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We all live in
a continually busy world. However, undeniably busy schedules
have made life more complex rather than making it simpler.
One such arena where this holds true is the world of
medicine. Newer technologies, newer diseases, and upscale
patient expectations, and added to all this is the
increasing threat of patient litigation, and the unveiled
possibilities of medical negligence.
Is there any
solution at all? Apparently yes. Making an effort towards
adapting your clinical practice to ‘audits’ can minimize if
not eradicate these risks on a gradual scale. To understand
this, first we need to understand what is “audit”.
Audit is one
way which services delivered can be monitored and maintained
in an increasingly critical environment. It is a powerful
quality improvement tool, in which the quality of care can
be reviewed objectively.
It is mutually
beneficial. IT not only provides the patient with a fair
idea of what the hospital healthcare delivery is like, but
is also gives time and opportunity to the whole clinical
team ( the doctors, nurses, physiotherapists etc.) to reflect
upon the existent healthcare delivery, and the possibilities
improvement, if required.
Clinical audit
is a tool in which, "evidence based" "best practice" norms
are determined for a particular service delivery, then the
existent service delivery is compared against it, to
determine gaps, if any.
The next and
final step is to correct these gaps / pitfalls, and re-audit
the steps in this ‘cycle’, to update and
maintain, the quality of health care delivery.
Upon further elaboration :
1.)
To establish best practice:
Within clinical
audit, criteria are used to assess the quality of care to be
provided by an individual, a team of an organization. These
criteria are explicit statements that define what is being
measured, and represent element of care that can be measured
objectively.
Criteria can be
classified into those concerned with:
-
Structure (what
is needed – staff, equipment, space).
-
Process (what is done-actions and decision taken).
-
Outcome (what is expected-quantifiable health status).
The advantage
of the aforementioned classification is that is becomes
easier to identify the source of problem. In case the
desired outcome is not achieved.
For example, in
your practice you must be already following an unwritten
protocol for a patient with an ‘X’ diagnosis, or steps/
tests to be done to come to the conclusion of the diagnosis.
The first step is to sit back and Determine, is the protocol
evidence based? If not, does it need updation to evidence
based standards?
Furthermore, it
is important to ask yourself if you were to prove that the
steps taken in the entire process of treatment were to be
taken in the entire process of treatment were to be proven,
are all facts documented? Will they be legally binding?
If not, a gap
exists at this level itself. After these correction have
been made, practice must be reviewed at regular intervals by
data collection and analysis. This is specially useful if
practice has several consultants, junior doctors and
residents and standardization of treatment is to be
achieved. There could be two ways leading to treatment,
dependent on consultant choice. However as long as they are
both agreed upon, and are evidence based, it is allright to
include them both. The final test is to observe the outcome,
not necessarily preferred process.
There fore
after the first audit step is established the next step as
discussed will be :
2.) To
measure care against criteria :
This step
requires considerable time and effort, and specialist
expertise.
Care has been taken to:
-
Develop
a systematic and logical questionnaire for taken into
account all the information required, in an ethical and
sensitive manner
-
Select
the right time frame/sample for data collection.
-
Appreciate
and make allowances for the resources constraint, if any.
-
Using
efficient and effective manual calculation (now obsolete)
and or computer software for the entry, validation and
analysis of the data collected.
The last step
is the most crucial of all :
3.) Making
improvements:
Even before
improvements can be made it is very important to arrange
feedbacks of step 2, to the team involved in the audits.
This feedback
should be done timely, or else the team loses interest and
it becomes a disadvantage for any audits, to be undertaken
in the future.
The gaps in the
outcome can be now classified, within the boundaries of
“structure” or “process”.
The need of
change thenceforth might be organizational, for a group,
for a group, or for an individual. The last option might be
rare since health care is a team effort, and any practice
involves several people.
It is also
equally important to identify the barriers of change and
address them, before the problem itself can be tackled.
Once these
three steps are completed, audit should be an annual
process, and therefore re-audited, in order to monitor the
outcomes constantly and maintain the quality of healthcare
in the given organization.
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