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.

1. Clinical Audit
- made simple
Dr Mamta Rath Datta
Source : RCOG Press

2. What is the difference between audit and
research ?
 Research is the systematic and rigorous process of enquiry that
aims to describe processes and develop explanatory concepts and
theories to contribute to scientific body of knowledge.
 Research aims to discover something new or find out whether an
untested technique actually works.
 Audit is about maintaining and achieving quality , through review ,
monitoring and evaluation against agreed standards.

3. Aims of Audit
 To improve patient outcome
 To promote the cost effective use of resources
 To provide education
 To empower health care staff
 To encourage reflection on one’s own practice.

4. THE AUDIT CYCLE
NABH
STEPS SUGGESTED IN BOTH THE FIGURES ARE THE SAME

5. Classification of criterion – based clinical
audit
 CRITERION BASED AUDIT
 Audit of structure – examining the organisation or resources (what is available)
 Audit of process - examining the activities themselves(what you do)
 Audit of outcome – examining the effectiveness of activities on individual and
communities (what are the results)
 Common types : Case notes review/critical incident or adverse event
audit/criterion based audit

6. Step 1: problem Identification:
 Identify possible auditable problems
 Consider whether the problem is imp. enough to audit
 Consider whether further investigation of the problem is
warranted.
 Consider whether it is practical to audit the problem.
 Consider whether auditing can improve the problem.

7. Identifying problems
 Problems identified by health professionals, hand over meetings, complaints,
highlighted by media, issues raised by government etc., feedbacks from clients
 Common problems :
 People
 Machines/equipments
 Materials /supplies
 Methods/techniques
 Investigations
 environment

8. Step 2: setting standards and establishing
criteria:
Criteria must be based on:
 Evidence
 Best practice
 Related to imp. aspects of care
 Capable of being measured
 Acceptable to all participating staff
 Realistic for the capacity of your
facility
Key points:
 Find guidelines on how the condition
is managed
 From the guidelines produce criteria –
key points on which to focus the audit
 Decide upon appropriate numerical
standards for each criterion

9. Step 3 : Measuring current practice
Work out what you need to know
Basic data
Audit criteria
Other relevant points
Work out how many cases you need
Create an audit pro forma and collect data

10. Step 4 :Analysing the data and comparing
practice with agreed criteria
 Gather and organise the data
 Work out some simple calculation, then summarise the key data
points in either tables or graph
 Compare the results with the audit standards and identify
performance gaps

11. Step 5,6 : Implement change and re-audit
 Do a root cause analysis
 Select appropriate intervention
 Make an action plan
 Carry out action plan.
 Re-audit – this is done so that you can see what impact your audit
has had and what changes have been made.

12. Come Lets do Audit

13. Sample Audit - An example of a simple straightforward
audit
 AUDIT OF POSTOP CS WOUND INFECTION –audit carried out in National Hospital,Uganda
 Identifying problem : need for doing something for wound infection identified in morning
meeting
 Is it important? – common issue with high rates of morbidity/mortality
 Is further investigation warranted? – Yes. There were many questions.Why is it common? Which
organisms cause it? How common is it?
 Is it practical to audit the problem?- As it was a common problem it would be easy to find enough
cases
 Can auditing improve the problem? Postop infection is a preventable problem , so an audit could
find areas for improvement
Step 1 : Identifying the problem

14. Step 2 : Setting standards and establishing
criteria
 Finding guidelines & evidence : National and WHO guidelines studied
 Puerperal sepsis was defined
 Management criteria was set
 Swab any pus and take blood cultures in severe cases
 Give broad spectrum antibiotics
 Use wound irrigation and debridement if necessary
 Develop valid criteria :
 70% patients with wound infections should have pus swabs taken
 100% patients should have broad spectrum antibiotics
 100% antibiotic collection should be documented correctly

15. Step 3 : Measuring current practice
 Collect data in audit proforma
 Work out how many cases you need – data from all cases in the ward on one day was
decided as enough in this example
Step 4 : Analysing data and comparing with agreed criteria
 Gather and organise data- data was put in one table
 Work out some simple calculations – Age range, percentages and averages were calculated
 Compare results to the audit standards and identify performance gaps

16. Step 5 : Root cause analysis using a why – why format

17. Step 6: Action plan created

18. Step 7 :Re - audit

19. Thank you