Audit Appraisal: An overview

S. Chockalingam

Orthopaedic Surgeon and Audit Core Committee, Kauvery Hospital, Trichy

Background

Change;

Continuous
Intermittent
Occasional

Continuous

Continuous incremental change is Kaizen

Intermittent

When clearly what we are doing is good, we don’t change for the purpose of changing
Even this can be audited to have a pat on our backs that we are providing high quality care to our patients

Limitations

Not Every Change is for the better
Hence we cannot change for the sake of c We need to justify
To justify, we need to demonstrate the reason for change.

Demonstration of need for change through Audit and Research

The Audit method: Someone has already done the hard work to show what is right through studies and research, and we believe it is right. Then we simply implement changes to our practice

Eg: WHO Surgery Check List

The Research Method: Either there is no research done earlier or you don’t agree with the conclusion of the existing literature. We want to find out what is right ourself and do the research method. This is indeed hard work

Eg: Dr Velmurugan Study.

Audit method

Clinical audit is the systematic analysis of the quality of healthcare, including the procedures for diagnosis, treatment and care, the use of resources and resulting outcome and quality of life for the patient. (NHS Executive 1993)

Clinical Audit is a process by which the change is done with the intention of change on the background of demonstrating the need for change.

Audit Cycle

This is the 150th meeting which started in 2009
Started as audit meeting in the basement, with two audit presentations
One was on ‘Pain chart audit on post-operative pain’.
Used to be a monthly meeting
The present format has been planned and executed from June 2023.

June 2023 to May 2024
Total meetings audited	21
Time period	June 2023 to March 2024
Total number of attendees over 21 meetings	1016
Average number of attendees	48
Range of attendee numbers is	32 to 59

Attenders of the meetings

GMD
Medical admin
Consultants
DNB
MEM
DMOS
Physician assistants

Audit topics summary

Total of 35 presentations
Introduction to clinical audit	1
Grand round	1
Research	2
Resource audit	1
Process audit	18
Outcome audit	12

Department	Audit Topic
Anaesthesia department	Post Spinal headache -A Real Concern. Post-Operative sore throat in GA- a concern
Audit Department	An Introduction To Clinical Audit “How To”, Audit Appraisal
Blood Bank	Adverse transfusion reactions
Cardiology department	Young ACS – Audit, Appropriate use of Cardiac biomarkers -Real world (Kauvery Scenario), Rotablation in PCI -- An audit
Critical care	Outcome of ICU patients
Diabetology	Pattern of needle disposal of insulin receiving diabetic patients
Duty Medical Officer	Continuous patient monitoring
ER	Transfer Check - Checklist
ENT	Outcome of orbital cellulitis in paediatric age group
General Medicine	Use of Blood products and Steroids in Dengue patients - A clinical Audit
Haematology	Challenges in setting up a HSTC in a Tier 2 City - Our Experience
Medical Admin	Clinical Parameters awareness
Medical Gastro	Etiology, Clinical characteristics and outcome of acute pancreatitis patients -at Kauvery Hospital Cantonment.
Microbiology	Prevalence of Streptococcus Pneumonia Serotypes in Kauvery Hospitals Trichy and its Clinical Relevance - An Audit HAI in ICU patients
Neonatology	“Neonatal HLH", our experience
Nephrology	An outcome audit of AKI at Kauvery hospital
Neuro Critical Care	Outcome of mechanically ventilated neurological patients
Neurology	The Importance of Time In Hyper acute Stroke
Neuro Surgery	Intrathecal antibiotics in anterior skull base fractures" an audit Grand Rounds from Brain and Spine department
OG department	A clinical Audit on Ectopic Pregnancy in a Tertiary care centre
Orthopaedics	Prerequisites of Day care Procedure in Orthopedics Audit Of Vitamin D Levels In Elderly Patients with fracture neck of femur
Paediatric Hemato Oncology	Survivors Of Childhood Cancer
Paediatrics	Rationalise and restrict antibiotic use paediatric patients
Radiology	Efficacy of US guided biopsy using coaxial system in Breast lesions - An audit
Surgical Gastro	Intraperitoneal Instillation Of Levo bupivacine In Laparoscopic Cholecystectomy.
Surgical Oncology	Rate of Malignancy in Indeterminate Ovarian Cyst- An Process Audit.
Urology	Management of Urethral Catheter related pain in Renal Transplant Recipients: Clinical Audit
Vascular Surgery	Limb salvage outcomes in extremity vascular trauma.
Departments presenting prior to end of May (Audit Year June to May)
Dental and facio maxillary	Plastic surgery
Ophthamology	Paediaric surgery
Pulmonology	CTVS

Audit Topics Departments Wise

All departments represented by original work by the respective team/ consultants at Kauvery Hospitals, Trichy
Few of the original work has been inter departmental work, which is commendable
We should be proud to have achieved this in the first year of implementing audit presentations

Audit Topics Publications wise

Total presentations	35
Total Publications	33
Percentage of Presentations vs Publications	94%
Indexed journal Kauverian medical journal	11%

Meeting Themes

1) Audit vs research	2) Types of Audit
3) Research vs Audit	4) Process vs outcome
5) Resource vs process	6) Clinical effectiveness
7) Clinical excellence	8) Neuro tertiary care
9) Appropriate use of antibiotics	10) Case Series
11) Quality of Care Audit	12) Safety audit
13) Setting the standards	14) Lessons Learnt
15) Recording, Justification	16) Audit of The Unpleasant experience
17) More than Meets the Eye	18) Moving towards the Desirable Outcomes
19) Kauvery, the Level 1 Trauma Centre	20) Six honest serving men
21) Ear marked Dates for all Departments will be provided	22) Each department audit program will be supported by the audit department
23) Data collection, analysis, statistical support and publication support	24) Audit Department will archive presentations into video presentations
25) Aim to increase 11% indexed publications to close to 50%	26) Audits will bring Original research at Kauvery

Take Home Message

Clinical Audit is now a standard in health care organisations and across a region or country
At Kauvery Hospital, we have conducted the departmental clinical audit program effectively
This audit of audit showed that we are on par with international standards
We shall have a program which will excel international standards next year.

Clinical Importance

Chronicling KAIZEN within our departments is also important

Clinical Audit can be used to document the KAIZEN changes made for Quality improvement.

Dr Chokalingam

Dr. S. Chockalingam
Orthopaedic Surgeon

Audit Appraisal: An overview

Audit Appraisal: An overview

S. Chockalingam

Journals