Medical audit is a systematic, critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment. It identifies areas for improvement by evaluating care against established standards. The goals of medical audit are to ensure best possible care for patients, improve clinical practice, and reduce patient suffering. It involves reviewing medical records, analyzing data, making recommendations, and implementing changes to treatment and care processes. Medical audit aims to enhance the quality of healthcare delivery through ongoing monitoring and assessment.

1. ROLE OF
MEDICAL AUDIT
IN
HEALTH CARE EVALUATION
By- Dr. Dharmendra Gahwai
(PG Student)
Guided by- Dr. Y.D. BADGAIYAN
Prof. and Head
Dept. of Community Medicine
CIMS , Bilaspur (CG)

2. BACKGROUND
• People learn the best when they are
helped to define their own problems
and
• When they accept their strength and
weakness, decide a course of action
and evaluate the consequences of
their decisions.

3. • Medical Audit is planned programme
which objectively monitors and evaluates
the clinical performance of all
practitioners.
• It identifies opportunity for improvements
and provide mechanism through which
action is taken to make and sustain those
improvements.

4. Initially the quality assessment techniques
were-
• Performance appraisal.
• Statistical quality control.
• Quality assurance
• Continuous quality assurance and
• Continuous quality improvements.

5. Now the specialties are -
• Total quality management(TQM).
• Just in time (JIT) and
• Zero deficit .

6. • The concept of quality assurance
has been replaced by
Medical Audit.

7. DEFINITION
•Medical Audit is defined as “the
evaluation of medical care in
retrospect through analysis of
medical records.”

8. • Medical Audit 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.
‘Principles for Best Practice in Clinical Audit’
the National Institute for Clinical Excellence (2002)

9. • Aspects of the structure, processes and outcomes
of care are selected and systematically evaluated
against explicit criteria.
• Where indicated, changes are implemented at an
individual, team or service level and further
monitoring is used to confirm improvement in
healthcare delivery.
‘Principles for Best Practice in Clinical Audit’
the National Institute for Clinical Excellence (2002)

10. • Input for Health Care facilities are men,
material , methodology , means ,
machinery and technology.
• They all work towards one objective – how
best we can provide quality patient care.

11. • Output of hospital is patient care.
• Patient care is intangible and therefore
does not liable itself to measurement.

12. • In measurement of any output the factors
to be considered quantity, quality and
consumer (patient)satisfaction .
• Patient satisfaction is subjective.

13. Why Medical Audit ?
• Mac Eachern stated that -
“financial deficiencies can eventually
be met but medical deficiencies may
cost lives and lost of health which can
never be retrieved”.

14. Why Medical audit?
• To ensure the best possible care for patients.
• To ensure clinical practice is evidence-based.
• Audit is an integral part of Clinical Governance.
• Assist with the implementation of national
initiatives .
• To improve working between multi-disciplinary
groups.

15. Why Medical Audit ?
• 1. Professional motive – Health care provider
can identify their lacunae and deficiencies and
make necessary corrections.
• 2. Social Motive – To ensure safety of public and
protect them from inappropriate , suboptimal
and harmful medical care.
• 3. Pragmatic motive – To reduce sufferings of
patient.

16. What can be audited?
• Structure – The resources and personnel
available, e.g. Investigation facility and
availability of doctors.
• Process – Amount and type of activities of
clinical care, e.g. annual review for diabetes.
• Outcome – Result of an intervention, e.g. pain
relief, patient satisfaction.

17. PHASES OF MEDICAL AUDIT
• 1. MEDICAL ACCOUNTING – is providing
adequate medical records of performance which
is basis for analysis.
• 2.ANALYSIS – actual analysis of recorded data
in the clinical records and field reports
pertaining to the professional work of the
hospital.

18. QUALITY CYCLE
Identify
problems
Identify
barrier
Correct
the
problem
Prevent
future
problem

19. EVALUATION OF QUALITY OF CARE
• It comprises three things –
• A. Quality of Technical Care.
• B. Quality of Art of Care.
• C. Administrative support enabling
doctors to practice ‘a’ and ‘b’.

20. • Technical Care can be assessed by adequacy of
diagnostic and therapeutic processes.
• Art of Care – manner and behaviour of
provider in delivering health care services.
• Administrative support - planning ,
organizing and directing all resources for patient
care to maximise productivity towards better
patient care based on evaluation report.

21. Pre-requisites for Medical Audit
• 1. Hospital Operational Statistics.
(a) Hospital Resources.
bed facility, diagnostic facility, treatment facility.
(b) Hospital Utilization Rates.
OPD, Days of care, operations, deliveries and deaths.
(c) Admission Data
- Hospital morbidity statistics.
- Average Length of Stay(ALS)
- Operation Morbidity.
- Outcome of operation.

22. Pre-requisites for Medical Audit
2.Standardized hospital statistics collection
and tabulation.
3.Medical Record should be accurate and
complete.
4.Medical record librarian.
5. Medical audit committee .
6.Hospital Planning and Research cell at
State level.

24. METHODOLOGY
1.Indirect method - Structure factors
2.Direct method - Process and Outcome
factors.

25. • STRUCTURE FACTORS
• Measurement concern with physical facility,
staff and equipments.
• Men, material and machine.

26. • PROCESS FACTORS
• It means the ‘way’ a patient is move through a
medical care system.
• The process criteria can be evaluated by the
outcome of procedures like – no. of patient
cured, infection rates , no. of bed sores , and
patient dissatisfaction.

27. Medical Audit Cycle
1. Select
topic
7. Implement
change
8. Re-audit
2. Agree
standards of
best practice
3. Define
methodology
4. Pilot
and data
collection
5. Analysis and
Reporting
6. Make
recommendations
Action Planning
Audit

28. STAGES OF MEDICAL AUDIT
• 1. Criteria development.
• 2. Selection of cases within diagnosis.
• 3. Work sheet preparation.
• 4. Case evaluation.
• 5. Tabulation of evaluation.
• 6. Presentation of reports.

29. STAGES OF MEDICAL AUDIT

30. 1.Criteria Development
• The audit committee should choose the
diagnosis to be studied.
• Once diagnosis have been selected the criteria
are developed.
- Indications for admission
- Hospital services recommended for optimal care
- Range of length of stay & indications for discharge
- Complications or additional diagnoses

31. 2.Selection of Cases within diagnosis.
• It is necessary to enough cases to be evaluated in
each selected diagnosis to enable the committee
to speak with assurance.
• When sample is used the sampling method and
interval should be explained.

32. 3.Worksheet Preparation
• A standard form or worksheet for each diagnosis
is designed.
• On these sheets recorded pertinent data taken
from the patients medical record.

33. • Variables: ( with structured sub variables)
▫ Basic data
▫ Indication for admission
▫ Initial diagnosis
▫ Diagnosis agreement
▫ History: each relevant history
▫ Physical examination
▫ Lab Tests
▫ Treatment
▫ Nursing care
▫ Complications
▫ Mortality/Discharge

34. 4. Case Evaluation
• Once worksheets are completed and the charts
are available the evaluation follows .
• It is desirable to have physicians make the final
evaluation regarding effectiveness of
hospital stay and quality of medical care.

35. • All members of medical staff regardless of
speciality to be involved in evaluation.
• A group of five clinicians is
considered optimum by Payne.

36. • Evaluation report includes –
• Admission: appropriate/ inappropriate
• Length of stay: appropriate/ inappropriate
• Hospital services: Adequate/inadequate
• Comments.

37. 5.Tabulation of Evaluation
• All pertinent information from the worksheets
should be compiled in tabular form.
• Table showing relationships among all variables
should be drawn.

38. 6. Presentation of Reports
• This may be done in form of written or oral in
front of
• - executive committee
• - to entire staff or
• - to department primarily concerned.

40. TYPES OF MEDICAL AUDIT
• Morbidity Audit
• Mortality Audit
• On spot audit
• Statistical Audit.

41. Morbidity Audit
•Retrospective study of medical
records for the particular
disease.

42. • Objectives are -
• To identify measure for adequate patient care
practices for particular disease.
• To develop norms for adequate medical care for
particular disease.

43. Mortality Audit (Death Audit)
•Review a case of death
within 48 hours of death .

44. • The case sheet should be examined
for quantitative as well as qualitative
adequacy.
• The diagnosis, investigation and
treatment should be analysed and
related with acceptable standard.

45. •The case are then discussed with
committee and inadequacy and
bottleneck are communicated to
the officer concerned.

46. On-Spot Audit
• In this method medical audit team
goes to a particular ward and carries
out audit when patient is still in ward
and treating medical team is present.

47. Statistical Audit
• Medical record data should be prepared
ward wise , unit wise or monthly basis.
• The audit committee examines this
statistical data and gross deviation from
the accepted standards is further
investigated.

48. • Following data may be used –
• 1. Average length of stay.
• 2.Bed occupancy rate.
• 3.Bed turn over rate.
• 4.Gross and Net death rate.
• 5.Infection Rate.
• 6.Complication rate.
• 7.Consultation rate.

49. Medical Audit Committee
• Medical Audit Committee in hospital consist of -
• Chairmen- Director/Principal
• Member Secretary - Medical Superintendent
• Members - - Representatives from
hospital administration, clinical departments
and nursing.

50. • The function of Medical Audit and
quality assurance committee shall be
coordination, information , planning
search for expertise and follow up.

51. ROLE OF HOSPITAL ADMINISTRATOR IN
MEDICAL AUDIT
• 1.To facilitate and provide good working
environment.
• 2.To provide physical facility and resources.
• 3.To motivate medical care provider .
• 4.Patient satisfaction survey to reveal grey areas.
• 5.To frame clear cut objectives and policies.
• 6.To conduct exit interview and make changes as
suggested.

53. • Patient care includes elements that may be
examined objectively or subjectively.
• The objective elements can be
measured by statistical documentation
and analysis.
• While subjective element require
qualitative judgment through clinical
evaluation.

54. • Continuous evaluation provides
stimulation for improvements of
clinical service, professional
education , hospital administration
and better patient care.

55. •Medical and death audit when
practiced together can go long
way in improving the quality of
patient care which at present is
far below the expectation of
community.