(MEDICAL)

CLINICAL AUDIT
Department of Public Health
Faculty of Medicine UNPAD
2013
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)
AUDIT
Evaluation of data, documents and
resources to check performance of systems
meets specified standards.
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.
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
Clinical Audit
The process by which doctors, nurses and other health
professionals regularly and systematically review and where
necessary change their clinical practice

The main objective of audit is to improve the
effectiveness and efficiency of patient care
Clinical Audit
The
structure of
care
The
outcome
of care
The
process
of care
Three main constituents
Structure
Staffing
Buildings
Operation time
etc
Process
Number of
operation
etc
Outcome
Mortality
Morbidity
Patient
satisfactory
Audit Cycle
Preparing
for audit
Selecting
criteria
Measuring
performanc
e
Making
improvemen
ts
Sustaining
improvemen
ts
Stage 1: Preparing for audit
Involving users
Selecting a topic
Defining the purpose
Planning

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?
Stage 2: Selection criteria
Defining criteria
Sources of evidence
Appraising the evidence

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
Stage 3: Measuring level of
performance
Planning data collection
Methods of data collection
Handling data

Stage 4: Making improvements
Identifying barriers to change
Implementing change


I dentifying barriers to change
Fear
Lack of understanding
Low morale
Poor communication
Culture
Pushing too hard
Consensus not gained

I mplementing Change:
(systematic approach)
o identification of local barriers to change
o support of teamwork
o use of a variety of specific methods
Stage 5: Sustaining improvement
Monitoring and evaluation
Re-audit
Maintaining and reinforcing improvement


AUDI T
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
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
REFERENCE
Fraser R. Lakhani M, Baker R. Evidence-Based audit in general practice.
Butterworth. Oxford. 1999.