EDITORIAL:Clinical Audit: Assessing the Standards of Clinical Practice

Clinical Audit is not a novel Medical entity, historically it dates back to the Work of Florence Nightingale during the Crimean War of 1853-1855 and Ernest Codman in early 1990s. We are very familiar with the concept of financial audit which is a mean of providing reasonable assurance of the company’s financial status and to provide lucrative solution for its users. Similarly Medical Audit is a mean of evaluating the outcome measure to specific standardized medical protocol so as to make it cost effective and to efficiently deliver to general population.
In the Modern Era with increasing awareness and availability of different source of information over the media and escalation in legal pressure it become imperative to standardize our clinical practice with evidence based medicine. Standardizing Medical practice has been a topic of controversies as we follow protocols set by developed countries which might not be appropriate in our circumstances. Therefore it is deemed necessary that we should set our own national protocols tailored as per our needs and make them Productive to both service providers and users.¹ The journey toward excellence has started² and in our everyday practice we are bringing these changes willingly without formal audit and knowingly after clinical meetings from reviews of Clinicopathological Conference and Multidisciplinary Meetings. One such example is confidential inquiry into Maternal deaths which over the years resulted in reduction of Maternal morbidity and mortality which is a reflection of positive outcome in clinical audit in our country.^3,4
The best way to put Clinical Audit and its Objective has been defined by National Institute for Health and Clinical excellence as “A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structure, processes, and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery”
Audit cycle⁵ can be considered to have five Principal steps, Selection of a topic, Identification of an appropriate standard, Data collection to assess performance against the pre-specified standard, Implementation of changes to and Re-audit if required.
Benefits of audit are multiple, it identifies and promotes good Clinical Practices, Provides cost effective use of resources, Promotes opportunities for education & training and Improvement of Inter-profession interaction of Staff (Nurses, Doctors, Paramedical, Stakeholders) which results into better service for the Patients.
Cost effective intervention can be introduced in low resource setting which will benefit more end users i.e. increase in use of day care unit and decrease in hospital stay by preoperative preparation. These savings of resources can then be utilized in areas of priorities. Thus in my personal point of view, best practice (evidence base) can be implemented according to our own Local Standards and the starting will be following bare minimal standards.
Recommendations
Culture of Audit should be introduced and facilitated in conducive environment in all major hospitals of the Country. Standard based and adverse occurrence audits should be carried out on regular basis and made compulsory for all the foundation year postgraduate students. Prevailing practice thereof can become an integral part of every Hospital in the Country.

References

1. Mirinda Mugford, Philip Banfield, Moira O’Hanlon. Effects of feedback of information on clinical practice BJM 1991;303:398-402.
2. Maqbool H. Jafary & Shaukat Ali Jawaid. Departmental clinical audit, Audit principles and the present status in Pakistan. Pak J Med Sci 2005; 21(1): 1-5.
3. Lt Col Ambreen Anwar Clinical audit- right time to take start. Pakistan Armed Forces Medical Journal 2011; vol 4(1).
4. Dermot Maher. Clinical audit in developing countries topical medicine and international health 1996; 1(4):409-413.
5. National Institute of Clinical Excellence. Principle for best practice in clinical audit London (NICE) 2002.