Clinical Audit
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Transcript of Clinical Audit
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(MEDICAL) CLINICAL AUDIT
Department of Public HealthFaculty of Medicine UNPAD2013
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Learning objectives• Describe the definition of clinical practice audit (C2)• Describe the objective of clinical practice audit (C2)• Describe the benefit of clinical practice audit (C2)• Describe the phase in clinical practice audit (C2)
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AUDIT
Evaluation of data, documents and resources to check performance of systems meets specified standards.
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Medical audit
“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.”
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From medical to clinical audit• The priority of audit was to involve all health
professionals• Transition from uniprofessional to multidiscipline audit• Medical audit refer to audit carried out by medical doctor
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Clinical Audit
• “The process by which doctors, nurses and other health professionals regularly and systematically review and where necessary change their clinical practice”
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• The main objective of audit is to improve the effectiveness and efficiency of patient care
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Clinical Audit
The structure of
care
The outcome of
care
The process of
care
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Three main constituents
Structure
Staffing
Buildings
Operation time
etc
Process
Number of operation
etc
Outcome
Mortality
Morbidity
Patient satisfactory
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Audit Cycle
Preparing for audit
Selecting criteria
Measuring performanc
e
Making improveme
nts
Sustaining improveme
nts
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Stage 1: Preparing for audit• Involving users • Selecting a topic• Defining the purpose • Planning
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Selecting a topic:
Is the topic concerned of high cost, or risk to staff or users?
Is there evidence of a serious quality problem?
for example patient complaints or high complication rates?
Is there potential for involvement in a national audit project or pertinent to national policy initiatives?
Is the topic a priority for the organisation?
Is good evidence available to inform standards?
for example systematic reviews or national clinical guidelines?
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Stage 2: Selection criteria • Defining criteria
• Sources of evidence
• Appraising the evidence
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Target criteria and standard
Systematically developed statements that can be used to assess the appropriateness of health care service or outcome
Criteria The percentage of events that should comply with the criterion
Target
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Stage 3: Measuring level of performance
Planning data collection
Methods of data collection
Handling data
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Stage 4: Making improvements
Identifying barriers to change Implementing change
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• Identifying barriers to change• Fear• Lack of understanding• Low morale• Poor communication• Culture• Pushing too hard• Consensus not gained
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Implementing Change:(systematic approach)o identification of local barriers to changeo support of teamworko use of a variety of specific methods
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Stage 5: Sustaining improvement
Monitoring and evaluation Re-audit Maintaining and reinforcing improvement
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AUDIT
• Measures current practice against specific standards• Never experimental• Uses data in existence by virtue of practice• May require ethical approval• Aims to improve delivery of patient care
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RESEARCH
• Provides sound basis for medical audit• Involves experimental trials• Uses detailed data collection • Needs ethical approval and registration • Aims to add to body of scientific knowledge
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REFERENCE
• Fraser R. Lakhani M, Baker R. Evidence-Based audit in general practice. Butterworth. Oxford. 1999.