medical Records
Clinical guidelines for minimum standards of records
have been issued by the Royal College of Surgeons, England.
Checklists for evaluating records were included in the first
audit report of the Royal College of Physicians, England.
Auditing the records of every patient who had general
anaesthesia should be done on the basis of the criteria shown
in the box.
Records correctly field
Percentage meet
Anaesthetic record present.
Patient name on sheet
Pre-operative assessment recorded
Operation date recorded
Operation type recorded
Anaesthetic technique specified
Blood pressure recorded
Oximeter reading recorded
Name of anaesthetist legible on record
Therapeutics
Prescribing
Audit of drug usage is valuable both clinically and
economically, and data (on choice, route, dose, and duration)
are generally well recorded. Such audit also highlights some
of the problems of implementing and maintaining change in
clinical practice.
Some studies of medications focus on choice of drug,
for example, thrombolytics; appropriateness; route of
administration; and serum monitoring.
Other forms of therapy also lend themselves to audit and
these often involve other clinical specialities and disciplines.
Non-surgical uses in the hospital could also be reviewed.
Although primarily relevant to dermatology, the use of PWA
treatment illustrates a general model for the discussion of
appropriateness which might precede audit of any tlierapy,
in terms of criteria for entry, process and exit.
Entry ‘i.#l .*;. ‘;;:‘.I’.: ._ -; ,,. .
On what criteria ae patients selected/refbsed?
4 diagnosis? ‘,.’
+ disability (physical/social)? .:1:.-.. ::c! ‘:. ‘:
+ extent of disease?
.‘- t
4 age of patient? . ‘.
+ failure of first line therapy? .
+ ability to attend for regular treatments?
‘_ -
‘,
Process ’ ‘;L< .;4 I
How should treatment be conducted?
+ what machine capacity / power is appropriate?
+ what staff supervise therapy? _.
+ safety/calibration procedures?. ‘: ’ i
Vol. 8 No. 4, October - December 2001
273
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5. JK-PRACTITIONER
+ number of exposures/frequency?
Exit
When should treatment cease?
+ percentage improvement?
+ failure to respond?
+ side effects?
The calibration and safety of equipment used by doctors
IS central to the overall quality of medical care.
Diagnostic Investigations
Radiology
Audit of the use of diagnostic radiology is indicated by
evidence of clinically unproductive ‘routines’ in many
sepecialities,, by potential savings in inconvenience to
patients staff time and hospital costs, and by the growing
concern over exposure to medical radiation.
The Joint Working Party of the Royal College of
Radiologists, London and the National radiological
Protection Board, London estimated that the current
population dosage could be halved without detriment to
patient care. The remaining half would still be three times
greater than the total of all other man-made sources of
populationradiation. Someofthisreductioncouldcomefiom
various means of optimizing dosages per examination, but
the greater contribution would be in avoiding unnecessary
X-rays. At least 20 per cent of X-ray examinations currently
carried out in the UK are clinically unhelpful in the sense
that the probability of obtaining information useful for
patient management is extremely low.
The Royal College of Radiologists, London
recommended a ‘temporary norm’, based on the lowest rate
found, of I2 per cent.
The guidelines may easily be developed into explicit
criteria for the audit of current request patrems.
Post-Mortem Examination
Autopsy findings are consistently reported to differ
substantially from antemortem diagnoses in 10 to 25 percent
of cases-indeed the ‘ultimate audit.’
Random Case Review
Cases may be selected randomly or by a predetermined
system from among the general workload for critical review
by doctors not previously involved in the clinical
management. Findings can then be presented to the audit
group for discussion. Checklists may be used to ensure that
each case is reviewed according to an agreed system of
questions.
The method is easy to use, requiring minimal resources
and no numerical data. Many groups find it a useful
introduction to more structured discussion of clinical
management. But it requires considerable time from the
reviewers prior to the meeting. MaJor issues may be missed
through the randomness of selection. Discussion tends to
be subjective and criticism often centres on the inadequacy
of the record and thus the junior staff.
In many hospitals, one or two audit meetings a year are
given to random reviews as a change from more focussed
analysis of single issues.
Patient Satisfaction
The assessment of the views of patients and their relatives
must be incorporated into the judgments which doctors apply
to their work. Formal surveys of patients’ lews aregneerally
included in the overall quality improvement programmes of
hospitals, rather than in medical audit. But audit may
scrutinize evidence of thorough history-taking treatment
plans agreed with patients, informaiton given, perceived
value of treatment and outcome measurements expressed in
the patients’ own terms.
The honest views ofpatients anddoctors on the objectives
of medical intervention do not always tally. For example,
cancer patients may choose less interventional therapy m
preference to higher chance of 5-year survival.
Complaints leading to litigation are increasing and
analysis of the Icauses can provide guidance for avoiding
similar events III the future. Failure to communicate, explain
or apologize can add substantially to even a relatively minor
mishap and beccme a prime reason why patients or relaltives
pursue legal redress. Clinical and admmistrahve lessons can
also be gleaned fromthe experience of the denfence
organizations, and provide material for audit.
Comparative Audit
The confidential pooling of aggregated data, using
standard definitions and formats, allows Individual doctors
to receive feedback on their own performance compared with
others working in the same field. This can be simplified
with standardized data systems, but the method of production
of the statistics is less important than their accuracy. The
most reliable data are those collected by individual clinicians.
Many examples of the use of comparative data are found in
surgery but the principle has been applied wthln health
regions to obstetrics and medical specialities.
Further Reading:-
1. Bennett J. and Shaw C.D. (1987). ‘Guidance on what should
be in the clincial medical recoirds for the Bri$ton health
district’, Med. Rec. Healthcare Info.. 28: 103-10.
2. Bennett J. and W&he K. (1991). ‘Occurrence screening as a
method ofaudit’, Br. Med. J., 300;1248-51.
3. Donaldson L.J. and Hill P.M. (1991). ‘The domiciliary
consultation service: time to take stock’. Br. Med. J., 302:449-
51.
4. Feely J. et al. (1989). ‘Hosptial fonmdaries: need for contmuous
intervention,’ Br. Med. J.. 300:28-30.
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274
6. JK-PRACTITIONER
5. Gau G. (1977). ‘The ultimate audit’. Br. Med. J., 1:1580-l.
6. Health D.A. (1981). ‘Medical audit in general medicine’. J.
Roy. ~011. Phys. Lond., 15:197-9.
7. Leape L.L., BrennanT.A,and LainiN. etal. (1991). ‘Thenature
of adverse events in hospitalised patients’, N. engl. hled. J.,
324377-84.
8. Massanari R.M , Wolkerson K.. and StreedS. (1990).
“concurrent surveillance for adverse outcomes of medical care’,
in Quality in health care. Proceedings of conference of
lntematronal Society for Quality Assurance, ISQA Stockholm.
9. morgan D.J.r., Sutters C.A.. and Pugh S. (1991). ‘Medrcal audit
and formulary management: a policy for rational use of
thrombolytic drugs’. Postgad. Med. J., 67: 165-9.
IO. Roberts C.J., Fowkes F.G.R.. Ennis W.P., and Mitchell M.
( 1983). ‘Possible impact of audit on chest X-ray requests from
surgical wards’. Lancet, ii:P446-8.
11. Royal College of Physicians (1989). Medical audit: a first
report-what, why and how? RCP, London.
12. Royal College of Radiologsts (1989). making the best use of
department of radiology. PCR, London.
13. Royal College of Radiologists (1989). ‘Preoperative chest
I .,
radiolokv’, Lancet, ii:83-6.
14. Royal College ofradiohogists, National Radiologjcal Protection
Board (1990). Patient dose reduction in diagnostic radiolog,
NRPB, Didcot.
15. Royal College of Surgeons (England) (1990). Guidelines for
clinicians on medical records and notes, RCS. London.
16. Russell G.A. and Berry P.J. (1989). ‘Postmortem audit in a
paediatric cardiology unit’, J. Clin. Pathol.. 42:912-S.
17. Sandler G. (1984). ‘Do emergency tests help in the management
of acute medical admissions?‘, Br. Med. J.. 289:973-7
18. Shaw C.D. (1990). ‘Criterion based audit’, Br. Med. J., 300,
649-5 1.
19. Shaw C.D. (1992). Speciality Medical Audit, King’s Fund
Centre, London,
20. Simpson N.B. (1990). Medical audit for dermatologists: a
practical &aide, British Association of Dermatologists. Glasgow.
21. Swindell P.J., reeves D.S.. Bullock D.W.. Davies D.J.. and
Spence C.E. (1983). ‘Audits of antibiotic prescribing in a Briston
Hospital’, Br. Med. J.. 286: 118-22.
22. Young D.W. (1988). “Improving laboratory usage: a review’,
Postgard. Med. J.. 64:283-9.
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