Medical Audit

1
Medical Audit

• Presenter Dr. Preeti Thaware

2
Frame work

• What is audit?
• What is medical audit?
• Why audit?
• Audit versus research
• The quality cycle
• Stages of medical audit

3
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.
4
 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.

5
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

6
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

7
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

8
Quality cycle
Prevent future problems
Identify problems
Correct the problem
9
Five stages of clinical audit
10
Stage 1 Preparing for audit

• Involving users
• Selecting a topic
• Defining the purpose
• Planning

11
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

12
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
13
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?

14
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

15
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.

16
Stage 2 Selection criteria

• Defining criteria
• Sources of evidence
• Appraising the evidence

17
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.

18
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.
19
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

20
Stage 3 Measuring level of performance

• Planning data collection
• Methods of data collection
• Handling data

21
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

22
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

23
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.

24
Stage 4 Making improvements

• Identifying barriers to change
• Implementing change

25
Stage 4 Making improvements continues..

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

26
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

27
Stage 5 Sustaining improvement

• Monitoring and evaluation
• Re-audit
• Maintaining and reinforcing improvement

28
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

29
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

30
Stage 5 Sustaining improvement continues..

• Maintaining and reinforcing improvement
• reinforcing or motivating factors built in by the
  management .
• integration of audit
• strong leadership

31
(No Transcript)
32
References

• Francis C. Hospital administration selected
  reading in hospital administration New Delhi
  India Hospital Association Delhi Jan 1990.
• George M. The Hospital Administration. New Delhi
  Jaypee 2003.
• Srinivasan A. Managing modern hospital by Medical
  audit and its administrations. New Delhi\London
  Response books. 2005
• Sarkharkar B, Principles of hospital
  administration and planning. Jaypee brothers
  medical publishers.1999.
• World Health Organization. Medical record
  documentation audit instructionsonline.Available
  from URLhttp//www.who.int.medical audit
• Jepson R,Weller D, Alexander Freda, Walker
  J.Impact of UK colorectal cancer screeing pilot
  on Primary care. Bitish Journal of general
  Practice. Jaunary 2005.
• Graham W, Wagaarachchi P, Penney G, MacCaw 
  BinnsA, Antwi K,Hall M. Criteria for clinical
  audit of th quality of hospital based obstetric
  care in developing countries.Bulletin of the
  world Health organization. 2000. 78 (5).
• Bhatnagar T, Mishra Cp, Mishra Rdrug
  prescriptionpractices Ahousehold study in rural
  varanashi.Indian Journal Preventive
  Medicine.200334(12).
• Srishyla M, Krishnamurthy M, Nagarani M, MaryC, C
  Andrade, BV Venkataraman. Prescription audit in
  an Indian hospital setting using the DDD (Defined
  Daily Dose) concept.Indian journal of
  pharmacology.1994  .Volume 26  ( 1 ). 23-28.
• . Neville R, Hoskins G. ,. McCowanC, Smith B.
  Pragmatic 'real world' study of the effect of
  audit of asthma on clinical outcome. Primary care
  respiratory Jouranal. 2004 Dec Vol 13 ( 4 )
  .