This document provides an overview of medical audit, including:
- Definitions of medical audit and clinical audit
- The history and evolution of audit from the 1850s to modern clinical audit practices
- The need for and benefits of medical audit
- The six stages of the audit process: preparing, selecting criteria, measuring performance, making improvements, sustaining improvements, and re-audit
- Types of clinical audits such as statistical, disease-specific, death, and infection control audits
- Key aspects of implementing a successful audit such as identifying criteria and standards, collecting and analyzing data, and identifying and addressing barriers to change.
Medical Records is a foremost important in the healthcare accreditation bodies like JCI,NABH are very adherent about its documentation,retention and confidentiality.
Medical Records is a foremost important in the healthcare accreditation bodies like JCI,NABH are very adherent about its documentation,retention and confidentiality.
Total Quality Management in HealthcareGunjan Patel
Now days, Healthcare systems are of fundamental interests to all level of Hospitals in our societies. Eventually, increasing importance and reliance are placed on total quality management in healthcare systems. Due to this rising importance that is also reflected in the increasing percentage of national and international resources for both private and public sector to allocated in hospital management systems. Hospitals and other healthcare organization across the globe have been progressively implementing TQM to reduce costs, improve efficiency and provide high quality patient care.
Medical Records: Intro, importance, characteristics & issuesSrishti Bhardwaj
Unit 1 of MHA SEM- III's syllabus of Medical records Management
(Bharati Vidyapeeth- Center for Health Management Studies & Research, Pune)
Self made- study purpose- reference presentation
avoid hyperlinks on certain slides- inactive
sources shared on last slide as REFERENCES
Hope it helps :)
Total Quality Management in HealthcareGunjan Patel
Now days, Healthcare systems are of fundamental interests to all level of Hospitals in our societies. Eventually, increasing importance and reliance are placed on total quality management in healthcare systems. Due to this rising importance that is also reflected in the increasing percentage of national and international resources for both private and public sector to allocated in hospital management systems. Hospitals and other healthcare organization across the globe have been progressively implementing TQM to reduce costs, improve efficiency and provide high quality patient care.
Medical Records: Intro, importance, characteristics & issuesSrishti Bhardwaj
Unit 1 of MHA SEM- III's syllabus of Medical records Management
(Bharati Vidyapeeth- Center for Health Management Studies & Research, Pune)
Self made- study purpose- reference presentation
avoid hyperlinks on certain slides- inactive
sources shared on last slide as REFERENCES
Hope it helps :)
Nursing audit assists in:
1. Evaluating Nursing care given,
2. Achieving deserved and feasible quality of nursing care,
3. Stimulating better nursing records maintenance,
4. Focuses on patient care provided and not on care provider,
5. Contributes to research in nursing.
Audit of clinical practice
1. What is clinical audit?
2. What is history of clinical audit?
3. Why clinical audit?
4. Audit cycle
5. Stages of clinical audit
UNIT-IV M.sc I year NURSING AUDIT CHN.pptxanjalatchi
Nursing audit is the process of collecting information from nursing reports and other documented evidence about patient care and assessing the quality of care by the use of quality assurance programmes.
EVIDENCE-BASED CPGs FOR HEMATOLOGY - ONCOLOGY UNIT, KING SAUD UNIVERSITY HOPSITALS
Saudi Arabia, Riyadh
King Saud University Hospitals
CPGs Committee
Quality Management Dept
CPGs Program
By YASSER SAMI AMER
Hospital Committees are regular standing committees prescribed by regulatory agencies and deemed necessary by hospital administration in formulating policies, coordinating and monitoring hospital-wide activities that are considered critical in the delivery of quality health care services.
These are in contrast to ad hoc committees, department and unit committees.
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Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
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Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
2. Contents
Introduction
Definition of Medical Audit
History of medical audit
Need, Advantages and approaches for medical audit
Pre-requisites for medical audit
Stages of medical audit
Types of clinical audit
Global scenario
Problems in Medical audit
Conclusions
References
3. What is Audit?
• The word „audit‟ has been derived from Latin word
„audire‟ which means „to hear‟.
• A systematic and critical appraisal of planning,
implementation and evaluation of services; in terms
of efficiency, effectiveness and quality, within given
resources.
Audit in the wider sense is simply a tool to find out
what you do now;
what you have done in the past, or
what you think you may wish to do in the future.
4. Definitions
• In 1989, the White Paper Working for patients defined
medical audit as „the systematic critical analysis of
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‟
• Medical audit later evolved into clinical audit and a
revised definition was announced by the NHS
Executive: „Clinical audit is the systematic critical
analysis of the quality of healthcare, including the
procedures used for diagnosis, treatment and care, the
use of resources and the resulting outcome and quality
of life for the patient(1991).
5. Definitions
• Clinical audit -quality improvement process to
improve patient care and outcomes by systematic
review and implementing change.
• Aspects of patient care – including structure,
processes and outcomes – are selected and
evaluated against explicit criteria and, where
necessary, changes are implemented at an
individual, team or service level.
• Further monitoring can then be used to confirm
the improvements in healthcare delivery.
(NICE)
6. By 1994, the term „clinical audit‟
appeared to have largely replaced the earlier term
„medical audit‟
Medical Audit
Clinical Audit
Review of clinical care
of patients provided by
the medical staff only
review of all aspects of the
clinical care of patients by
medical and paramedical staff.
8. But it became operational only in 2007, after
the establishment of National Accreditation
Board for Hospitals and Healthcare
Providers (NABH) in 2005.
1962:
Mudaliar committee
1969:
Dr Sushila Nayar
Mid 1980s:
more formal audit
needed- accelerated
by publication of
the Confidential
Enquiry into Peri
operative Deaths
(CEPOD) in 1987
and the
Government White
Paper, entitled
„Working for
Patients‟ in 1989.
9. NEED FOR CLINICALAUDIT
2. For Society- To ensure safety of
public and protect them from care
that is inappropriate, suboptimal
& harmful.
1. For Professionals- Healthcare providers
can identify their lacunae/deficiencies and
make necessary corrections.
3. For health promotion- To reduce patient sufferings and avoid the
possibility of denial to the patients of available services or injury by
excessive or inappropriate service.
10. PURPOSE OF CLINICAL AUDIT
• To plan future course of action it is necessary to obtain baseline
information through evaluation of achievements for comparison purpose
with a view to improve the services.
• Regulatory in nature for- full & effective utilization of staff & facilities.
• Assess the effectiveness & efficacy of health programs & services.
• Describe and measure present performance
• Help developing explicit standards
• Suggests what need to be changed
• Help mobilize resources for change
11. Approaches of Clinical Audit
Care is evaluated at the time
it is taking place
CLINICALAUDIT
CONCURRENT
AUDIT
RETROSPECTIVE
AUDIT
Care is evaluated after it
has been completed
through records
Audit may be Internal OR External
13. Medical Audit Committee (MAC)
• MAC should consist of hospital consultants, committed to
Medical audit.
• It should be constituted of Medical administrator
1. Chairman- Senior clinicial consultant.
2. Member Secretary-Medical record officer.
3. Members- clinicians, Pathologist, Radiologist, Matron (NS)
and representative of MS.
• The committee should meet once in a month and submit the
report to medical superintendent (MS) as confidential.
14. Hospital operational statistics
a) Hospital resources : Bed compliment, diagnostic and
treatment facilities, staff available.
b) Hospital utilization Rates : Days of care, operations,
deliveries, deaths, OPD attendance, laboratory
investigations etc.
c) Admission Data: Information, on patients i.e. hospital
morbidity and mortality statistics, average length of
stay, hospital infection rate, etc.
The procedure of collection and tabulation of hospital
statistics should be standardized.
15. Medical records
• All the junior staff (Residents) to be trained and retrained as
how to fill up the medical records.
• Being the primary source of data, all the medical records must
be complete in all aspects before sending to the records
department.
• A well trained medical record librarian should be present for
carrying out quantitative analysis.
• Records to be properly tied up, coded and indexed month-
wise/disease-wise for easy retrieval.
• A complete and correct medical record is the backbone of
medical audit.
16. PRINCIPLES
1. Health authorities and medical staff should define
explicitly their respective responsibilities for the
quality of patient care.
2. Medical staff should organise themselves in order to
fulfil responsibilities for audit and for taking action
to improve clinical performance.
3. Each hospital and specialty should agree a regular
programme of audit in which doctors in all grades
participate.
17. PRINCIPLES
4. The process of audit should be relevant, objective,
quantified, repeatable, and able to effect appropriate
change in organisation of the service and clinical
practice.
5. Clinicians should be provided with the resources for
medical audit.
6. The process and outcome of medical audit should be
documented.
7. Medical audit should be subject to evaluation.
18. STAGES OF MEDICALAUDIT
• Preparing for AuditStage 1
• Selecting CriteriaStage 2
• Measuring PerformanceStage 3
• Making ImprovementStage 4
• Sustaining ImprovementStage 5
• Re- AuditStage 6
19. Stage 1: PREPARING FOR AUDIT
USERS
INFORMATION
SELECTING
A TOPIC
PRIORITISE
AUDIT
DEFINING
THE
PURPOSE
PLANNING
AUDIT
20. 1. USERS INFORMATION
o Focus of any audit- those receiving care.
o The concern of users - identified from various sources:
letters containing comments or complaints
critical incident reports
individual patients‟ stories/ feedback from focus grps
direct observation of care
direct conversations.
21. 2. SELECTING A TOPIC
• Topic should be of concern to service users and has
potential to improve service user „outcomes‟.
• It should be of clinical concern (e.g. an acknowledged
variation in clinical practice, high-risk procedures,
complex management).
• It should be financially important (either very common
and/or very expensive).
• It should be of local and/or national importance (e.g. a
Department of Health initiative).
22. 3. MEASURE TO PRIORITISE
HIGH
COST
HIGH
RISK
SERIOUS
QUALITY
PROBLEM
POTENTIAL
FOR NAP
PRIORITY FOR
ORGANISATION
EVIDENCE
AVAILABLE
(EBR)
23. 4. DEFINING THE PURPOSE
o Purpose must be established before appropriate methods for audit
can be considered.
o The following series of “action verbs” may be useful in defining
the aims of an audit
INCREASE
ENHANCE
IMPROVE
ENSURE
REDUCE
CHANGE
24. 5. PLANNING
o Involve ALL the people concerned
o Fix time and plan resources
o Access the evidence
o Methodology for data collection
o Pilot study
o Report for action
o Re-audit
All these should
be documented
25. STAGES OF MEDICALAUDIT
• Preparing for AuditStage 1
• Selecting CriteriaStage 2
• Measuring PerformanceStage 3
• Making ImprovementStage 4
• Sustaining ImprovementStage 5
• Re- AuditStage 6
26. STAGE 2: SELECTION OF CRITERIA
DEFINITION
OF CRITERIA
SOURCES OF
EVIDENCE
APPRAISING
THE
EVIDENCE
27. 1. DEFINING CRITERIA
• The audit criteria will provide a statement on what should
be happening.
• the standards will set the minimum acceptable
performance for those criteria.
• The criteria and standards must be
– Specific – clear, understandable
– Measurable
– Achievable
– Relevant – to the aims of the audit
– Theoretically sound – based on current research.
28. 1. DEFINING CRITERIA
EXAMPLE
• Audit title- the incidence of wound infection
following hernia repair
• Criteria- there should be no wound infection in such
cases.
• Standard- 95%, i.e. practice is satisfactory if less than
5% of cases have wound infection.
29. 2. SOURCES OF EVIDENCE
Standards may be based on one, or any
combination, of the following:
• National guidance or standards (e.g. Patients‟ Charter).
• College or professional organisation guidelines.
• Laws (e.g. Mental Health Act 1983).
• Standards used locally by colleagues or competitors (e.g.
neighbouring trust, ward, etc.).
• Evidence based Research (from which standards can be
developed).
• Literature review of other clinical audits which have
published their standards/results.
• Current knowledge from clinical experience.
30. 3. APPRAISING THE EVIDENCE
• Evidence needs to be evaluated to find out if it is valid, reliable
and important.
• Whether meeting:
o Aims/Objectives,
o Study methodology,
o Past results/conclusions
o Extent of applicability
• Likely bias/causes for concern
31. STAGES OF MEDICALAUDIT
• Preparing for AuditStage 1
• Selecting CriteriaStage 2
• Measuring PerformanceStage 3
• Making ImprovementStage 4
• Sustaining ImprovementStage 5
• Re- AuditStage 6
33. 1B. METHODS OF DATA
COLLECTION
Do not try to collect too many items, keep it simple, short and
relevant to present study.
Computer-stored data
Case notes/Medical Records
Local surveys through questionnaires, interviews, focus groups
Prospective recording of specific data and compilation
Keep focus on the objective of the audit.
34. 1A. PLANNING DATA
COLLECTION
The collected data- needs to be precise, essential and adequate.
To conduct- pilot study.
The reliability of data can also be improved by providing
appropriate training in data collection for the person
undertaking this task.
.
35. 2. DATA ANALYSIS
The following approaches may be used in analysing the data:
• descriptive statistics
• statistical tests
When analysing the data, we generally want to try to reach to
conclusions about the general pattern of actual practice.
36. 3. DISSEMINATION OF FEEDBACK
FINDINGS
Health Information Exchanges (HIE) to be strengthened-
important that all the key stakeholders are made aware of the
findings of the project and are provided with an opportunity to
comment on them.
A combination of passive feedback (written information) and
active feedback (discussion of findings) is preferable when
communicating the findings of the project.
37. STAGES OF MEDICALAUDIT
• Preparing for AuditStage 1
• Selecting CriteriaStage 2
• Measuring PerformanceStage 3
• Making ImprovementStage 4
• Sustaining ImprovementStage 5
• Re- AuditStage 6
39. 1. IDENTIFYING BARRIERS TO
CHANGE
Fear
Lack of understanding
Low morale
Poor communication
Individual Culture
Pushing too hard
Doubt of outcome
Consensus not gained
40. 2. IMPLEMENTING CHANGE
A systematic approach needed for:-
what needs to change
how change could be achieved
who needs to take these actions
when the proposed actions will begin
how these actions will be monitored and by whom
how and when to assess whether the actions taken have achieved
the desired outcome
Provide support for teamwork/Change culture
41. STAGES OF MEDICALAUDIT
• Preparing for AuditStage 1
• Selecting CriteriaStage 2
• Measuring PerformanceStage 3
• Making ImprovementStage 4
• Sustaining ImprovementStage 5
• Re- AuditStage 6
43. 1. MONITORING AND
EVALUATION
Although improving performance is the primary goal of audit,
sustaining that improvement is also essential.
Only minimum number of essential indicators should be
included in monitoring.
If performance targets not reached during implementation,
modifications to the plan/additional interventions will be
needed.
Failed ICD-10 adoption approach in healthcare
settings- result in more intense regulatory
scrutiny and decrease financial results.
44. 2. REINFORCING IMPROVEMENT
Factors to be identified for maintaining improvement.
Reinforcing or motivating factors built in by the management to
support the continual cycle of quality improvement.
Strong leadership
Integration of audit into organisation‟s
wider quality improvement system
45. STAGES OF MEDICALAUDIT
• Preparing for AuditStage 1
• Selecting CriteriaStage 2
• Measuring PerformanceStage 3
• Making ImprovementStage 4
• Sustaining ImprovementStage 5
• Re- AuditStage 6
46. STAGE 6: RE-AUDIT
After an agreed period, the audit should be repeated. The
same strategies for identifying the sample, methods and
data analysis should be used to ensure comparability
with the original audit. The re-audit should demonstrate
that the changes have been implemented and that
improvements have been made. Further changes may
then be required, leading to additional re-audits.
agreed actions have occurred
changes have achieved the desired improvements – i.e. closer to set target
and, therefore, improvements in service delivery
standards continue to be met (where no changes were made).
49. 1. STATISTICAL AUDIT
• Data on different indicators set by Audit committee are prepared
unit-wise on monthly basis.
• Data is generated, compiled and supplied by MRD.
• Data so obtained is critically examined and compared against
standard norms.
• Any deviation from standard norm warrants investigation to find
out possible cause and its remedial measure.
50. INDICATORS USED:
BED TURN
OVER RATE
BED
OCCUPANCY
AVERAGE
LENGTH OF
STAY
NET DEATH
RATE
ANAESTHETIC
DEATH
AUTOPSY RATE
CONSULTATION
RATE
INFECTION
RATE
51. 2. AUDIT OF OPERATED CASES
• A group of patients who have been operated for a similar
surgical condition are analysed under this method.(e.g. Lap
Cholecystectomy).
• Particular emphasis is laid on the pathological reports of the
tissues during operation.
• The percentage of the preoperative diagnosis which tally with
the pathological diagnosis is an important parameter.
• Type of antibiotics used, PAC notes, Surgery and anaesthesia
operative notes, Postop infection rates are the points which are
investigated in this type of audit.
• Case sheets are examined against standard norms and
shortcomings are intimated to concerned unit for future
precaution and rectification.
52. 3. AUDIT OF OBSTETRIC CASES
Indicators used are same as operative cases.
some additional points to be taken are-
• No. of C.S. done with indications.
• No. of forceps/ vacuum application.
• No. of Maternal Complications.
• No. of maternal or Neonatal deaths.
53. 4. AUDIT OF DEATH CASES (Mortality Review)
• All the deaths taking place after 48 hrs. of admission to the
hospital should be subjected to review by the committee.
• Case sheets are examined for quantitative as well as qualitative
inadequacies and are then communicated to respective units
for remedial measures.
Various parameters used are :
A. Diagnosis, investigations, time of examination (delay)
B. Treatment given was acc. to standard treatment or not.
C. Type of consultations obtained and recorded.
D. Daily monitoring of Progress.
54. 5. AUDIT OF RANDOM CASES
• Case sheets of discharged patients are randomly selected during a
month-TO STUDY QUALITY OF RECORD MAINTENANCE,
DIAGNOSTIC DEFICIENCY, TREATMENT & OUTCOME.
• Various parameters used:-
a) History, physical exam, diagnostic skills
b) Investigations done, treatment given, progress notes
c) Nursing care chart
d) Initial diagnosis is compared with final diagnosis.
e) Treatment given is judged against correctness, adequacy acc. to
norms.
f) End result of treatment is compared with patient condition at
discharge.
Any deviation from norms are intimated for improvement.
55. 6. AUDIT OF DISEASE CASES
• All case sheets are arranged unit-wise and month wise.
• Group of physicians are asked to lay down certain norms
regarding specific disease with respect to:
a) Investigations to be done
b) Line of treatment
c) Average length of stay
d) Likely complications
Case sheets are examined against norms. The unit in which
shortcoming are found is directed to improve.
.
56. Example-
• Study subjects- All operated cases for gall bladder diseases at AIIMS,Delhi
• Study design- Retrospective study of medical records (During 1977)
• Methodology- Study carried in 3 phases:-
i. Phase1-
a) Cases were selected
b) Norms/Criteria were established as per their own standards (by surgeons
& anesthesiologists)
i. Phase 2- Medical records- relevant info abstracted
ii. Phase 3- Group discussion- To identify gaps & provide solution for
improvement
Results/Observations:
1) Overall,quality of patient care-quite satisfactory as per the norms set.
2) Problems & shortcomings- identified in certain parameters.
3) Use of antibiotics- Judicious & consistent.
4) Adequate PAC & monitoring- by anesthetists.
5) Post-operative infection rate & death rates- acceptable limits.
6) Post-op cases:
- Complication rates high
- Inadequate advise to pt at discharge.
- Follow-up record- Unavailable/Incorrect
- Length of stay before surgery-Longer than expected.
- Investigations for some pts- Not done/ Done without any reason
- Inadequate consultations with other specialties
- Poor recording of medical records
Solutions:
1) Remove communication gap between senior faculty members
and resident staff – Regarding appropriate guidelines- To
improve quality of pt care & medical records
2) Ensure proper programming of cases- for proper utilization of
available resources
3) Investigations without any specific reason- To be Avoided
4) Proper documentation & medical record maintenance- Stressed.
5) Reduce unnecessary delay- special investigations- radiology dept.
Recommendation:
Suitable clinical & administrative medical staff organization-
suggested for medical audit programs in large teaching
57. Medical Audit: Global View
USA: Medical audit became mandatory in 1974.
Since the passage of Medicare & Medicaid in 1965, hospital-wide
quality assurance mechanisms are being implemented.
Joint Commission on Accreditation of Healthcare Organisations
(JCAHO)- important role in implementation of quality assurance in
healthcare settings.
American Medical Association (AMA) plays vital role in imparting
guidelines for diagnostic and therapeutic medical interventions.
Patient Protection and Affordable Care Act (PPACA), 2010- Enacted
for better health outcomes, lower costs and improving methods of
distribution and accessibility of services by healthcare providers.
58. UK: Medical audit first got importance in 1989-91.
British Govt. emphasized and proposed reforms in National
Health Services (NHS) for medical audit.
National bodies provide guidelines, design, cost of quality
implications, training for support staff.
King‟s Fund Center, London- houses Quality Assurance program
and Medical Audit program.
Medical audit program contributed a lot through various articles
and publications worldwide.
59. Australia:
Increase in National Health spending proved to be a stimulus
for development of formal audit program in 1970s.
Australian Medical Association(AMA) together with
Australian Council on Healthcare Standards(ACHS) in 1979-
formed Peer Review Resource Center(PRRC)- so as to peer
review within medical profession and to identify barriers to
conduct the same.
ACHS in 1983- made Quality Assurance mandatory standard
for accreditation in healthcare settings.
PRRC also assists Royal Colleges in conducting national
surveys.
60. PROBLEMS IN MEDICALAUDIT
1. Lack of organized medical report, incomplete records, poor
quality maintenance.
2. Fear of action and lack of motivation of medical staff.
3. Ignorance of value of medical audit by hospital staff.
4. Suppression of facts, wrong reporting. Completion of records
after death restricts the true value of medical audit.
5. The major loopholes are on the part of commitment, participation
and seriousness for the audits. Audits in Indian scenario are still
more or less considered as an obligation and are done only to
fulfil the requirement of various accreditation or other external
agencies rather than for the improvement of hospital processes
and quality in actual.”
6. Low number of auditors is also a concern for hospital audit in
this country.
61. 7.The techniques for doing this are imperfect and are not
standardized, despite the seemingly clear-cut methods described in
official publications.
8.Being retrospective and dependent entirely on information
contained in the record, auditing can only assess limited aspects of
the technical quality of care
PROBLEMS IN MEDICALAUDIT
62. Conclusions..
o Today, due to growing individual income, health has become a priority
for Indians.
o Patients put a lot of value to the quality of healthcare provided by the
hospitals.
o In recent years, with the mushrooming of hospitals, patients have an
array of hospitals to choose from.
o So the competition among the hospitals to maintain their standards
and improve them as and when required has become stiff.
o In addition, number of malpractice and negligence suits against the
providers of healthcare are increasing.
63. Conclusions..
o This also puts additional pressure on organizations and practicing
physicians to evaluate the quality of care provided.
o Hospitals have to create patient care and safety impact, the moment
a patient is admitted to the hospital through processes and
infrastructure.
o The process of audit ensures consistency in delivery of clinical and
non-clinical services; it also addresses the habit of continual
improvement
64. Conclusions
o Medical audit is far more important to a hospital than financial
audit. Financial deficits can be met eventually but medical
deficiencies can cost lives, or loss of health thereby resulting in
unwanted agony.
o Medical audit has just begun to gain momentum in India and
needs acceptability by the hospital systems and medical
fraternity as an improvement initiative rather than a fault finding
mechanism.
65. References
„Medical Audit in India‟ 2nd ed- Book by Anjan Prakash,
Deepali Bhardwaj
http://www.rfhha.org/images/pdf/Thesis_&_Dessertations/003
7.pdf
Improving and strengthening use of ICD-10 and medical
record system in India,2005,CBHI,DGHS,MOHFW
„Criteria based clinical audit‟ article by Pushpa
Kottur,Karnataka
Internal audit capabilities and Needs survey-2014, Protiviti
Various other articles from web.