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PubMed2004

[The role of clinical audit in the quality improvement of health care].

The aim of clinical audit is continuous improvement of the quality of care through systematic and critical review of current practice against explicit criteria and the implementation of change if necessary. The audit is a regular multidisciplinary activity by which all participants of care including doctors, nurses and other health professionals carry out a systematic review of their own practice. Data collected during the process of audit should be handled with care, and individual data concerning care-givers, patients or health professionals must be treated confidentially. Clinical audit needs realistic timeframe and necessary resources as well as tolerant culture of learning organisations. Furthermore the success of clinical audit depends on the commitment and support of the management of the organisations. Clinical audit could relatively easily be embodied into the current practice of peer-review processes and other quality improvement initiatives in Hungary. Widespread and systemic application of clinical audit may improve the quality of patient care and maintain the trust of the population. However, clinical audit should be effective and cost-effective. The recently published methodological guideline by the Ministry intends to promote good practice in clinical audit.

Humans↗
PubMed2003

Using clinical audits to identify practitioner learning needs.

Clinical audits are used in medicine to monitor practice performance, provide practice feedback, and identify learning needs. Although relatively new to veterinary practice, they hold promise as personal learning needs assessment tools. Continuing veterinary medical education providers are in a unique position to assist practitioners in the design, implementation, and evaluation of clinical audits. This paper discusses the types, the interpretation, and the potential uses of data from clinical audits in the veterinary setting and links audits to continuing veterinary medical education.

Animals↗
PubMed2000

Reviewing audit: barriers and facilitating factors for effective clinical audit.

OBJECTIVE: To review the literature on the benefits and disadvantages of clinical and medical audit, and to assess the main facilitators and barriers to conducting the audit process. DESIGN: A comprehensive literature review was undertaken through a thorough review of Medline and CINAHL databases using the keywords of "audit", "audit of audits", and "evaluation of audits" and a handsearch of the indexes of relevant journals for key papers. RESULTS: Findings from 93 publications were reviewed. These ranged from single case studies of individual audit projects through retrospective reviews of departmental audit programmes to studies of interface projects between primary and secondary care. The studies reviewed incorporated the experiences of a wide variety of clinicians, from medical consultants to professionals allied to medicine and from those involved in unidisciplinary and multidisciplinary ventures. Perceived benefits of audit included improved communication among colleagues and other professional groups, improved patient care, increased professional satisfaction, and better administration. Some disadvantages of audit were perceived as diminished clinical ownership, fear of litigation, hierarchical and territorial suspicions, and professional isolation. The main barriers to clinical audit can be classified under five main headings. These are lack of resources, lack of expertise or advice in project design and analysis, problems between groups and group members, lack of an overall plan for audit, and organisational impediments. Key facilitating factors to audit were also identified: they included modern medical records systems, effective training, dedicated staff, protected time, structured programmes, and a shared dialogue between purchasers and providers. CONCLUSIONS: Clinical audit can be a valuable assistance to any programme which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at nurturing effective audits, valuable opportunities will be lost. Paying careful attention to the professional attitudes highlighted in this review may help audit to deliver on some of its promise.

Attitude of Health Personnel↗
PubMed2000

Measuring the quality of clinical audit projects.

The aim of the study was to develop and pilot a scale measuring the quality of audit projects through audit project reports. Statements about clinical audit projects were selected from existing instruments assessing the quality of clinical audit projects to form a Likert scale. Audit facilitators based in Scottish health boards and trusts piloted the scale. The participants were known to have over 2 years of experience of supporting clinical audit. The response at first test was 11 of 14 and at the second test 27 of 46. Audit facilitators tested the draft scale by expressing their strength of agreement or disagreement with each statement for three reports. Validity and reliability were assessed by test - re-test, item - total, and total - global indicator correlation. Of the 20 statements, 15 had satisfactory correlation with scale totals. Scale totals had good correlation with global indicators. Test re-test correlation was modest. The wide range of responses means further research is needed to measure the consistency of audit facilitators' interpretations, perhaps comparing a trained group with an untrained group. There may be a need for a separate scale for reaudits. Educational impact is distinct from project impact generally. It may be more meaningful to treat the selection of projects and aims, methodology and impact separately as subscales and take a project profiling approach rather than attempting to produce a global quality index.

Evidence-Based Medicine↗
PubMedDate not supplied

Clinical audit makes progress in care and teamwork.

Clinical audit should be about improving the delivery of care to patients as well as promoting multidisciplinary working in clinical teams. For clinical audit to move forward it must relate to, and be integrated with, four key areas: clinical effectiveness, the contracting process, patient-focused care and the development of clinical teams. This article discusses how users of health services can be helped to participate fully in clinical audit and its role in enhancing professional development of team members.

Humans↗
PubMed1996

Clinical audit and the purchaser-provider interaction: different attitudes and expectations in the United Kingdom.

OBJECTIVES: To explore and describe the views on clinical audit of healthcare purchasers and providers, and in particular the interaction between them, and hence to help the future development of an appropriate interaction between purchasers and providers. DESIGN: Semistructured interviews. SETTING: Four purchaser and provider pairings in the former Northern Region of the National Health Service (NHS) in England. SUBJECTS: Chief executives, contracts managers, quality and audit leaders, directors of public health, consultants, general practitioners, audit support staff, and practice managers (total 42). MAIN MEASURES: Attitudes on the present state and future development of clinical audit. RESULTS: Purchasers and providers shared common views on the purpose of clinical audit, but there were important differences in their views on the level and appropriateness of involvement of health care purchasers, integration with present NHS structures and processes (including contracting and the internal market), priority setting for clinical audit, the effects of clinical audit on service development and purchasing, change in behaviour, and the sharing of information on the outcomes of clinical audit. CONCLUSIONS: There are important differences in attitudes towards, and expectations of, clinical audit between health care purchasers and providers, at least in part due to the limited contact between them on audit to date. The nature of the relation and dialogue between purchasers and providers will be critical in determining whether clinical audit meets the differing aspirations of both groups, while achieving the ultimate goal of improving the quality of patient care.

Administrative Personnel↗
PubMed1999

The lack of integration of clinical audit and the maintenance of medical dominance within British hospital trusts.

Concerns have been expressed repeatedly about the effectiveness of clinical audit. Some have argued that this is limited by the lack of integration within day-to-day practice and with other NHS policy initiatives. We aimed to explore what mechanisms were being used to develop annual clinical audit programmes within NHS Trusts, and to describe the influence of other initiatives on this; to understand how such influences are exerted; and to understand the role of key players, in order to inform future programme development. Semi-structured face-to-face interviews were performed with Chairs of Clinical Audit Committees, Clinical Audit Managers and Co-ordinators (N = 15) in the former Yorkshire Region of the NHS in England. Concerns about the development, planning and integration of clinical audit focused upon an almost exclusive medical dominance and upon how audit leadership could be delivered within the context of hospital management structures. The lack of an overall plan for the development of clinical audit in most sites was seen as enabling the doctors' agenda to dominate. Purchasing authorities were recognized as being important, but often with limited influence. Other influences on the audit agenda, such as research and development (R&D) and clinical risk management, were rarely well co-ordinated. These findings concur with previous studies in identifying a wide range of constraints on the progress of audit. Several of these constraints operate within the internal environment, for example the doctors' agenda, and concerns about management involvement. Such constraints require resolution in order to facilitate the integration of audit with other initiatives and to achieve the goals of audit effectively. Clinical effectiveness and clinical governance may offer a means of facilitating this integration.

Health Policy↗
PubMedDate not supplied

Auditing clinical placements.

The auditing of clinical areas is an important aspect of evaluating and maintaining standards in the Project 2000 scheme of nurse education. The auditing process brings many unexpected additional benefits, including increased ownership of the course and a developing sense of partnership between clinicians and educators. It is not an endeavour that should be undertaken lightly, and many problems can be prevented by good planning, which may include extensive piloting of the audit tool and process.

Clinical Competence↗
PubMed1993

MAAGs (Medical Audit Advisory Groups): the Eli Lilly National Clinical Audit Centre.

Outlines the framework for promoting audit in general practice, created as one part of the health service reforms. Medical Audit Advisory Groups (MAAGs) were set up in each district with the aim of participation in audit of all general practitioners by April 1992. The activities undertaken have included those recommended by the Department of Health; the most significant of these being the appointment of lay facilitators who are able to assist general practitioners and primary care teams co-operate over efforts to improve the quality of care, and may offer one means of introducing some of the methods of total quality management into general practice. Discusses the problems which remain: audit is not yet sufficiently systematic, interface audit with secondary care is at a very early stage, the ways to involve managers and patients in audit remain to be clarified, and there is little evidence of the consequences of audit in terms of improved care. The Eli Lilly National Clinical Audit Centre has been set up within the Department of General Practice, University of Leicester, in order to address these issues.

Family Practice↗
PubMed1999

Scaling the quality of clinical audit projects: a pilot study.

OBJECTIVE: To pilot the development of a scale measuring the quality of audit projects through audit project reports. DESIGN: Statements about clinical audit projects were selected from existing instruments, assessing the quality of clinical audit projects, to form a Likert scale. SETTING: The audit facilitators were based in Scottish health boards and trusts. STUDY PARTICIPANTS: The participants were audit facilitators known to have over 2 years experience of supporting clinical audit. The response at first test was 11 out of 14 and at the second test it was 27 out of 46. INTERVENTIONS: The draft scale was tested by 27 audit facilitators who expressed their strength of agreement or disagreement with each statement for three reports. MAIN OUTCOME MEASURES: Validity was assessed by test-re-test, item-total, and total-global indicator correlations. RESULTS: Of the 20 statements, 15 had satisfactory correlations with scale totals. Scale totals had good correlations with global indicators. Test-re-test correlation was modest. CONCLUSIONS: The wide range of responses means further research is needed to measure the consistency of audit facilitators' interpretations, perhaps comparing a trained group with an untrained group. There may be a need for a separate scale for reaudits. Educational impact is distinct from project impact generally. It may be more meaningful to treat the selection of projects and aims, methodology and impact separately as subscales and take a project profiling approach rather than attempting to produce a global quality index.

Female↗
PubMed1996

Clinical audit: integrating the management of quality.

The recent implementation of clinical audit by the Department of Health seeks to both integrate existing professional audit activities, and to integrate the resulting multi-professional audit more closely with other quality-assurance activities developed by corporate management and purchasers. This paper, which is based on studies of medical and clinical audit undertaken over the past 3 years, examines the potential for integration in the light of, first, the history and characteristics of the different forms of quality assurance initiative and, second, a comparison of their different properties. In many ways clinical audit appears to stand between domination by both professional and managerial influences, which may enhance its potential for integrating different approaches. If, however, clinical audit is to succeed it is suggested that it requires a strong managerial infrastructure; with clearly delineated responsibilities related to the different modes of quality assurance.

Contract Services↗
PubMed2006

Quality improvement in New Zealand healthcare. Part 3: achieving effective care through clinical audit.

In this third article in the Series on quality improvement, we examine the effectiveness of dimension of healthcare quality. To satisfy this dimension, two equally important facets must be attended to. First the best available evidence must be sought through research, and second that evidence must be applied--this second function is the domain of quality improvement activities generally and clinical audit in particular. Clinical audit is one of the main tools to establish whether the best evidence is being used in practice, as it compares actual practice to a standard of practice. Clinical audit identifies any gaps between what is done and what should be done, and rectifies any deficiencies in the actual processes of care. In this article, the steps involved in a clinical audit, how it is different to research, and the question of whether clinical audit requires ethical approval are explored.

Evidence-Based Medicine↗
PubMed2001

Clinical audit: can we improve further?

Clinical audit is an important tool for comparing one's practice against existing standards. The authors have analysed the Junior Doctor's understanding of audit by performing a survey and questionnaire from 146 trainees, SpRs and SHOs from nine hospitals. The study showed that 107 (72.8%) performed audit and among those who performed audit, 52 (48.6%) experienced difficulty in obtaining data. This study highlights the importance of support needed to encourage the junior doctors to participate in audit programmes.

Adult↗
PubMed1996

What is clinical audit?

The emphasis of clinical audit should be on improvement in care. Audit can only improve healthcare if it includes a mechanism for change. The fact that information about outcomes is collected does not necessarily mean that care is being audited, nor that improved care will result. Audit must be distinguished from data collection, surgical epidemiology, and research.

Data Collection↗
PubMed1995

Links between clinical audit and contracting systems.

In 1989, a programme of clinical audit was introduced throughout the UK National Health Service (NHS), in an attempt to improve care through the application of quality methodology to clinical issues. However, the role of clinical audit in the new NHS "internal market" is unclear. Reviews evidence on the development of audit and concludes that it has operated largely in isolation, under professional control. Central policy is now advocating greater purchaser and provider management involvement in audit, enabling feedback from and to service provision and management decisions. Where there are constructive local relationships the opening up of audit should be beneficial, but these do not always exist. Discusses a range of models for the interaction of clinical audit with wider NHS management systems. Recommends a split system of professionally controlled background audit and collaborative shared audits to balance conflicting goals.

Clinical Competence↗
PubMed2006

Variations in the ability of general medical practitioners to apply two methods of clinical audit: A five-year study of assessment by peer review.

INTRODUCTION: Clinical audit has a central role in the NHS clinical governance agenda and the professional appraisal of medical practitioners in the UK. However, concerns have been raised about the poor design and impact of clinical audit studies and the ability of practitioners to apply audit methods. One method of making informed judgements on audit performance is by peer review. In the west of Scotland a voluntary peer review model has been open to general practitioners since 1999, while general practice trainees are compelled to participate as part of summative assessment. The study aimed to compare the outcomes of peer review for two methods of audit undertaken by different professional and academic groups of doctors. METHODS: Participants submitted a criterion audit or significant event analysis in standard formats for review by two informed general practitioners (GPs) using appropriate instruments. Peer review outcome data and the professional status of doctors participating were generated by computer search. Differences in proportions of those gaining a satisfactory peer review for each group were calculated. RESULTS: Of 1002 criterion audit submissions, 552 (55%) were judged to be satisfactory. GP registrars were significantly more likely than GP trainers (P < 0.001) and other established GP groups (P < 0.001) to gain a satisfactory peer review. GPs in non-training practices were less likely to achieve a satisfactory review than registrars (P < 0.001) and colleagues in training practices (P < 0.001). Of 883 SEA submissions, 541 (65%) were judged as satisfactory, with all groups gaining a similar proportion of satisfactory assessments, although GP registrars may have outperformed non-training practice GPs (P = 0.05). CONCLUSION: A significant proportion of GPs may be unable to adequately apply audit methods, potentially raising serious questions about the effectiveness of clinical audit as a health care improvement policy in general medical practice.

Clinical Competence↗
PubMed1996

Clinical audit, related cycles and types of health care quality: a preliminary model.

This paper is drawn from a study carried out in England, funded by the Department of Health. The aims of the study were to explore clinical audit in the four health professions of clinical psychology, occupational therapy, physiotherapy and speech and language therapy and to develop a model of clinical audit and guidelines for use by practitioners and managers. The focus in this paper is the model development. Included are examples of audits relevant to different types of health care quality that illustrate the process of clinical audit using the model. The modelling process involved interrogating the clinical audit cycle and related cycles against the data and identifying their inter-connecting links. The model was refined and reformulated to include guidelines for the professions on what is needed to make clinical audit work. The position of the professional service manager is crucial. A mandate that includes creating machinery at provider unit level, mobilizing the principal working groups and promoting internalization of audit by practitioners, is essential for audit to be effective.

England↗
PubMed1997

The relationship between clinical audit and ethics.

The aim of this paper is to start a debate about ethical issues associated with the practice of clinical audit. This is an area that has not received much consideration. The role of clinical audit is to raise general clinical standards. The ethical issues of clinical audit may have far-reaching consequences for clinicians, patients, health care providers and purchasers. Guidance is required to provide consistency in approach so that those involved in clinical audit, at whatever level, can be confident that they are following good practice. Clinicians and managers often think of good practice as being a technical matter. The main point of this paper is to bring out important ethical dimensions to good practice.

Confidentiality↗