1. For Improving Patients’ Care
Understanding Audit
For
Improving Patients’ Care

2. Objectives Define Medical Audit (M-Audit) and explain types of audit.
Recognize important terminology used in M-Audit.
Explain Audit Cycle
Identify framework for M-Audit to assess patients’ care
Differentiate between Criteria and standards

3. Objectives
6. Discuss ground rules for a topic to conduct Audit, and related Audit questions
7. Plan for a M-Audit topic.
8. Identify data could be utilize for conduction of Audit
9. Recognize the benefits of M-Audit
10. Identify the difference between M-Audit and research

4. Contents Types of Medical Audit (M-Audit) Terminology Audit Cycle
Audit framework
Criteria and Standards
Ground rules for an Audit topic
Planning Audit
Audit Questions
Data for Audit
Benefits
Audit and Research

5. Think
Pair
&
Share

6. Medical Audit A scenario
A huge number of our primary care clinics visitors are diabetic patients.
We would like to know that the diabetic care is appropriate in PCC.
What are the areas to be evaluated?
How we can plan for evaluation of Diabetic care in our clinic?
Medical Audit

7. What is Medical Audit? “…method used by health professionals to:
Assess
Evaluate &
Improve
…. the care of patients in a systematic way to enhance their health and quality of life”.

8. Terminology used in M-Audit
Self, Peer & External M-Audit
Audit Cycle
Structure, Process & Outcomes
Criteria & Standards
Planning for M-Audit
Audit Questions
Data Sources, Collection & Presentation

9. Types of Audit
Self Audit
Peer Audit
External Audit

10. COMPARE WITH STANDARDS
Audit Cycle
SET STANDARDS
IMPLEMENT CHANGE
OBSERVE PRACTICE
COMPARE WITH STANDARDS

11. Objectives are Covered
Define Medical Audit (M-Audit) and explain types of audit.
Recognize important terminology used in M-Audit.
Explain Audit Cycle

12. A framework for assessing care:
Audit requires a framework
Description, measurement, comparison and evaluation of the quality of health care can be made.
Three constituents of quality are:
Structure Process Outcomes

13. Scope of Audit STRUCTURE PROCESS OUTCOME Building Practice equipments
Working team
Prescribing habits
Hospital referrals
Laboratory / X ray use
PROCESS
Prevention / Control of disease
Improved level of functions
Relief of symptoms
Prevention of premature death
Minimizing the cost
Increase patient satisfaction
OUTCOME

14. Structure Describes the physical attributes of health care,
building, equipments,
Employees in the team: # and types,
Patient records.
Common sense suggests that health care is likely to be more effective if it is carried out in comfortable surroundings with the right equipments and by the most appropriate people.

15. Process
Describes the care given by the health care team, i.e., what the practitioner does, the sum of actions and decisions that describes a person’s professional practice.
Doctors and nurses tend to identify the process of care with quality because it describes what they do for their patients
It reflects their attitudes, knowledge and skills.

16. Outcomes
Describe measures that lie between true process and the definitive outcome.
They are easier to measure yet they predict, or are assumed to predict, definitive outcome.
Example: The Hb A1C for diabetic patients

17. Scope of Audit
STRUCTURE
PROCESS
OUTCOME

18. Outcome**
is the change in a patients’ current and future health status that can be attributed to antecedent health care
Therefore the definitive indicators of health
Describe the effectiveness of care.
For example, did the patient survive a potentially fatal condition ?

19. Criteria
&
Standards

20. Criterion
Describe a definable and measurable item of health care, which describes quality, and which can be used to assess it.
Example:
Females of susceptible age should be immunized against rubella.
All diabetic patient should receive pneumococcal vaccination
All children requesting attention for acute problems will be seen on the same day.

21. Standards
Describes the level of care to be achieved for any particular criterion.
Example:
Females of susceptible age should be immunized against rubella. The standard might specify that 98% of the female population at risk should receive protection.

22. Outcome-Intermediate
Criterion
Standards
Structure
Patients records will include summary cards.
Should apply to 50% of records.
Process
All patients attending out-patient clinics will have complete nursing assessments.
This should apply to :
50% - year 1,
75% - year 2,
95% - year 3,
Following the introduction of the standard.
Outcome-Intermediate
Patients with established HTN will have a diastolic level less than 120/80 mm Hg with in the first year of treatment.
The target level will be achieved in 80% of cases.

23. Objectives are Covered
4. Identify framework for M-Audit to assess patients’ care 5. Differentiate between Criteria and standards

24. Ground rules for choosing an audit subject
Is the subject chosen:
likely to benefit patients and the practice?
relevant to professional practice and development?
significant or serious in terms of the process and outcomes of patients care?
having potential for improvement?
capable of holding the interest and involvement of team members?
likely to repay the investment of time, money and effort involved?

25. The use of resources
It is important to decide on the maximum level of resources a team is prepared to commit to an audit.
In doing this it is also important to ensure that the subject examined is appropriate to the skills and resources available.
Resources can be divided into several categories: time, money, people.

26. Audit Questions - Examples
Are the waiting times for hospital outpatient appointments acceptable?
What are the complication rates of a particular type of surgery?
Are the consultants to whom patients are referred kind and considerate?
Which groups of patients are attending follow-up clinics unnecessarily?
How many of our Diabetic patients are controlled?

27. Planning an audit: 10-steps guidelines
Define the nature of the perceived problem.
Produce a clear written statement of aims.
Construct clear audit question.
Define the criteria & standard
Select the most appropriate method.
Identify the main analysis to be made.
Start small.
Have a short time-scale.
Proceed step by step.
Indicate how the possible need for change is to be handled.

28. Data Sources Routine practice data External data Medical records
Practice activity analysis
Prospective recording
Surveys
Interviews
Direct observation
Confidential enquiries

29. Data collection grid 1 2 3 4 5 → 20 Age Sex Drug Marital Status
→ 20
Age
Sex
Drug
Marital Status
BP recorded
Case 1 75 M A S Y
Case 2 81 B W
Case 3 77 F C N ↓ 40

30. Data presentation card
Age (years)
Married
Single
Total
BP recorded
Antihypertensive prescribed
75 – 79 9 3 12 13 4 2 6 10 1
85 – 89 7
90 – 94 8
95 – 99 19 21 40 28

31. Presentation of data
The analysis of data produces results that need to be converted into information which the practice team can understand and to which they can relate
Trends or insights must be presented in a visual way that communicates the information effectively.

32. Objectives are Covered
6. Discuss ground rules for a topic to conduct Audit, and related Audit questions 7. Plan for a M-Audit topic. 8. Identify data could be utilize for conduction of Audit

33. Benefits of Medical Audit?

34. Benefits of Medical Audit
Reducing errors
Improve efficiency / effectiveness
Demonstrating good care
Meeting patients’ needs / expectations
Stimulating education
Bidding for resources
Effective defense

35. Medical Audit
&
Research?

36. M-Audit Research Based on the comparison of practice against standards
Based on an idea (hypothesis), Qs
Creates knowledge of current clinical
practice and need for improvement
Creates new knowledge regarding most beneficial practice
Small scale over a short time period
Large scale over a long time period
Does not necessarily need a
statistically valid sample size
Needs a statistically valid sample size
Basic statistical analysis usually
suffices
Extensive statistical analysis is required
Clear responsibility to act on findings
No mechanism to act on findings
Does not usually require ethical
approval
Always requires ethics committee approval

37. Plan an Audit
A huge number of our primary care clinics are diabetic patients who are followed in the clinic.
We would like to know that the diabetic care is appropriate in PCC.
What are the areas to be evaluated?
How we can plan for the evaluation of Diabetic care in our clinic?

38. Planning an audit: 10-steps guidelines
Define the nature of the perceived problem.
Produce a clear written statement of aims.
Construct clear audit question.
Define the criteria & standard
Select the most appropriate method.
Identify the main analysis to be made.
Start small.
Have a short time-scale.
Proceed step by step.
Indicate how the possible need for change is to be handled.

39. Objectives are Covered
Define Medical Audit (M-Audit) and explain types of audit.
Recognize important terminology used in M-Audit.
Explain Audit Cycle
Identify framework for M-Audit to assess patients’ care
Differentiate between Criteria and standards

40. Objectives are Covered
6. Discuss ground rules for a topic to conduct Audit, and related Audit questions
7. Plan for a M-Audit topic.
8. Identify data could be utilize for conduction of Audit
9. Recognize the benefits of M-Audit
10. Identify the difference between M-Audit and research

41. Summary
Audit ia an important process to assess, evaluate and improve patients’ care
Appropriate selection of an audit topic is an important step for success
It is a continuous and cyclic process.
It could be conducted internally or from an external body
Dedicated team members needed

42. THANK YOU