Basics of Medical/Clinical Audit

What is audit?

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.

Medical Audit (MA) has a more specific meaning, and this is vital for the measurement of the quality of care given to the practice population. MA requires standard-setting, data collection, comparison with standard’s, review of data and standards, review of current practice, change in that practice and further data collection and comparison with the original data.

This can be summarised in the Audit cycle. As a tool it leads to reading around a subject, searching for evidence or best practice for the standard-setting, use of IT to collect data and communicate with patients. Changes have to be negotiated with the various members of the practice, and the primary health care team. Finally, the resultant audit is a valuable tool for the practice when looking at quality issues. There is also scope to seek financial help for such an audit from the Health Authority, savings and other sources.

Medical Audit

The study of some part of the structure process and outcome of (clinical) care, carried out by those personally engaged in the activity concerned, to measure whether set objectives have been attained and thus assess the quality of care delivered.

Audit involves

  • A systematic examination
  • Comparison of results against set criteria
  • Assessment of quality of care with a view to improvement
  • Monitoring the effect of audit-induced changes

Why audit?

  • Educational value for participants
  • (Im)prove effectiveness and efficiency
  • Reassure consumers

What to audit

  • Structure
  • Process
  • Outcome

How to audit?

  1. Define the standards which you should be able to realistically reach of the area which you intend to audit. Standards should be
    • Realistic
    • Owned/ownable
    • Parallel to existing standards – “one country, two systems”.
  2. Set the criteria by which you will measure those standards.
  3. Compare your results against your defined standard. Is change needed?
  4. Review the results of any changes made.

How to define standards?

  • Talking
  • “Good practice is…”
  • “What is acceptable…”
  • “What is unacceptable…”
  • A level of detail rather than a level of generality
  • Clear

Key questions in medical audit

  • What do we do?
  • Do we do what we think we do?
  • What should we do?
  • Are we doing what we should be doing?
  • How can we improve what we do?
  • Have we improved?

The audit cycle

Audit cycle

The audit assessment form can be used to determine the completeness of an audit.

Types of sampling

  • Random sampling – using some form of random number generator.
  • Systematic sampling – eg: every second patient.
  • Stratified sampling – according to similar characteristics eg male.
  • Cluster sampling – eg only 2 of 6 partners audied and results relatd to the whole practice.

Sample size

 

Research or audit?

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