(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 Outcome Mortality Morbidity Patient satisfactory

Audit Cycle Preparing for audit Selecting criteria Measuring performance Making improvements Sustaining improvements Audit Cycle

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

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

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

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

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.