1. (MEDICAL) CLINICAL AUDIT
Department of Public Health
Faculty of Medicine UNPAD
2013

2. 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)

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

4.  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.”

5. 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

6. Clinical Audit
“The process by which doctors, nurses and other health professionals regularly and systematically review and where necessary change their clinical practice”

7. The main objective of audit is to improve the effectiveness and efficiency of patient care

8. Clinical Audit The structure of care The outcome of care
The process of care

9. Three main constituents
Structure
Staffing
Buildings
Operation time
etc
Process
Number of operation
Outcome
Mortality
Morbidity
Patient satisfactory

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

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

12. 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?

13. Stage 2: Selection criteria
Defining criteria
Sources of evidence
Appraising the evidence

14. 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

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

16. Stage 4: Making improvements
Identifying barriers to change
Implementing change

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

18. Implementing Change:
(systematic approach)
identification of local barriers to change
support of teamwork
use of a variety of specific methods

19. Stage 5: Sustaining improvement
Monitoring and evaluation
Re-audit
Maintaining and reinforcing improvement

20. 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

21. 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

22. reference
Fraser R. Lakhani M, Baker R. Evidence-Based audit in general practice. Butterworth. Oxford