History of Audit
One of first ever clinical audits was undertaken by Florence Nightingale during the Crimean War of 1853- 1855. Appalled by the unsanitary conditions and high mortality rates among injured or ill soldiers, she and her team of 38 nurses applied strict sanitary routines and standards of hygiene to the hospital and equipment,and kept meticulous patient records of the mortality rates. Following this change in standards the mortality rates fell from 40% to 2%. Her methodical approach is recognised as one of the earliest programs of outcomes-management.
Audit Today
Clinical audit has moved on from the days of Florence Nightingale and has been variously defined but the standard definition is that ‘Clinical audit is a quality improvement process that seeks to improve the patient care and outcomes through systematic review of care against explicit criteria and the implementation of change’. Aspects of the structures, processes and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to guarantee improvement in healthcare delivery.
Types of Audit
- Standards-based audit - A cycle which involves defining standards, collecting data to measure current practice against those standards, and implementing any changes deemed necessary.
- Adverse occurrence screening and critical incident monitoring - This is often used to peer review cases which have caused concern or from which there was an unexpected outcome.
- Peer review - An assessment of the quality of care provided by a clinical team with a view to improving clinical care.
- Patient surveys and focus groups - These are methods used to obtain users' views about the quality of care they have received.
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Clinical Audit - The Process
Clinical audit can be described as a cycle or a spiral, see figure above. Within the cycle there are stages that follow the systematic process of: establishing best practice; measuring against criteria; taking action to improve care; and monitoring to sustain improvement. As the process continues, each cycle aspires to a higher level of quality.
Clinical Audit and PatientCare Report
Clinical audit of patient care reports can address topics which involve at lease one of the following criteria:
- High Risk (to either patients or staff)
- Wide variation in local procedure
- Issue of local concern
- Subject identification as a problem area.
Any enquiries on clinical audit or patient data collection can be sent to jacqueline@phecc.ie
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