medical audit

Define medical audit. Describe the conditions, prerequisites & steps for conducting medical audit in a general hospital : 

Define medical audit. Describe the conditions, prerequisites & steps for conducting medical audit in a general hospital Medical Audit Assessment court without a prisoner

General Discussion : 

General Discussion Quality? Quality Control? Quality Assurance/ Quality improvement? Total Quality Management/ Continuous Quality Improvement? Accreditation? Audit?

Medical Audit : 

Medical Audit Medical Audit is defined as the evaluation of medical care in retrospect through analysis of medical records. Medical Audit is a systematic approach to peer review medical care; in order to identify opportunities for improvement and to provide a mechanism for realizing them. Medical audit relates to practices initiate directly by doctors, and measure how far the clinicians have conformed to the norms & standards of medical practice while treating the patients. It is a tool to evaluate the quality of patient care on the basis of documented evidence to support diagnosis, treatment & justify utilization of hospital facilities & resources

Conditions: Structure: : 

Conditions: Structure: Formal agreement among administration & clinicians on responsibility Medical staff cooperatively accepts responsibility Named consultant to coordinate audit Committee/Group Every doctor assigned to a speciality Formal groups in charge of drug policy, infection control, PG education, Ethics, Medical records Time identified Timely DATA Clerical support

Conditions: Process : 

Conditions: Process Each specialty meets formally & regularly Attended by all members of speciality Recommendations are recorded, distributed & reviewed Medical staff receive audit reports from each speciality

Conditions: Outcome : 

Conditions: Outcome Recommendations lead to documented changes in availability of services organization of services written clinical policy clinical practice utilization of resources Improvements are measured in key issues such as complication rates avoidable mortality

Prerequisites : 

Prerequisites Medical Audit should be carried out by fair & impartial clinicians Initiative for Medical Audit must come from the medical staff themselves, rather they should desire it realizing the benefits to the patients & Themselves ( development of a professional, scientific, evidence based practice, continuous learning, medical education as teaching tool , not a punitive tool) A good system of MEDICAL RECORD KEEPING under a trained medical record officer/technician Well defined disease related Criteria

Types of medical audit : 

Types of medical audit Morbidity Audit Mortality Audit On spot audit Statistical Audit

Methodology : 

Methodology Criteria Development Selection of Cases within Diagnosis Work Sheet Preparation Case Evaluation Tabulation Report Presentation

Criteria Development : 

Criteria Development Choose the diagnoses to be studied: depending upon the case load/ mortality profile/public health importance etc by committee Indications for admission Hospital services recommended for optimal care Range of length of stay & indications for discharge Complications or additional diagnoses

Work Sheet (tool) Preparation : 

Work Sheet (tool) Preparation Standard worksheet, A Structured worksheet with YES, NO, NA to be prepared on which pertinent data are taken from records of patient. Variables: ( with structured sub variables) Basic data Indication for admission Initial diagnosis Diagnosis agreement History: each relevant history Physical examination Lab Tests Treatment Nursing care Complications Mortality/Discharge

Case Evaluation : 

Case Evaluation All members of medical staff regardless of speciality to be involved in evaluation, a group of five clinicians is considered optimum by Payne Admission: appropriate/ inappropriate Length of stay: appropriate/ inappropriate Hospital services: Adequate/inadequate Comments

Applications: : 

Applications: Adequacy & quality of care Caesarean cases study & Unnecessary surgery study Educational tool Evidence based medicine Scientific approach Professionalism

Thank You : 

Thank You

Medical audit & NRHM : 

Medical audit & NRHM