Clinical Audit

Clinical audits are part of the continuous quality improvement process that focus on specific issues or aspects of health care and clinical practice. They consist of measuring a clinical outcome or a process, against well-defined standards set on the principles of evidence-based medicine.
Clinical audit is a way to learn if healthcare is being provided is in line with standards and allows care providers know where their service is doing well and where there could be improvements.
The main stages of the clinical audit process are:
1) Selecting a topic.
2) Agreeing standards of best practice (audit criteria).
3) Collecting data.
4) Analysing data against standards.
5) Feeding back results.
6) Discussing possible changes.
7) Implementing agreed changes.
8) Allowing time for changes to embed before re-auditing.
9) Collecting a second set of data.
10) Analysing the re-audit data.
11) Feeding back the re-audit results.
12) Discussing whether practice has improved.
This process is called the Audit Cycle
The topic of the clinical audit should be chosen systematically so that the HCO benefits as a whole from the audit. Clinical audit projects are best focussed on the processes like treatments or procedures, which have direct impact on patient outcomes. In particular, it would be a good choice to face a problem that involves the clinician in terms of: (1) High volumes of work; (2) High costs in terms of health and/or economic; (3) High risk; (4) High variability; (5) High complexity; and (6) High innovation.
As a reference the listed few resources can be used:
• National Institute of Clinical Excellence (NICE),
• Publication of conclusive new evidence about clinically effective healthcare.
  • local or regional treatment guidelines, protocols, or frameworks.
  • user views or complaints.
  • adverse incident/near miss reporting (eg: clinical/critical incident reporting).
The clinical audit team should be formed, and this can be Uni-disciplinary or Multi-disciplinary depending on the care plan and the chosen topic. Once the topic has been selected, the purpose of the project must be defined, so that a proper audit methodology can be chosen and designed. The aim of an audit could include the implementation of new processes (for example laboratory protocols, surgical procedures, etc.) and/or the improvement of current strategies.
Once the preliminary steps of the audit have been defined, the next step is to set the standards, which the current clinical practice will be compared to. At this point, it is important to clarify some definitions: (1) Indicator: a variable that allows to describe complex phenomena and to measure changes in relation to defined criteria, in order to guide the decisions aiming at obtaining or maintaining the changes. It can be expressed as absolute number, percentage, rate, or average; (2) Criterion: it is a definable and measurable aspect of health care that describes its quality. 
Standards should be SMART (Specific, Measurable, Attainable, Relevant & Time bound) and are more specific than objectives. They are quantifiable statements detailing the specific aspects of patient care and management that you intend to measure current practice against. Standards should always be based on the strongest, most up-to-date, evidence of what constitutes best practice. If standards are available in the form of guidelines, you should base your audit on the most widely applicable guidelines available, e.g. national guidelines rather than regional or local guidelines.
Clinical audit should always be conducted within an ethical framework.
In clinical audit data can be collected prospectively or retrospectively. Before proceeding with data collection, it is necessary to carefully plan the variables to be recorded and define the type of analysis to be conducted on the collected data. These points are important to prevent the collection of useless data and minimise wastage.
The sample population will be dependent upon your topic. The majority of clinical audit tends to assess the care of a defined group of patients who share certain characteristics. Typically, the fact that they have the same medical condition, have received the same form of treatment or were seen within a certain time frame.
Data analysis is the main part of your clinical audit. The data analysis should establish which standards are being met and which are not. If a standard is not being met, then you need to identify why and how practice can be improved to ensure that the standard is met in the future. You may also consider if there were other, acceptable reasons for the standard not being met, i.e. an exception not considered during the planning stage.
Finally, all the findings drawn from data analysis and the subsequent discussion, including strategies to implement change, should be reported in a detailed account to be distributed to all participants of the audit, as feedback and reminder of the work done.
Once the changes or corrective actions are implemented, re audit the process after a defined period to assess the impact of the changes made.
If it is observed that the objectives have not been achieved and the plan of improvements was not effective or sufficient, it could be necessary to make changes to planned strategies. However, also in case of success, a monitoring plan should be equally scheduled in order to maintain the improvements made.
Chetana S Nayak
Partner & Co founder
Medigrow Healthcare Consulting LLP

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