Transcript Slide 1

Clinical Audit
Professor (Dr.) Shamsun Nahar
MBBS, MSC (LONDON)
PhD (Cambridge, UK)
Objectives of the session
At the end of the session the students should
• be able to define clinical audit
• Importance of clinical audit
• Able to discuss the audit cycle
• Able to identify the structure, process and outcome indicators
• Able to discuss types of clinical audit and methods used in
clinical audit
What is clinical audit?
The systematic critical analysis of the quality of
health care, including
– the procedures used for diagnosis, treatment and
care,
– the use of resources and the resulting outcome
and quality of life for patients.
– it embraces the work of all healthcare
professionals"
What we do in clinical audit?
1. Critical analysis of your own skills and ways
of working for self improvement
2. Critical look at the system that delivers care
to your patients (i.e. your environment)
What does clinical audit achieve?
• Best practice
• Best outcome
Planning an audit
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Choose the audit topic
Study the current situation
Analysis and compare with standards
Identify causes for not meeting the standards
Identify the changes to be done
Write a plan for implantation and Implementation of
changes
• Re-audit
The audit cycle
The clinical audit process seeks to identify areas for service improvement, develop &
carry out action plans to rectify or improve service provision and then to re-audit to
ensure that these changes have an effect
Audit topic
“SMART”
Specific
Measureable
Achievable
Realistic
Timely way
What is required for an audit?
• Criteria are those
aspects of care that
you wish to examine.
• A criterion is a
measurable outcome
of care
• This should be in the
form of a statement.
• Standards are the prestated or implicit levels
of success that you wish
to achieve (Target)
• we usually express it as
a percentage
Criterion & Standard
Criterion
This should be in the form
of a statement
e.g. All patients with
hypertension who smoke
should be offered
smoking cessation advice.
e.g. The temperature of the
refrigerator in the
immunization room
Standard
When the criterion has
been defined at a numerical
level, it is referred to as a
standard.
e,g.100% patients with
hypertension who smoke
should be offered smoking
cessation advice.
e.g. The temperature of the
refrigerator in the
immunization room should
not exceed + 8oC
Criteria and standards
Criteria should be
 Precise
 Clear
 Effective
 Measureable
 Quality- oriented
Standards should be
 Comprehensive
 Practical
 Scientific
 Relevant
 Efficacious
 Effective
 Efficient
 Feasible
WHAT AREAS CAN YOU ‘AUDIT’?
A useful framework has been provided by
Donabedian (1966) who classified topics
under three headings:
Structure: The availability of resources and
personnel of an organization
 Process: The activities undertaken, that is
what is done with the service’s resources.
Outcome: The effect of the activities on the
‘health/well-being’ of the service user.
List the indicators under the following headings
STRUCTURE INDICATORS , PROCESS INDICATORS , OUTCOME INDICATORS
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Well trained physicians
Well trained nurse
Health educator
Clinical guidelines
Relevant history
Measuring wt,ht
Measure and recording B.P
Conducting CVS Examination
Conducting Fundi Examination
Conducting Feet Examination
Medical records
Individual diabetic file(POMR)
DM Register
Referral register
Complete data base(including
smoking)
Problems list
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Relevant history
Measuring TC/TG/HDL/LDL
Measuring HbA1C
Health education (diet, exercise,
drugs,fastingfoot care, travelling,
complications)
Assessment of compliance to ( diet,
treatment, exercise)
Health education materials
Well equipped laboratory
Trained lab technician
Appointment system
Action plan for diabetes care
Drugs(Insulin, syringes)
Good control(FBS<126mg/dl)
Poor Control(FBS>140mg/dl)
Overweight
Obesity
Complications
Smokers
Annual Check up
Types of clinical audits
• Standards based audits
– To see if standards are met or are being
improved
• Adverse / critical incident
– Screening of such incidents
– Monitoring of such incidents
• Peer review
– Was the quality of care optimal. Case reviews
and discussions (often multidisciplinary)
• Patient surveys
– Patients point of view of the quality of service
The main methods used in audit of the
quality of care are:
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Direct observation
Checklists
Documentation audit
Questionnaires
Interviews
Case review
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Comparison Between Clinical
Research & Clinical Audit
Characteristic
Clinical Research
Clinical Audit
Purpose
PROVE
IMPROVE
Character
Scientific Inquiry
Systematic Measurement
Function
Sets Standards
Compares Standards
Sample Size
Statistical Significance
Commitment to Act
Bases for
Measurement
Testing Hypothesis
Standard of Practice
Methods
New Treatment
No New Treatment
Outcome
Increased Knowledge
Improved Practice
Remember
Clinical audit is not research, but it does
make use of research methodology in
order to assess practice.
Analyse & presentation of audit data
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Analyse data and write the report
present findings should provide an unbiased picture of
actual practice
– Link findings with the objectives and standards
– Show overall pattern of actual practice compared to
the measures used in the audit
– Information which helps to explain variances
Overview of Self-directed Learning
Objectives of the session
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To define the Self-directed Learning (SDL)
To identify the characteristics of a Self-directed Learner
To understand the importance of Self-Directed Learning
To describe the Self-Directed Learning Strategies
To understand the importance of Self-directed learning &
Medicine
• To find out the Sources of learning
Self-directed learning & Medicine
• Half of what you'll learn in medical school will be
shown to be out of date within five years of your
graduation; the trouble is that nobody can tell
you which half—so the most important thing to
learn is how to learn on your own. ---- Dr. Dave
Sackett
• Self-directed learning (SDL) has been identified as
an important skill for medical graduates.
 To meet the challenges in today's healthcare
environment, self-directed learning is most
essential.
Self-directed learning & Medicine
Before beginning, you might want to read:
What is Critical Appraisal? - Critical appraisal is the process
of carefully and systematically examining research to judge
its trustworthiness, and its value and relevance in a
particular context.
• What is Evidence Based Medicine Evidence-based
medicine is the meticulous, explicit and judicious use of
current best evidence in making decisions about the care of
individual patients.
What is Self-directed Learning (SDL)
• Self-directed learning is the method used when a
learner, rather than an institution or teacher ,
controls both the learning objectives and the means
of learning.
A process in which students take the initiative. It
involves five steps
1. diagnose their learning needs,
2. formulate learning goals,
3. identify resources for learning,
4. select and implement learning strategies,
5. evaluate learning outcomes.
Why Self-Directed Learning ?
 First reason is that there is convincing evidence that people who take the
initiative in learning, learn more things and learn better than people who sit
at the feet of teachers passively waiting to be taught.
 The second reason is that self-directed learning is more in tune with our
natural processes of psychological development; an essential aspect of
maturing is developing the ability to take increasing responsibility of our own
lives to become increasingly self-directed.
 The third reason is that many of the new developments in education put a
heavy responsibility on the learners to take a good deal of initiative in their
own learning.
 Fourth reason is that it can tackle one of the most enduring problems in
medical education: the exponential growth in knowledge. It is a fact that the
course cannot teach everything that doctors consider relevant, and continued
additions can lead to what Abrahamson (1978) describes as "curriculum
hypertrophy."
Characteristics of a Self-directed Learner
Independence
• Self-directed learners are fully responsible people who can
independently analyze, plan, execute, and evaluate their own
learning activities.
Self-management
• Self-directed learners can identify what they need during the
learning process, set individualized learning goals, control their own
time and effort for learning, and arrange feedbacks for their work.
Desire for learning
• For the purpose of knowledge acquisition, self-directed learners’
motivations for learning are extremely strong.
Problem-solving
• In order to achieve the best learning outcomes, self-directed
learners make use of existing learning resources and feasible
learning strategies to overcome the difficulties which occur in the
learning process.
skills help you succeed at being a self-directed learner
'Learning to learn' is a crucial skill.
The following skills help you succeed at being a self-directed learner.
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Study them and think of your own abilities.
Are you able to question, inquire and solve problems,
keep an open mind to others' points of view, scan data and quickly choose relevant
resources,
collect data on your performance through self-observation and feedback from
others,
set goals to improve your personal performance, observe and model others'
performance to improve your own,
make a firm commitment to working on your goals, move through the full learning
cycle,
continually motivate yourself ?
Be proactive for SDL
Take note of the skills that you feel comfortable with and also note which ones you
would like to strengthen.
Think of how you can work on them and improve them. Then make a conscious
effort to do it.
Sources of learning
Sources of learning
• Online learning supports the self-directed
learner in pursuing individualized, self-paced
learning activities.
• Students can visit
– libraries, museums and various institutes worldwide,
– talk to professionals,
– access recent research, and read newspapers and
peer reviewed scholarly journals online.
Medical Journals in KSA
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Saudi Arabia Medical Journal
The Annals of Saudi Medicine
KAU (King Abdulaziz Univeristy) Medical Journal
The Annals of Thoracic Medicine
Journal of family & community medicine
Journal of the Saudi Heart association
Neuro sciences
Saudi Dental Journal
Saudi Journal of disability & Rehabilitation
Saudi Journal of Gastroenterology
Saudi Journal of Kidney Diseases &Transplantation
Saudi Journal of Obstetric & Gynecology
Saudi Journal of Ophthalmology
Saudi Journal of Sports Medicine Association
Saudi Journal of Anesthesia
Journal of Infection and Public Health
Journal of Parasitology Research
Saudi Journal of Biological Sciences
Websites for Self directing Learning
Thank you