What is clinical audit?
"Clinical 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 (2002, NICE/CHI)
In a simpler way to say, a clinical audit is a process to improve & update the level of quality of care in clinical setting...
Straight to the point, let's see how clinical audit should be done, step by step. From what I've learnt, there are 6 stages in clinical audit.
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1) SELECT A TOPIC
✏ Topics selected from:
---- Routine data
---- Patient satisfaction survey
---- Observation of care delivery
---- Inputs from stakeholders
---- Enthusiasm of a certain care groups
✏ Topic selection criteria:
---- Can be improved
---- High risk, cost, volume, problem
---- Support or concensus from clinician
---- Clear clinical guidelines
✏ Develop objectives:
---- Objective: general & specific objectives
---- Specific = e.g. appropriateness, timeliness, effectiveness, etc.
---- E.g.: To improve diagnosis of appendicitis, etc.
✏ Stage 1 result (example):
---- Topics: Tuberculosis
---- Objective: To improve quality of services for patients with tuberculosis
---- Specific objective: Ensure diagnosis is made according to guidelines.
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2) DETERMINE CRITERIA & STANDARD
✏ Criteria:
---- Definition: Things/Evidences to be reached
---- Common criteria: Processes (e.g. diagnosis, treatment, etc)
---- Less common: Input (due to lack of $), Output (too complicated!)
---- Writing criteria: Standard, Exceptions, Instructions for data collectors
✏ Stage 2 result (example):
---- Criteria: Tuberculosis
---- Standard: 2 sputums (100%)
---- Exception: Can't be collected in child with certain age.
---- Instr. for data collectors: Collect 2 sputums in suspected patients in allowed age range.
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3) COLLECT DATA
✏ Data types:
--- Retrospective:
------ ➥ data from previous time (past)
------ ➥ pro- readily available
------ ➥ cons- some may not be a complete source of data
--- Prospective:
------ ➥ data that will be collected after the plan is made
------ ➥ pro- complete according needed criteria
------ ➥ cons- some may not be a complete source of data
✏ Evaluating Criteria Codes:
-- ➟ Code I : According to standards
-- ➟ Code II : Not according to standards, but meeting the exception (justified)
-- ➟ Code III : Not according to standards and not meeting the exception (unjustified)
✏ Variables:
---- selected to understand certain patterns or variations
---- E.g.: hospital, doctor, nurse, ward, patient characteristics (age,etc)
✏ Stage 3 result: Put in a table (variables & criteria data for each medical records)
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4) DATA ANALYSIS
✏ To be done:
---- Re-check: esp for deficiency (ensure that deficiency is correct)
---- Identify the sample, if it is represent the population
---- Measure level of compliance
---- Measure pattern of deficiency
---- Identify cause of deficiency using quality tools
✏ Analysis methods:
---- Bar graph, Check sheet, Histogram, Scatter diagram, Ishikawa/Fish-bone diagram, etc
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5) MAKE CHANGES
✏ "Most important in an audit cycle is making changes" - Baker et al (1999)
✏ Changes categories (Langley, 1996)
---- Eliminate waste
---- Improve work-flow
---- Optimize inventory
---- Change the work environment
---- Enhance the producer-customer relationship
---- Manage time
---- Manage variation
---- Design systems to avoid mistakes
---- Focus on the product or service
✏ Follow-up!
---- Plan for corrective actions (problems, plan of action, team, timeline)
---- Plan of follow-up (method, timeline, team)
---- Revised criteria (if any)
---- Approval from the authority
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6) RE-AUDIT
✏ Repeat the clinical audit cycle.
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Last but not least,
"Good is not good, when better is expected!"... ;)
Knowledge is power.
and He is the Most Powerful, for He knows everything :)
