Medical Audit

Frame work What is audit? What is medical audit? Why audit? Audit versus research The quality cycle 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 sponsorer Protect current and future funding Improve quality. It does not involve experiments It uses data that already exists

Audit:- are we doing the best thing in the best way? 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:- What is the best thing to do/the best way to do it 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

Prevent future problems Quality cycle Identify barrier Prevent future problems Identify problems Correct the problem

Five stages of clinical audit

Stage 1: Preparing for audit Involving users Selecting a topic Defining the purpose Planning

Stage 1: Preparing for audit continue……. Involving users: genuine collaborators sources of data The 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 enhance to increase to change to ensure

Stage 1: Preparing for audit continue……. Planning: Involve ALL the people concern. Time and resources Access the evidence Methodology Pilot Report and Action Re-audit Data collection instrument 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 Aim /objectives Methodology Results /conclusions Applicable to your patient group 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 Examples 1.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 identification of local barriers to change support of teamwork 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: monitor and evaluate the change 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