Background
Clinical audit is a quality improvement strategy. Clinical audit selects aspects of patient care and evaluates the performance of a service against an agreed set of criteria or standards to answer the following questions:
- What is happening now? (baseline)
- What should be happening? (according to evidence, best practice, other agreed standards)
- How can we improve?
- Have our improvements resulted in a change? (the audit cycle).
Benchmarking is the process of establishing ‘best practice’. A benchmark is a standard of performance derived from that process. The benchmarking cycle involves comparing performance between comparable health care services, identifying practices and processes that result in superior performance, implementation of best practices and evaluation in order to make improvements. Data are collected to answer the questions:
- How do we compare with other similar services? (baseline)
- What can we learn from each other about what needs to be improved?
- What can we learn about what practices work?
Multidisciplinary issues
Audit activities in palliative care are likely to be most effective when they are team based, [1] as the outcomes reflect the care delivered by the whole team, and follow up changes need the commitment of the team.
Key messages
- A Cochrane systematic review of audit and feedback shows that audit can result in small to moderate changes in practice, and that it has most impact when current practice is very different from the baseline standard being audited against, and where there is intensive feedback about the results. [2]
- Positive outcomes of clinical audit include improvements in patient care and satisfaction, and improved communication between care providers. Audit can be a powerful stimulus to change. [3]
- The value of clinical audits and benchmarking are related to the quality of the information collected in each process. This can be improved by using validated audit tools which have been developed for the palliative care setting, and well studied, and integrating them into routine care wherever possible. [1]
Active research areas / controversies
- Audit tools are not yet well developed for some important aspects of palliative care, such as psychosocial and spiritual care. [4]
References
- Higginson, I., ed. Clinical Audit in Palliative Care. 1st ed. Radcliffe Medical Press; Oxford: 1993.
- Jamtvedt G, Young JM, Kristoffersen DT, O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews. 2006 Apr 19;(2):CD000259.
- Johnston G, Crombie IK, Davies HT, Alder EM, Millard A. Reviewing audit: barriers and facilitating factors for effective clinical audit. Quality in Health Care. 2000 Mar;9(1):23-36.
- Charlton R, Smith G, White D, Austin C, Pitts M. Audit tools for palliative care services: identification of neglected aspects of care. American Journal of Hospice & Palliative Care. 2002 Nov-Dec;19(6):397-402.
This page was created on 22 May 2008