Clinical audit
Clinical audit is a systematic process used in healthcare to evaluate and improve the quality of patient care by comparing actual treatment practices against established standards. This evaluation seeks to determine if healthcare providers are effectively meeting the needs of their patients based on defined criteria. Initially rooted in the work of early healthcare pioneers like Florence Nightingale and Ernest Amory Codman, clinical audits have evolved from sporadic evaluations to a more structured approach, particularly since the 1980s.
The audit process typically involves multiple stages, focusing on key aspects such as the structure, process, and outcomes of care. For example, an audit may assess whether adequate healthcare resources, like nutritionists, are available in a community for effective diabetes management. A successful clinical audit can provide valuable insights that assist medical staff and administrators in making informed decisions to enhance patient care and resource utilization.
Although recognized as beneficial, the implementation of clinical audits may vary due to perceived limitations, including resource constraints. Nonetheless, when executed properly, audits can uncover critical areas for improvement, such as training needs or communication issues among staff, ultimately leading to better healthcare outcomes.
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Clinical audit
A clinical audit is a tool used to determine if health care quality standards are being met. It is an evaluation of care a patient received compared to established criteria. Changes to care may be made as a result of a clinical audit. If so, the results are again evaluated to see if changes have improved patient care.
A poorly conducted audit may fail to provide useful results. Therefore, planning and communication are necessary. National bodies, regional groups, or local facilities may perform clinical audits.
Background
Clinical audit has a long history in health care. While early practitioners relied on tradition to guide care, a few sought to evaluate treatments and outcomes clinically. Some collected data, including mortality statistics, to find connections to treatments and conditions.
Florence Nightingale, who is regarded as the founder of modern nursing, began to evaluate procedures and results during her career as a nurse and administrator in the late nineteenth century. She was caring for soldiers in a hospital in Istanbul, Turkey, during the Crimean War (1853–1856), when the death rate at military hospitals was high. Nightingale realized that medical care must be evaluated to be improved. When she returned home to England, she persuaded the government to establish a commission to evaluate data about the army and patient care. The results were astounding. The vast majority of deaths reviewed by the committee were caused by preventable diseases that soldiers caught because of unsanitary conditions, rather than wounds they received in battle. Nightingale, who was extraordinarily gifted in mathematics and statistics, presented the commission's findings in diagrams, which showed a 99 percent decrease in fatalities after sanitary procedures were put in place. Nightingale continued to examine statistics and develop procedures for nurses to follow while caring for patients. When scientists confirmed that germs caused illness, she emphasized the need for hygienic practices—such as handwashing—and sanitary living conditions to preserve public health. She monitored mortality statistics and charted results of changes.
American surgeon Ernest Amory Codman also was concerned with charting outcomes and evaluating procedures based on results. He promoted the end result idea, which states that medical staff should track patients' conditions long enough to determine whether treatment is beneficial. If treatment is not successful, the staff should try to learn from the failure to improve outcomes. The end result idea led to the development of the American College of Surgeons' hospital standardization movement, which sought to ensure that all facilities offered quality care. Codman evaluated military medical procedures during World War I (1914–1918). Much of his work was concerned with reviewing medical records to identify errors in care.
While some evaluation of records was undertaken sporadically during the twentieth century, formal medical audits began during the 1980s. Physicians primarily conducted these. Clinical audit was created soon after, when medical, nursing, and therapy audits were combined.
Overview
Clinical audit is a systematic process to assess, evaluate, and improve patient care. It compares treatment to a defined standard of care. The audit questions whether a facility's staff members are doing what they believe to be right and if it is being done correctly. The audit also looks at factors such as the structure of care (Are facilities located in areas where they are needed?), process of care (Are enough physicians on staff to meet patient needs?), and outcome of care (Is impact measureable? Is it negative or positive?). For example, if diabetes management were a concern in a community, an audit would examine if enough nutritionists and other health care professionals were located in the community to meet patients' needs. It would also examine if treatment effectiveness can be measured in terms of patients who can manage their condition without medication or by other criteria. The audit would then examine how statistics before and after treatment compare.
A successful audit appeals to a wide audience—medical staff and administrators, for example. Even a topic related to patient care can have an impact beyond the medical concerns. Hospitals are interested in providing the best care, and statistics about patient care can help management determine if standards are being met and if practices should change. Financial considerations are also a factor, and an audit that benefits the facility can draw wide support from multiple departments.
An audit should have a focus that is specific and important. A valuable topic is more likely to be approved by the institution and supported by the staff members who will collect the data. Resources may be limited, so the audit should target a topic that will have an impact—on patient care or a facility's use of resources, for instance. The focus must be measureable, for example in terms of patient improvement, reduction of readmission or mortality rates, or efficiency. A facility may choose to target a topic because it is known to be a problem. For instance, a facility may respond to medication errors by performing a clinical audit to determine how to reduce errors.
Those involved in carrying out an audit should understand the criteria so they collect data that is needed and do not compile unnecessary information. This includes an understanding of current practice or standards. Audit designers should check with national organizations to find best-practice recommendations for an issue and compare them to local and regional standards. If no best practices have been established, the clinical team may establish standards for the audit. Standards should be based on sound evidence and should be SMART: specific, measurable, achievable, relevant, and time-bound.
Audit organizers must establish methodology for collecting data. This includes ensuring enough cases are included and avoiding data bias—for example, a study could be biased if it takes place during an outbreak of influenza or other event that influences the number or type of patients in a facility. The audit must adhere to ethical standards. If data that is needed is normally collected by a facility, the audit may examine patient records. However, if it is not part of the normal patient record, staff will have to be informed to ensure information is recorded consistently.
A clinical audit can improve patient care as well as staff performance. It may reveal shortcomings, such as insufficient staff training or communication breakdowns. Although clinical audits are regarded as valuable to health care professionals and facilities, facilities may not conduct them for various reasons, such as perceived lack of resources.
Bibliography
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