1. Clinical Audit and the Audit Cycle

2. What we are going to cover today
The audit cycle
Criteria and standards
Structure, process and outcome
An audit example
Problems with audit
How audit fits into ‘Clinical Governance’

3. A definition of audit
“The systematic critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources and the resulting outcome and quality of life for the patient” Working for Patients 1989

4. Effective audit An educational activity Promotes understanding
Resource effective
Raises standards
Promotes change
Source of information
Peer led
Involves patients

5. The audit cycle Problem or objective identified
Criteria agreed and standards set
Re-audit
Make necessary changes
Audit (Data collected)
Identify areas for improvement

6. Another way of expressing the audit cycle
Determine which aspects of current work are to be considered
Describe and measure present performance
Develop explicit standards
Decide what needs to be changed
Negotiate change
Mobilise resources for change
Review and renew the process

7. Criteria and standards
Criteria are those aspects of care that you wish to examine
Standards are the pre-stated or implicit levels of success that you wish to achieve

8. Structure, process and outcome
Structure refers to resources you have available (including current knowledge, skills and attitudes)
Process refers to what you actually do, e.g. a protocol
Outcome refers to the health benefits, cost effectiveness or person satisfaction

9. The great lunch audit Problem Criteria Standards
The service user feels that their meals are cold on arrival from the kitchen because they are plated up in advance
The meals will be hot and satisfying to the service users
The meals shall be plated up once service users are sat at the table

10. The great lunch audit Methods
A member of the care staff will work with the kitchen staff for two weeks to check that the meals are not plated until the service users are ready to eat. They will then conduct group interviews with the SUs to assess the improvement and produce feedback.

11. Contents of an audit Background Literature review
Criteria and standards
Methods or protocol
Results
Recommendations for change
Recommendations for further audit

12. Why audit Useful clinically Encourages teamwork
Improves patient/service user care
Financial benefits (sometimes!)

13. Problems with audit Audit and research Statistical verification
Outcome measures and proxies
Protocols
Closing the loop - introducing change and re-audit

14. Activity
Choose an area in your workplace which you would like to change. Using the clinical audit cycle, identify the problem, criteria and standards and the outcome you would like to achieve.

16. A word about clinical governance
“A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards by creating an environment in which excellence in clinical care will flourish” A First Class Service 1998

17. ‘Clinical Governance’
Practice accreditation
Practice development plans
Research
Postgraduate medical education
Special interest groups
Evidence based medicine
Audit
Personal development plans
Dissemination of guidelines

18. ‘Clinical Governance’
Accountability

19. Reference www.glospccag.nhs.uk/userfiles/docstore/pdf/.../auditcycle
Morrell, C and Harvey, G.(2003) The clinical Audit handbook. London. Bailliere Tindell