Frame work1. What is audit?

2. What is medical audit?

3. Why audit?

4. Audit versus research

5. The quality cycle

6. Stages of medical audit

What is audit?

Evaluation of data, documents and resources to check performance of systems meets specified standards.

Audit in the wider sense is simply a tool to find out what you do now; this often to be compared with what you have done in the past, or what you think you may wish to do in the future.

 What is 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.”

An audit is a cyclical process

-defining standards,- collecting data,- identifying areas for improvement, - making necessary changes - back round to defining new standards.

Why audit?

Maintain participant and staff safety.Maintain data quality .Protect reputation of staff, host and sponsorerProtect current and future fundingImprove quality.It does not involve experimentsIt uses data that already exists

Audit:- are we doing the best thing in the best way?Measures current practice against specific standardsNever experimentalUses data in existence by virtue of practiceMay require ethical approvalAims to improve delivery of patient care

Research:- What is the best thing to do/the best way to do it

Provides sound basis for medical auditInvolves experimental trialsUses detailed data collection Needs ethical approval and registration Aims to add to body of scientific knowledge

Quality cycle

Correct the

problem

Prevent future

problems

Identify problems

Five stages of clinical audit

Stage 1: Preparing for auditInvolving users Selecting a topicDefining the purpose Planning

Stage 1: Preparing for audit continue…….Involving users:- genuine collaborators- sources of dataThe concerns of users can be identified from various

sources, including:-Letters containing comments or complaints -Critical incident reports -Individual patients’ stories or feedback from focus groups -Direct observation of care -Direct conversations

Stage 1: Preparing for audit continue…….Selecting a topic:- starting point - careful thought and planning

There seems little point in trying to audit a rare condition, with a cheap intervention with a fairly superficial outcome

Stage 1: Preparing for audit continue…….Selecting a topic:Tool for prioritise audit topics questions: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?

Stage 1: Preparing for audit continue…….

Defining the purpose- purpose must be established before appropriate methods

for audit can be considered. - Once topic selected, purpose define then suitable audit

method can be chosen.- The following series of verbs may be useful in defining the

aims of an audit to improve to enhanceto increaseto changeto ensure

Stage 1: Preparing for audit continue…….Planning:o Involve ALL the people concern.o Time and resourceso Access the evidenceo Methodologyo Piloto Report and Actiono Re-audito Data collection instrumento All these should be documented.

Stage 2: Selection criteria Defining criteria

Sources of evidence

Appraising the evidence

Stage 2: Selection criteria continue………

Definition of criteria:- an individual, a team, or an organisation- This can include assessment of the process and/or

outcome of care- The choice depends on the topic and objectives of the

audit. - They should relate to important aspects of care and be

measurable.

Stage 2: Selection criteria continue………

Sources of evidence:- Systematic methods should be used

. good-quality guidelines

. reviews of the evidence

. previously use criteria for same purpose

. Measurement of outcome

Can develop own standards.

reference to levels achieved in audits undertaken by other professionals is useful.

Stage 2: Selection criteria continue………

Appraising the evidence:

-Evidence needs to be evaluated to find out if it is valid, reliable and important

o Aim /objectiveso Methodologyo Results /conclusionso Applicable to your patient groupo Bias/ causes for concern

Stage 3: Measuring level of performance

Planning data collection

Methods of data collection

Handling data

Stage 3: Measuring level of performance continues…….Planning data collection:- the data collected are precise- Essential- User group to be included

Examples1.All children under 16 years diagnosed with asthma and registered with the primary healthcare team.

2. All women receiving treatment for breast cancer in M.G.I.M.S

Stage 3: Measuring level of performance continues…….Methods of data collection: Do not try and collect too

many items,keep it simpleaand short.

- Computer stored data,Case notes/Medical Records,Surveys , Questionnaires, Interviews

Focus Groups, Prospective recording of specific data

- How will this be done?-Compare performance against the criteria-Keep focused on the objective of the audit

Stage 3: Measuring level of performance continues…….

Handling data:- ethical implications of and their responsibilities under the

Data Protection Act (1998) when collecting data and presenting results.

Stage 4: Making improvements

Identifying barriers to change Implementing change

Stage 4: Making improvements continues……..Identifying barriers to change

- Fear

- Lack of understanding

- Low morale

- Poor communication

- Culture

- Pushing too hard

- Consensus not gained

Stage 4: Making improvements continues……..

Implementing Change:- systematic approach o identification of local barriers to changeo support of teamworko use of a variety of specific methods

Stage 5: Sustaining improvement

Monitoring and evaluation Re-audit Maintaining and reinforcing improvement

Stage 5: Sustaining improvement continues……..

Monitoring and evaluation- systematic approach to changing professional practice

should include plans to:o monitor and evaluate the change o maintain and reinforce the change

Stage 5: Sustaining improvement continues……..Re-audit

-Review evidence

-Measure effectiveness

-Decide how often to re-audit

- Ongoing process monitoring

-Adverse incidents

-Significant events audit

Stage 5: Sustaining improvement continues……..

Maintaining and reinforcing improvement- reinforcing or motivating factors built in by the

management .- integration of audit- strong leadership