Audit and Audit Cycle

Audit is the process used by health professionals to assess, evaluate and improve care of patients in a systematic way in order to enhance their health and quality of life.

• Audit is further defined by the Department of Health as the systematic critical analysis of the quality of medical care, including diagnosis, treatment, outcome, use of resources, and effects on quality of life for the patient.
• It is very important to differentiate between audit and research. Research investigates ideas whereas audit investigates the performance of processes and outcomes.
• Identifying the need for change may come from personal or practice experience as well as GP contract requirements and PCT agenda.
• A problem may be identified from every day practice. Problems can be identified in 3 basic areas:
  • Structure: the input of care, e.g. manpower, premises and facilities.
  • Process: the provision of care, looking at what is done and how it is done.
  • Outcome: result of any specific clinical intervention.

Any audit requires both agreement and understanding of the whole team, both of the relevance and process of the audit.

1. Select a topic
2. Decide on criteria and standards
3. Agree data collection rules
4. Collect data
5. Reflect on results: compare with the standards set, identify the strengths and weaknesses, e.g. knowledge, skills, attitudes, and consider potential changes.
6. Agree and implement change as necessary
7. Monitor progress after an agreed interval by repeating the audit cycle: revise criteria and standards as agreed and appropriate but changing criteria and standards makes comparison with previous audits and therefore assessment of progress much more difficult.

When constructing criteria and standards:

• Make unambiguous statements
• Refer to the literature indicating current practice
• Choose criteria and standards in line with current practice
• Ensure the criteria and standards are based on fact

Criterion

• A definable measurable item of health care that describes quality and which can be used to assess it. An example would be the number of people with coronary heart disease who have had their cholesterol checked within the last one year.
• All audits must contain criteria that should be evidence-based.

Standard

• Describes the level of care to be achieved for any particular criterion.
• A Standard describes the level of care to be achieved for any particular criterion. An example would be that 80% of people in the target group should have achieved cholesterol levels within agreed and accepted limits. The level of standard can often be controversial and there are 3 options:
  • A minimum standard: the lowest acceptable standard of performance. Minimum standards are often used to distinguish between acceptable and unacceptable practice.
  • An ideal standard: the care it should be possible to give under ideal conditions, with no constraints.
  • An optimum standard: lies between the minimum and the ideal. Represents the standard of care most likely to be achieved under normal conditions of practice. Setting an optimum standard requires consensus with other members of the team.

• Identify what data needs to be collected, how and in what form it needs to be collected, and who is going to collect it.
• Remember only collect information that is absolutely essential.

• With the information collected analysis is possible, and identification of any area of care below the predetermined standard of the criteria can be made.
• The results can then be used to develop an action plan ie what needs to be done, how it needs to be done, who is going to do it and when is it going to be done.

The audit cycle is now almost complete, but without re-evaluating the care the practice is giving it is impossible to see if recommendations have been implemented and the level of care improved.