Power of Clinical Audit: Elevating Healthcare Beyond Borders: The Mindful Surgeon

Clinical Audit is a vital part of quality control and improvement in any institution, and healthcare is no exception. But in many healthcare settings, it is not as structured or an integral component for quality control as it should be. But you can still do clinical audits in any setting. Dr Sarah Amin gave a lovely talk about doing clinical audits in the UK. So, in this blog post, we will talk about doing audits anywhere in the world.

To initiate a clinical audit, you need a standardized guideline. This could stem from respected bodies like the World Health Organisation, surgical societies, or medical associations. Alternatively, you can rely on national guidelines or standards recognized in your country. You can also create policies collaboratively with experts in your field, supported by their experience and current evidence.

1. Setting the Standard: The process starts by establishing a standard to measure outcomes against.

2. Data Collection: Collect data meticulously, whether through questionnaires, records, or other means. This collected data and the findings must be reproducible, so you need to keep a record of them.

3. Dissemination of Findings: Share your findings locally, in mortality and morbidity meetings, through presentations, or by circulating email or leaflets.

4. Introducing Interventions: If the outcome is below the requirements of the standard, then you should develop actionable measures like workshops, alerts, or process changes to improve the quality of care.

5. Re-Audit: After implementing interventions, re-audit to assess improvement and gather feedback.

6. Audit Cycle Completion: Repeating the process closes the audit cycle, showcasing whether improvements have been made.

Why engage in clinical audits?

They offer several benefits:

1. Quality Control and Governance: Participate in healthcare quality control and governance, shaping positive change.

2. Experience in Implementing Change: Gain hands-on experience in introducing changes to healthcare practices.

3. Publication and Presentation: Share your findings at local and regional conferences, enhancing your professional portfolio.

4. Quality Improvement Project: Clinical audits can evolve into quality improvement projects, impacting patient care.

Real-life Example:

I conducted an audit on adrenal incidentalomas found in CT scans. By following European guidelines, the audit assessed whether these cases were managed appropriately. I had to go through the reports of almost 6,000 CT scans by myself to assess the rate of adrenal incidentaloma. The audit revealed that many incidents were not being properly followed up on or managed. The audit results were presented in a local setting. It won a prize at a regional conference for oral presentation. I also presented it as a poster at an international conference. This also helped to formulate a guideline for the management of adrenal incidentaloma in my local trust. This was then counted individually as a quality improvement project under my leadership. So, from one single audit, I got three important things out.

Getting Started: Common Topics

Some common audit topics can be performed in any setting.

·Drug prescribing: An audit about safe drug administration is vital to a patient safety audit. You can also do an audit in a clinic setting about how new medications like thyroxine, antidiabetic, or epileptic medications are prescribed correctly, whether the patients are being adequately followed up, and whether investigations checking the required dosage are being done routinely.

·Infection control: Infection control is another key audit in any hospital. The rate of infection and the microorganisms causing it must be checked. You can introduce infection prevention measures such as education about asepsis and a proper antibiotic, then re-audit to see if there are any improvements.

·Maternal and child health: If you are in a rural setting, mother and child health can be a popular topic of audit. Checking the level of peripartum care that the mother and baby receive can have an impact on the health of the community.

·Quality of Service: How patients are assessed in emergency care and whether they are seen and treated within an appropriate timeframe is an audit of patient safety and the efficiency of that service. Similar audits can be undertaken for outpatient clinics.

·Mortality and morbidity: This is an important audit for any clinical service. This can be in a surgical ward or even an oncology ward after receiving chemo or radiation therapy. Every institute is required to keep this audit for clinical coding and to assess the quality of service they provide.

·New Diagnosis Management: What kind of support does a patient receive when they are diagnosed with a new condition like diabetes or COPD? Supporting interventions such as lifestyle modification and prevention play an essential part in the management of these diseases. So, you can do an audit to see whether the patients are receiving adequate advice and what kind of impact they are having.

·Antibiotic: An audit of antibiotics is very important. This not only ensures their judicious prescription but also the development of resistance to antibiotics. In the UK, the guideline is to prescribe a single dose of antibiotic to any patient having a mesh for a hernia operation. So, a simple audit can be done to see whether this is being followed.

·Documentaion Audit: Documentation audit like operation notes, and reports of CT scan/ pathology report needs to be done in a certain order, mentioning information that is very standardised. Royal Colleges of each speciality have their standardized guidance. This is an easy audit that can be done anywhere.

So, to summarise the clinical audit process,

1. Obtain permissions from the clinical lead, the audit department, or both.

2. Collect data aligned with your chosen topic.

3. Match the data against standards or guidelines.

4. Circulate the finding among the relevant parties.

4. Introduce interventions if needed.

5. Re-audit to gauge improvement and make further adjustments.

6. Get a certificate or letter of completion from the consultant, clinical lead, or audit department for each audit cycle.

Whether you're a healthcare professional in the UK or anywhere else, clinical audits provide a potent tool for effecting positive change. They facilitate quality control and continuous improvement and offer opportunities for professional growth. Engage in clinical audits to transform healthcare practices and contribute to better patient outcomes worldwide.