Quality assurance and quality improvement in medical practice – Part 3. Clinical audit in medical practice

2012 ◽  
Vol 153 (5) ◽  
pp. 174-183 ◽  
Author(s):  
Sándor Gődény
Keyword(s):  
Quality Assurance ◽  
Quality Improvement ◽  
Medical Practice ◽  
Best Practice ◽  
Clinical Audit ◽  
Clinical Effectiveness ◽  
Service Improvement ◽  
Quality Improvement Process ◽  
Quality Improvement Interventions ◽  
Definition Of

The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised. Orv. Hetil., 2012, 153, 174–183.

What is clinical audit’s purpose: quality assurance or quality improvement?

2011 ◽  
Vol 2 (2) ◽  
pp. 79-83
Author(s):  
Nancy Dixon
Keyword(s):  
Quality Assurance ◽  
Quality Improvement ◽  
Patient Care ◽  
Clinical Audit ◽  
Audit Process ◽  
Quality Improvement Process ◽  
Quality Assurance Process ◽  
Quality Of Patient Care ◽  
Assurance Process

Clinical audit has become a key activity for healthcare organisations and professionals in England. The clinical audit process is frequently described as a cycle of steps that includes making changes in practice. However, some evidence suggests that clinical audit is not effective in producing improvements in the quality of patient care. The explanation may be that clinicians and managers are seeing clinical audit as a quality assurance process, which implies making small adjustments in practice to conform to standards, rather than as a quality improvement process.

scholarly journals Embedding EBVM into Practice

2017 ◽  
Vol 2 (1) ◽  
Author(s):  
Bradley Viner
Keyword(s):  
Open Access ◽  
Patient Care ◽  
Practice Guidelines ◽  
Clinical Guidelines ◽  
Best Practice ◽  
Clinical Performance ◽  
Clinical Audit ◽  
Clinical Effectiveness ◽  
Pros And Cons ◽  
Audit Cycle

<p>Embracing EBVM as a concept is an important first step, but is of little value unless it is translated into an improvement in patient care. This session will discuss how EBVM can be incorporated into clinical guidelines at a practice level, using a team-based approach to maximise concordance. The pros and cons of using practice guidelines as a means of improving clinical effectiveness will be discussed, followed by an illustration of how the clinical audit cycle can be used as a tool to ensure that Best Practice as a established by practice guidelines is applied to produce an improvement in clinical performance.</p><p> <a href="/index.php/ve/article/view/95/128"><img src="/public/site/images/bridget/Bradley_twitte_image.PNG" alt="" /></a></p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" />

scholarly journals Quality and Quality Improvement in Occupational Health Nursing

AAOHN Journal ◽  
1992 ◽  
Vol 40 (7) ◽  
pp. 326-332 ◽  
Author(s):  
Anne Keenan Widtfeldt
Keyword(s):  
Health Care ◽  
Quality Assurance ◽  
Quality Improvement ◽  
Occupational Health ◽  
Professional Education ◽  
Quality Assurance Program ◽  
Customer Requirements ◽  
Technical Specifications ◽  
Health Nursing ◽  
Definition Of

The definition of quality in health care is changing to incorporate the industrial definition, which is “conformance to technical specifications and customer requirements” (Conbere, 1992). A quality assurance program is the basis of a qualThis article is reprinted from AAOHN Update Series, Volume 4 with permission from the Continuing Professional Education Center, Inc., Skill-man, NJ.

scholarly journals "There's no point in complaining, nothing changes": rural disaffection with complaints as an improvement method

2006 ◽  
Vol 30 (3) ◽  
pp. 322 ◽  
Author(s):  
Judith A Jones ◽  
Terri A Meehan-Andrews ◽  
Karly B Smith ◽  
John S Humphreys ◽  
Lynn Griffin ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Quality Improvement ◽  
Health Services ◽  
Service Improvement ◽  
Access To Health Services ◽  
Access To Health ◽  
Quality Of Health Services ◽  
Rural Consumers ◽  
Lack Of Knowledge

Objective: To validate earlier findings that lack of access to health services is the most likely issue of complaint by rural consumers, and that lack of knowledge about how to make effective complaints and scepticism that responses to complaints bring about service improvement account for the under-representation of complaints from rural consumers. Design: Unaddressed reply-paid mail survey to 100% of households in small communities, and 50%, 20% or 10% in progressively larger communities. Setting: Eight communities in the Loddon-Mallee region of Victoria. Participants: 983 householders most responsible for the health care of household members, responding to a mailed questionnaire. Main outcome measures: Issues of complaints actually made; issues of unsatisfactory situations when a complaint was not made; reasons for not complaining; to whom complaints are made; and plans for dealing with any future complaint. Results: Earlier findings were confirmed. Lack of access to health services was the most important issue, indicated by 54.8% of those who had made a complaint, and 72% of those who wanted to but did not. The most common reason given for not complaining was that it was futile to do so. Lack of knowledge of how to make effective complaints which might contribute to the quality assurance cycle was evident. Conclusions: Rural consumers? disaffection with health complaints as a means to quality improvement poses a significant barrier to consumer engagement in quality assurance processes. Provider practices may need to change to regain community confidence in quality improvement processes. CONSUMER VIEWS ABOUT the quality of health services provide a valuable source of information to those concerned with accountability and quality assurance in service provision.1,2 When such views are expressed as complaints which are responded to in ways which focus on quality improvement rather than allocation of blame, opportunities may arise to improve the quality of health services for all consumers.3,4

Use of prone position restraint within a mental health trust

2017 ◽  
Vol 22 (1) ◽  
pp. 52-60 ◽  
Author(s):  
Elizabeth Shaw ◽  
Anushtayini Sivananthan ◽  
David Phillip Wood ◽  
James Partington ◽  
Alison Pearl Reavy ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Prone Position ◽  
Clinical Audit ◽  
Physical Restraint ◽  
Challenging Behaviour ◽  
Improvement Project ◽  
Content Type ◽  
Care Processes ◽  
Improvement Interventions ◽  
Quality Improvement Interventions

Purpose The purpose of this paper is to improve the quality of care of patients presenting with challenging behaviour. Design/methodology/approach Current guidelines are described, and adherence to the standards is audited, with a particular emphasis on physical restraint. Findings The results of the clinical audit revealed that in the substantial majority of episodes of challenging behaviour, non-physical techniques were used prior to the need to intervene with physical restraint; however, when physical restraint was used, there was limited use of staff debriefs to facilitate reflection- and work-based learning. A potential diagnostic link to the likelihood of use of prone position restraint was also a finding. The results of a quality improvement project undertaken in response to the findings of the clinical audit demonstrated significant and sustained improvements in adherence to most standards. Practical implications Continuous improvements to the safety of both patients and staff when managing acute challenging behaviour requires ongoing quality improvement interventions underpinned by the application of human factors principles. Originality/value The completion of this audit cycle suggests that it is useful to measure specific points of care processes, however, continuous improvement interventions are indicated to lead to sustained improvement – in this paper this is demonstrated by the safer management of challenging behaviour.

Clinical audit, quality improvement, and safety in palliative medicine

2021 ◽  
pp. 1335-1350
Author(s):  
Irene J. Higginson ◽  
Mevhibe B. Hocaoglu
Keyword(s):  
Palliative Care ◽  
Quality Assurance ◽  
Quality Improvement ◽  
Palliative Medicine ◽  
Audit Quality ◽  
Clinical Audit ◽  
Test Methods ◽  
Quality And Safety ◽  
Educational Component

Audit approaches and methods are now well advanced in palliative care, especially in clinical audit. This chapter discusses these approaches and methods, and addresses such questions as ‘Why perform clinical audit in palliative medicine?’ and ‘How do we assess the quality and safety of palliative care?’ It discusses the evolving terms of audit, quality assurance, quality improvement, safety, and governance, and how to apply clinical audit to palliative medicine. Audit requires resources, and so it must be sure to benefit patients and families, be kept as simple and efficient as possible, and have a strong educational component. There is also a need to develop and test methods of audit in a global healthcare context. If palliative approaches extend backwards to include patients earlier in care, rather than those just near to death, then the audit could become a means for clinical dialogue and education between specialties.

Reducing inappropriate rasburicase use to promote cost-effective care.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 312-312
Author(s):  
Arjun Gupta ◽  
Komal Patel ◽  
Taylor Roberts ◽  
Eileen M. Marley ◽  
Hsiao Ching Li ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Best Practice ◽  
Tumor Lysis Syndrome ◽  
Kidney Injury ◽  
Cost Savings ◽  
Cost Effective ◽  
Baseline Period ◽  
Hospital System ◽  
Effective Interventions ◽  
Quality Improvement Interventions

312 Background: Rasburicase is recommended for treating established Tumor lysis syndrome (TLS) and patients at high-risk for TLS. Unfortunately, it is an expensive medication and unnecessary use contributes to expenses. Methods: A multidisciplinary quality improvement team reviewed the process of ordering rasburicase and its prescription patterns at Parkland Heath and Hospital System, Dallas, TX between 10/2015-9/2017. Use was determined as appropriate/ inappropriate based on internally approved indications (laboratory TLS, at-risk for TLS, acute kidney injury and hyperuricemia, failure of or inability to administer allopurinol). Quality improvement interventions were implemented based on weaknesses identified. Results: 65 doses of rasburicase were administered during the 2-year baseline period; 21 (32.3%) of these were grossly inappropriate. The most common ordering providers were oncologists (23 orders, 35%), hospitalists (16 orders, 25%), intensivists (11 orders, 17%), and emergency physicians (8 orders, 12%). Ordering process review identified several pitfalls: one-click ready to sign order, auto-population of dosage, no hard-stop requiring providers to review rasburicase indications, and no pharmacy oversight. We aimed to reduce the percentage of inappropriate rasburicase orders from a baseline of 32.3% to 10% over 3 months. In 2/2018, we implemented PDSA cycle 1 including introducing a best practice advisory requiring providers to select an approved indication for medication use and changed auto-population of rasburicase dosage to 3 mg. A mandatory secondary review by pharmacy prior to dispensing the medication was implemented. Over a 3-month period post-change (2/2018- 5/2018), 11 of 11 rasburicase administered doses have been appropriate (0% inappropriate). Conclusions: A multidisciplinary team and classic quality improvement methodology was able to reduce inappropriate rasburicase use from 32.3% to 0%, with significant cost savings. Straightforward electronic medical record interventions and increased pharmacy oversight are effective interventions in curbing medication overuse. We will periodically re-assess utilization patterns and refine PDSA cycles as needed.

Quality assurance and quality improvement in medical practice – Part 1. Definition and importance of quality in medical practice

2012 ◽  
Vol 153 (3) ◽  
pp. 83-92
Author(s):  
Sándor Gődény
Keyword(s):  
Quality Assurance ◽  
Health Status ◽  
Quality Management ◽  
Medical Practice ◽  
Quality Measurement ◽  
The European Union ◽  
Management Quality ◽  
Hungarian Population ◽  
Healthcare Finance

In Hungary healthcare finance has decreased in proportion with the GDP, while the health status of the population is still ranks among the worst in the European Union. Since healthcare finance is not expected to increase, the number of practicing doctors per capita is continuously decreasing. In the coming years it is an important question that in this situation what methods can be used to prevent further deterioration of the health status of the Hungarian population, and within this is the role of the quality approach, and different methods of quality management. In the present and the forthcoming two articles those standpoints will be summarized which support the need for the integration of quality assurance in the everyday medical practice. In the first part the importance of quality thinking, quality management, quality assurance, necessity of quality measurement and improvement, furthermore, advantages of the quality systems will be discussed. Orv. Hetil., 2012, 153, 83–92.

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