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.

1. WELCOME

2. Presented by
Capt. Rezoan
Roster no: 36
OBC: 82

3. Clinical audit definition.
The definition from National Institute for
Clinical Excellence (NICE) is-
“A quality improvement process that seeks to
improve patient care and outcomes through
systematic review of care against explicit
criteria and the implementation of change”
Comparing practice with standards and
implementing changes to improve practice.

4. Clinical audit(cont)
Clinical audit can be also defined as..........
“The systematic critical analysis of the quality
of medical care, including the procedures used
for diagnosis and treatment, the use of
resources and the resulting outcome and
quality of life for the patient”
Comparing what really happens with what
should happen and improve patient care and
services

5. Clinical audit(cont)
“ Clinical audits give me a way to check that
the care I am providing is of a high standard.
It helps with my education and training and
keeps me up to date with best practice”
“ Clinical audits give me a way to
demonstrate that my service is meeting
quality targets. Its part of a culture that puts
quality firmly on the agenda”

8. History of clinical audit.
Florence Nightingale is often credited with
undertaking the first audit of healthcare.
During the Crimean War, Florence Nightingale
realized that mortality of British soldiers was
exceedingly high. It was recognized that
admission to the battle hospital increased a
soldier’s chance of death. In January 1855
there were 2844 death in hospital – 83 from
wounds and 2761 from infectious diseases.

9. History of clinical audit(Cont)
After reviewing conditions
Nightingale indentified:
a. French soldiers received much
better care and survival rate in
French hospitals was much
greater.
b. Water supply to British
hospitals was contaminated.

10. History of clinical audit(Cont)
c. Food supplies were inadequate.
d. Basic sanitation was not met.
e. Operations on soldiers were often
carried out on open wards
f. Chronic shortage of medical and
surgical supplies

11. History of clinical audit(Cont)
• Results:
Prior to Nightingale’s interventions
40% 0f British soldiers admitted to battle
hospitals died there. Within 6 months of
Nightingale’s arrival and interventions
death rate of British soldiers had fallen to
2%.

12. Why should you do clinical audit ?
Supporting doctors
Protecting patients
Quality improvements
Individual support
Horizontal control
Comparability and Transparency
Protections of employees
A new nice challenge

13. Why should we do clinical
audit(cont).
 Others.
(a) Things have changed
(b) Duty of care
(c) Best practice
(d) Best outcome
(e) Duty to deliver best quality service
(f) More accountability for our actions
(g) Critical analysis of your own skills and ways of working
(self improvement)

14. Benefits of clinical audit.
Improves the delivery of the health care.
Highlights deficiencies.
Highlights good practices to the patients and staff.
Promotes change.
Ensures standards exist, as well raises them.
Reinforces evidence based practice.
Improves team work.
Best that we can deliver individually or collectively
as a group of health professionals.

15. Types of clinical audit.
 National Clinical Audit
 Local Clinical Audit
 Other Processes Similar to and Related to Clinical
Audit.
 Peer review
 Critical incident monitoring
 Patient experience surveys
 Non-audit or Quasi – Audit activities
(a) Research
(b) Service Evaluation
(c) Patient Outcomes Programs
(d) Patient Satisfaction Inquiries
(e) Formal Investigations

16. Criteria of Effective Clinical Audit.
An educational activity
Promotes understanding
Resource effective
Raises standards
Promoted change
Source of information
Involves patients.

17. The audit cycle (can be also)
Problem or
objective
identified
Criteria agreed and
standards set
Audit (Data
collected)
Identify areas for
improvement
Make
necessary
changes
Re-audit

18. Five stages of clinical audit

19. Type of Hospital Data.
• a. Average Length of Stay (ALOS)
• b. Bed Occupancy Rate (BOR)
• c. Bed Turnover Rate (BRT)
• d. Complications Rate
• e. Admission Rate
• f. Discharge Rate

20. Contents of Clinical Audit.
• a. Background
• b. Literature review
• c. Criteria and Standards
• d. Methods or Protocols
• e. Results
• f. Recommendations for change
• g. Recommendations for further audit

21. Quality care.
Quality of care can be defined as ‘the
degree to which health services for
individuals and populations increase the
likelihood of desired health outcomes
and are consistent with current
professional knowledge’.

22. Dimensions of quality.
EFFICIENCE
Was the right thing done timely-
EFFECTIVENESS
What is the right thing to do –
APPROPRIATENESS
Was the right thing done? –
PERFORMANCE
Was the right thing done properly and
well?
Was the OUTCOME satisfactory?
(including acceptability)

23. Clinical audit for quality care.
Simply said…………
……….improving the quality of
patient care by looking at current
practice and modifying it
where necessary.