Medical Audit

How do I carry out a clinical audit?
This section summarises the main stages in carrying out an audit.  For m ore detail on each
of the stages here to access the United Bristol Healthcare site.
Your organisation may require you to register an audit.  To find out if this is required contact
your  clinical  effectiveness/governance  support.  (link  to  website  NHS  Board  contact  list  –
not available as yet)
1.  Choose your topic What makes a good topic?
·  Agreed problem
·  Important
·  Good evidence
·  Measurable
·  Amenable to change
·  Achievable w ithin your resources (IT, space, financial and human)
What is an important topic?
·  High level of concern
·  High impact on health of patients or resources
·  Common procedures or conditions
What are your organisational priorities?
·  National standards or guidelines
·  NHS Board priorities
·  local audit programme
·  Local problems and priorities
·  User views or complaints
2.  Define your A ims and Objectives
·  Aims
Why are you doing this project?
What are you hoping to achieve?
·  Objectives
How specifically w i ll you achieve your aims?
What will you improve and assess?
3.  Set your Standards
If you are looking critically at clinical care you need to identify evidence of good practice as
a basis for setting standards.  More information on appraising and using evidence i s
available in the Evidence and its Uses Unit (hyperlink to evidence and its uses unit)
Where do you get your standards from?
o  National guidelines, standards & local priorities
o  Other teams
o  Establish baseline standards
Once you have established your standards
·  State your Criteria – elements of care or activity, which can be measured
·  Set your desired level of performance or target (usually a percentage)
Standard:  Patients with a diagnosis of diabetes mellitus should be reviewed every 6
months (British Hypertension Society guideline 2004)
Criteria:  All should have a BP check
Target:  30% to have a BP of <140/<80 mmHg
Clinical audits usually involve looking at information already collected about a patient or
treatment.  However issues of confidentiality and unsound practice have to be considered.
Each NHS Board has an ethics committee that meets regularly to assess research and
special interest projects.  If you have any questions relating to ethical issues related to an
audit it is useful to speak to someone from the committee or the research department.
4.  Collect your data. ­ Agree your method
In the NHS w e collect lots of data but how much of it is used to make useful, informed
decisions about improving patient care?  Before you design a data collection tool, check
what i nformation you collect at the moment.
Consider
·  Retrospective (trawl existing records)or prospective (collect data from now)
·  Who is your target population?
·  What data w ill you collect? (only what i s absolutely necessary)
·  Who will collect the data?
·  Where will you get the data from?
·  What time period w ill you use? (i.e. start date and finish date)
·  How wi ll you select your sam ple? (how many subj ects do you need)
Data collect ion – Key points
·  Develop a simple data collect ion form based on the information you want to collect.
·  Check it out with colleagues to make sure that i t is giving you the data you need to
know.
·  Don’t be sidetracked into collecting information that is interesting rather than useful.
·  Remember to anonymise any personal data so that patients are not recognisable.
Sources of data
·  Clinical records
·  Disease or activity data sets
·  Survey/questionnaire
·  Interview.
If you are undertaking a large audit or are using unfami liar data collection tools, PILOT  first.
5.  Analyse your data
·  Make sure you leave time to analysis your data
·  Do you need statistical help?
·  Use spreadsheets if you can
·  Present your data in a clear, understandable and visually appealing way
6.  Interpret your data.
·  What does it mean?
·  How does it compare with your target?
·  Look carefully at those that didn’t meet the target
7.  What changes need to be made?
To help you implement changes, develop an action plan
·  Do you need to look at something in m ore detail?
·  Is it clear what changes need to be made? (If not, you may need to look in more detail
at a specific part of treatment e.g. use run charts to track variation)
·  How are you going to implement changes?
·  Who needs to be involved?
·  What new resources do you need?
8.  Make the changes.
·  Set new targets
·  Tell people what you’ve done
o  Your colleagues and manager
o  Audit newsletter
o  Poster display at local events
o  Present or display findings at national events
·  Re­audit your practice with the changes, check standards.
Clinical audit is about improvement.  If you are not changing or improving things as a result
of audit then ask yourself ­ w hy am I doing this?  You m ay need to rethink your audit
priorities or get others involved.