DOCSLIB.ORG

Kwazulu-Natal Province, Republic of South Africa

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Kwazulu-Natal Province, Republic of South Africa QU ALITY ASSURANCE PROJECT O P E R A T I O N S R E S E A R C H R E S U L T S The Impact of Accreditation on the Quality of Hospital Care: KwaZulu-Natal Province, Republic of South Africa October 2003 University Research Co., LLC ● 7200 Wisconsin Avenue, Suite 600 ● Bethesda, MD 20814 ● USA ● www.qaproject.org The Quality Assurance Project (QAP) is funded by the U.S. Agency for International Development (USAID) under Contract Number GPH-C-00-02-00004-00. The project serves developing countries eligible for USAID assistance, USAID Missions and Bureaus, and other agencies and nongovernmental organizations that cooperate with USAID. QAP offers technical assistance in the management of quality assurance and workforce development in healthcare, helping develop feasible, affordable approaches to comprehensive change in health service delivery. The project team includes prime contractor University Research Co., LLC (URC), Initiatives Inc., and Joint Commission Resources, Inc. The work described in this report was carried out by the Quality Assurance Project under USAID Contract Number HRN-C-00- 96-90013, managed by the Center for Human Services, URC’s nonprofit affiliate, in partnership with Joint Commission Resources, Inc. and Johns Hopkins University. The Impact of Accreditation on the Quality of Hospital Care: KwaZulu-Natal Province, Republic of South Africa October 2003 J. Warren Salmon, John Heavens, Carl Lombard, and Paula Tavrow Foreword by James R. Heiby Commentaries by Stuart Whittaker, Marie Muller, and Marilyn Keegan, and by Anne L. Rooney O P E R A T I O N S R E S E A R C H R E S U L T S The Impact of Accreditation on the Quality of Hospital Care: KwaZulu-Natal Province, Abstract Republic of South Africa The number of countries implement ing accreditation programs in their healthcare systems has grown in the past decade, but accreditation’s impact has not been tested rigor• ously using a randomized control Table of Contents trial. The purpose of this study was to conduct such a trial in a devel FOREWORD By James R. Heiby ........................................................................... 1 oping country setting and to air its I. INTRODUCTION .............................................................................................. 3 implications. The KwaZulu-Natal (KZN) province of South Africa was II. BACKGROUND ............................................................................................... 3 chosen because it had just con ABBREVIATIONS .................................................................................................... 4 tracted with the Council for Health Services Accreditation of Southern III. OBJECTIVE OF THE STUDY ........................................................................... 4 Africa (COHSASA) to introduce hos IV. RESEARCH METHODOLOGY ......................................................................... 5 pital accreditation into KZN public A. Sampling ..................................................................................................... 5 hospitals. Following discussions between COHSASA and the Joint B. Data Collected ............................................................................................ 5 Commission International (JCI), a 1. COHSASA Standards ............................................................................ 5 joint research team representing the 2. Indicators of Hospital Quality ................................................................ 6 Medical Research Council (MRC) of C. Data Management Procedures .................................................................. 7 South Africa and JCI, under the 1. COHSASA Data ..................................................................................... 7 sponsorship of the USAID Quality 2. Quality Indicator Data ........................................................................... 7 Assurance Project, was engaged to study the impact of the COHSASA D. Data Analysis .............................................................................................. 7 accreditation program on KZN E. Timeframe for Data Collection ................................................................... 7 hospitals. V. RESULTS ......................................................................................................... 9 The KZN province agreed that 20 A. Compliance with COHSASA Standards .................................................... 9 randomly selected public hospitals, B. Impact on Indicators of Quality ................................................................ 10 stratified by size, could be part of the study. Ten of these hospitals VI. DISCUSSION ................................................................................................... 15 entered the accreditation program A. COHSASA Standards ............................................................................... 15 in 1998; the other ten, which served B. Quality Indicators ..................................................................................... 15 as a control, entered about two VII. CONCLUSION ................................................................................................ 17 years later. The study prospectively measured the effects of the REFERENCES ....................................................................................................... 18 COHSASA hospital accreditation APPENDIX ............................................................................................................ 19 program on various indicators of hospital care. The study used sur• COMMENTARIES .................................................................................................. 25 vey data from the COHSASA By Stuart Whittaker, Marie Muller, and Marilyn Keegan ............................... 25 accreditation program measuring By Anne L. Rooney ....................................................................................... 47 Continued on page iv Abstract Continued Acknowledgements The research team wishes to express its gratitude to the hospital structures and processes, along with following individuals and organizations for serving on the eight indicators of hospital quality of care col Research Project Steering Committee and for their support lected by an independent research team. The and important contributions to this research study: Professor indicators of hospital quality had been devel Stuart Whittaker, COHSASA, Chair; Professor Ronald Green- oped by consensus of an advisory commit Thompson, KZN Department of Health; Dr. Ivan McCusker, tee in South Africa. The indicators were: nurse COHSASA Board of Directors and Technology Advisory perceptions of quality, client satisfaction, cli Committee; Dr. Ken Yamashita, USAID/South Africa; Dr. Nico ent medication education, accessibility and Walters, Medical Research Council (MRC); and Ms. Anne completeness of medical records, quality of Rooney, Quality Assurance Project/Joint Commission peri-operative notes, hospital sanitation, and International. labeling of ward stocks. Indicators of mortal ity and morbidity were dropped because of We thank the following for the foreword and commentaries: difficulty in achieving comparability across the James R. Heiby, Chief Technical Officer for Quality Assurance hospitals. The investigators compared the and Workforce Development, USAID Bureau for Global Health, performance of the ten hospitals participat Office of Health, Infectious Diseases and Nutrition. ing in the accreditation program (intervention Stuart Whittaker, Chief Executive Officer, Council for Health hospitals) with the ten not yet participating Service Accreditation of Southern Africa (COHSASA), and (control hospitals). Honorary Associate Professor, Department of Community About two years after accreditation began, the Health, Nelson R. Mandela School of Medicine, University of study found that intervention hospitals signifi Natal, South Africa; cantly improved their average compliance Marie Muller, Professor of Nursing and Dean of the Faculty of with COHSASA accreditation standards from Education Nursing at Rand Afrikaans University, 38 percent to 76 percent, while no appre Johannesburg, South Africa; and ciable increase was observed in the control Marilyn Keegan, Communications Manager for COHSASA. hospitals (from 37 percent to 38 percent). This improvement of the intervention hospitals rela Anne L. Rooney, RN, MS, MPH, Executive Director of Interna tive to the controls was statistically significant tional Services, Joint Commission International, Oakbrook and seems likely to have been due to the Terrace, IL USA. accreditation program. However, with the exception of nurse perceptions of clinical Recommended citation quality, the independent research team observed little or no effect of the intervention Salmon JW, Heavens J, Lombard C, and Tavrow P with on the eight quality indicators. Limitations of foreword by Heiby, JR, and commentaries by Whittaker S, the study design may have influenced these Muller M, Keegan M, and Rooney AL. 2003. The Impact of results. Several intervention hospitals were still Accreditation on the Quality of Hospital Care: KwaZulu-Natal trying to achieve accredited status at the time Province, Republic of South Africa. Operations Research of the second COHSASA survey, and in gen Results 2(17). Bethesda, MD: Published for the U.S. Agency eral the full impact of the program may take for International Development (USAID) by the Quality Assur• longer
Load more

Recommended publications
  • Clinical Audit/Quality Improvement Projects Guidance for Professional
    Clinical Audit/Quality Improvement Projects Guidance For Professional Competence Scheme Prepared by Faculty of Public Health Medicine December 2012 1 KEY POINTS ON AUDIT FOR PUBLIC HEALTH . This document is produced by the Faculty of Public Health Medicine Ireland (FPHMI) to support and guide participants of the FPHMI Professional Competence Scheme (PCS) to achieve their requirement of completing one clinical audit / quality improvement project each year. This document is a guide for doctors practising public health medicine and who are either on the Specialist or General Division of the Register . All doctors must participate in professional competence . Each doctor must define his/her scope of practice . All doctors whose practice include both clinical and non‐clinical work should engage in both clinical audit and other quality improvement practices relevant to their scope of practice . Audit can be at individual, team, departmental or national level . Each doctor must actively engage in clinical audit / systematic quality improvement activity that relates directly to their practice. ‘The Medical Council’s Framework for Maintenance of Professional Competence Activities’ sets one clinical audit per year as the minimum target. The time spent on completing the audit is accounted for separately from other Continuing Professional Development (CPD) activities. It is estimated that the completion of one clinical audit will take approximately 12 hours of activity. The main challenges in undertaking audit in public health practice include o Lack of explicit criteria against which to measure audit o Timeframes for measuring outcomes which can be prolonged and thus process measures are more readily measured Can’t seem to format this box which is smaller than the text o Changing public health work programmes in Departments .
    [Show full text]
  • Onsite Guide
    A HIA 3 8T H A N N U A L C O N F E R E N C E ONSITE GUIDE SPONSORED BY Scan to download the AHIA Conference App www.ahia.org TABLE OF CONTENTS AHIA MISSION & VISION AHIA Mission and Vision . 3 & VISION AHIA MISSION TABLE OF CONTENTS TABLE Hotel Floor Plan & Site Map . 4-5 Welcome . 5 Schedule of Events by Day . 6-15 AHIA Board of Directors & Conference MISSION STATEMENT Planning Committee . 17 The Association of Healthcare Internal Auditors provides leadership Exhibit Hall Hours & Social Events Schedule . 18-19 and advocacy to advance the healthcare internal audit profession AHIA Conference Tracks . 20-21 globally by facilitating relevant education, resources, certification 2020 Save the Date . 21 and networking opportunities. Conference Schedule Sunday, September 15 . 22-30 VISION STATEMENT Monday, September 16 . 31-44 To be the premier association for healthcare internal auditing. Tuesday, September 17 . 45-59 Founded in 1981, the Association of Healthcare Internal Auditors Wednesday, September 18 . 61-67 (AHIA) is a network of experienced healthcare internal auditing Sponsors . 68-69 professionals who come together to share tools, knowledge and Exhibitor Hours & Drawing . .. 70 insight on how to assess and evaluate risk within a complex and dynamic healthcare environment. AHIA is an advocate for the Exhibitor Floor Plan . 71 profession, continuing to elevate and champion the strategic Exhibitor Listing . 72-82 importance of healthcare internal auditors with executive CPE Certification . 85 management and the Board. If you have a stake in healthcare governance, risk management and internal controls, AHIA is CHIAP™ Certificants . 86–88 your one-stop resource.
    [Show full text]
  • Clinical Audit: a Simple Guide for NHS Boards & Partners
    Clinical audit: A simple guide for NHS Boards & partners Authors: Dr. John Bullivant, Director, Good Governance Institute (GGI) Good Governance Andrew Corbett-Nolan, Institute Chair, Institute of Healthcare Management (IHM) Contents Executive summary Executive summary 3 Whilst this guide is specifically about clinical audit, much of what • Delivers a return on investment. is described here is relevant to the way in which NHS Boards can • Improvements are implemented and sustained. 1. Clinical audit: Ten simple rules for NHS Boards 5 monitor clinical quality as a whole within the context of clinical or integrated governance. A PCT has specific responsibilities in relation to clinical audit that 2. Foreword 7 should be managed through the Professional Executive Clinical audit has been endorsed by the Department of Health in Committee (PEC) or an equivalent committee. 3. Clinical audit as part of the modern healthcare system 9 successive strategic documents as a significant way in which the quality of clinical care can be measured and improved. Originally, Boards should use clinical audit to confirm that current practice 4. Definitions and types of clinical quality review 11 clinical audit was developed as a process by which clinicians compares favourably with evidence of good practice and to reviewed their own practice. However, clinical audit is now 5. The importance and relationship of clinical audit to clinical ensure that where this is not the case that changes are made recognised as an effective mechanism for improving the quality that improve the delivery of care. governance, NHS Boards and their partner organisations 15 of care patients receive as a whole.
    [Show full text]
  • Principles of Surgical Audit
    Principles of I Surgical Audit How to Set Up a Prospective 1 Surgical Audit Andrew Sinclair and Ben Bridgewater Key points • Clinical audit can be prospective and/or • A clinical department benefits from a clear audit retrospective. plan. • Audit information can be obtained from • Clinical audit improves patient outcome. national, hospital, and surgeon-specific data. Much of the experience we draw on comes from cardiac Introduction surgery, where there is a long history of structured data collection, both in the United States and in the United Clinical audit is one of the “keystones” of clinical govern- Kingdom. This was initially driven by clinicians [1–3,5], ance. A surgical department that subjects itself to regu- but more recently has been influenced by politicians and lar and comprehensive audit should be able to provide the media [6,7]. Cardiac surgery is regarded as an easy data to current and prospective patients about the qual- specialty to audit in view of the high volume and pro- ity of the services it provides, as well as reassurance to portion of a single operation coronary artery bypass those who pay for and regulate health care. Well-organ- graft (CABG) in most surgeons practice set against a ized audit should also enable the clinicians providing small but significant hard measurement end point of services to continually improve the quality of care they mortality (which is typically approximately 2%). deliver. There are many similarities between audit and research, but historically audit has often been seen as the “poor relation.” For audit to be meaningful and useful, it Why conduct prospective audit? must, like research, be methodologically robust and have sufficient “power” to make useful observations; it would There are a number of reasons why clinicians might be easy to gain false reassurance about the quality of care decide to conduct a clinical audit as given in Table 1.1.
    [Show full text]
  • Toolkit to Develop and Strengthen Medical Audit Systems
    Toolkit to Develop and Strengthen Medical Audit Systems Practical Guide by Implementers for Implementers December 2017 2017 심사평 메뉴얼북 표지.indd 2 17. 11. 29. 오후 8:26 2017 심사평 메뉴얼북 표지.indd 3 17. 11. 29. 오후 8:26 Toolkit to Develop and Strengthen Medical Audit Systems Practical Guide by Implementers for Implementers December 2017 2017 심사평 메뉴얼북 내지 책.indb 1 17. 11. 29. 오후 8:39 THIS GUIDE WAS PRODUCED by the Joint Learning Network for Universal Health Coverage (JLN), an innovative network of practitioners and policymakers from around the globe who engage in practitioner-to-practitioner learning and collaboratively develop practical tools to help countries work toward universal health coverage. For inquiries about this guide or other related JLN activities, please contact the JLN at [email protected]. This work was funded by a grant from the Rockefeller Foundation and by the Government of South Korea. The views expressed herein are solely those of the authors and do not necessarily reflect the views of the organizations. Note: This is the first release of the Medical Audits Toolkit. The toolkit has been reviewed by the participants of JLN’s Medical Audits collaborative, under which the product was developed. Attempts have been made to have the toolkit reviewed by external experts, such as medical audit professionals. A more rigorous review by external experts, along with feedback from countries will be incorporated to make it a comprehensive guide for use by countries looking to strengthen their medical audit systems. Revised version(s) of the toolkit will be available at www.jointlearningnetwork.org.
    [Show full text]
  • Clinical Audit: a Simplified Approach Mansoor Dilnawaz, Hina Mazhar, Zafar Iqbal Shaikh
    Journal of Pakistan Association of Dermatologists 2012; 22 (4):358-362. Review Article Clinical audit: A simplified approach Mansoor Dilnawaz, Hina Mazhar, Zafar Iqbal Shaikh Department of Dermatology, Military Hospital (MH), Rawalpindi Abstract A clinical audit measures practice against standards and performance. Unlike research which poses the question, “what is the right thing to do?” clinical audit asks are we doing the right thing in the right way? An approach for understanding a clinical audit is provided. A basic clinical audit example of a case note audit is presented. A simplified template to help the beginners is included. Key words Clinical audit. Introduction and steps of clinical audit We should determine what we are trying to measure and define gold standards. The next Audit is a key component of clinical stage is about setting the standards. Criteria are governance, which aims to ensure that the those aspects of care that we wish to examine. patients receive high standard and best quality Standards are the pre-stated or implicit levels care.1,2 It is important that health professionals of success that we wish to achieve. The are given protected and adequate time to standards are based on the local, national or perform clinical audit.4,5,6,7 Clinical audit runs international guidelines. They should be in a cycle and aims to bring about incremental relevant to our practice. A couple of example improvement in health care. Guidelines and of the sources includes National Institute of standards are set according to perceived Clinical Excellence (NICE) and the British importance and performance is then measured Association of Dermatologists (B.A.D) web against these standards.8,9,10 .
    [Show full text]
  • Clinical Audit: a Comprehensive Review of the Literature
    CENTRE FOR CLINICAL GOVERNANCE RESEARCH Clinical audit: a comprehensive review of the literature The Centre for Clinical Governance Research in Health The Centre for Clinical Governance Research in Health undertakes strategic research, evaluations and research-based projects of national and international standing with a core interest to investigate health sector issues of policy, culture, systems, governance and leadership. Clinical audit: a comprehensive review of the literature First produced 2009 by the Centre for Clinical Governance Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052. © Travaglia J, Debono D, 2009 This report is copyright. Apart from fair dealing for the purpose of private study, research, criticism or review, as permitted under the Copyright Act, 1968, no part of this publication may be reproduced by any process without the written permission of the copyright owners and the publisher. National Library of Australia Cataloguing-in-Publication data: Title: Clinical audit: a comprehensive review of the literature 1. Literature review method. 2. I. Travaglia J, II. Debono, D. III. University of New South Wales. Centre for Clinical Governance Research in Health. Centre for Clinical Governance Research, University of New South Wales, Sydney Australia http://clingov.med.unsw.edu.au Centre for Clinical Governance Research in Health, UNSW 2009 i Clinical audit: a comprehensive review of the literature Clinical audit: a comprehensive review of the literature Duration of project February to May 2009 Search period 1950 to May 2009 Key words searched Clinical Audit Databases searched Medline from 1950 Embase from 1980 CINAHL from 1982 Criteria applied Phrase Contact details Contact: Jo Travaglia Email: [email protected] Telephone: 02 9385 2594 Centre for Clinical Governance Research in Health Faculty of Medicine University of New South Wales Sydney NSW 2052 Australia Centre for Clinical Governance Research in Health, UNSW 2009 ii Clinical audit: a comprehensive review of the literature CONTENTS 1.
    [Show full text]
  • Exploring Variation in the Use of Feedback from National Clinical
    Alvarado et al. BMC Health Services Research (2020) 20:859 https://doi.org/10.1186/s12913-020-05661-0 RESEARCH ARTICLE Open Access Exploring variation in the use of feedback from national clinical audits: a realist investigation Natasha Alvarado1* , Lynn McVey1, Joanne Greenhalgh2, Dawn Dowding3, Mamas Mamas4, Chris Gale5, Patrick Doherty6 and Rebecca Randell7 Abstract Background: National Clinical Audits (NCAs) are a well-established quality improvement strategy used in healthcare settings. Significant resources, including clinicians’ time, are invested in participating in NCAs, yet there is variation in the extent to which the resulting feedback stimulates quality improvement. The aim of this study was to explore the reasons behind this variation. Methods: We used realist evaluation to interrogate how context shapes the mechanisms through which NCAs work (or not) to stimulate quality improvement. Fifty-four interviews were conducted with doctors, nurses, audit clerks and other staff working with NCAs across five healthcare providers in England. In line with realist principles we scrutinised the data to identify how and why providers responded to NCA feedback (mechanisms), the circumstances that supported or constrained provider responses (context), and what happened as a result of the interactions between mechanisms and context (outcomes). We summarised our findings as Context+Mechanism = Outcome configurations. Results: We identified five mechanisms that explained provider interactions with NCA feedback: reputation, professionalism, competition, incentives, and professional development. Professionalism and incentives underpinned most frequent interaction with feedback, providing opportunities to stimulate quality improvement. Feedback was used routinely in these ways where it was generated from data stored in local databases before upload to NCA suppliers.
    [Show full text]
  • What to Do When an Audit Letter Comes… Sarah Reed BSE,CPC,CPC‐I AAPC Fellow
    What To Do When An Audit Letter Comes… Sarah Reed BSE,CPC,CPC‐I AAPC Fellow 1 The speaker has no financial relationship to any products or services referenced in this program. This program is intended to be informational only. The speaker is not an authoritative source by law. Attendees are advised to reference payer specific provider manuals, on‐line or otherwise, for verification prior to making changes to their coding, documentation and/or billing practices. 2 Content Ms. Reed will address with the attendees the different types of external audits and their purpose (including, but not limited to, CERT, OIG, HEAT,UPIC, ZPIC, MAC, MIC and commercial payer). In addition to defining and educating on what the intent of the audit is, she will provide information on how to respond and track these audits in your practice. Who should be involved ‐ from manager to coding staff to providers ‐ and how should you respond? Ms. Reed will also give some education tips for sharing in the practice so that staff understands the process and the importance of the audit in progress. 3 Slides and Information Please be aware that not all the information presented in todays session is listed on the slides you are viewing. These slides are a base for the presentation. You will need to take notes on specific discussions in the session. Do not be afraid to ask questions and make comments. This is an interactive education session. 4 Time Out • One of first clinical audits was undertaken by Florence Nightingale during the Crimean War of 1853‐1855.
    [Show full text]
  • Principles for Best Practice in Clinical Audit
    Principles for Best Practice in Clinical Audit Radcliffe Medical Press Radcliffe Medical Press Ltd 18 Marcham Road Abingdon Oxon OX14 1AA United Kingdom www.radcliffe-oxford.com The Radcliffe Medical Press electronic catalogue and online ordering facility. Direct sales to anywhere in the world. # 2002 National Institute for Clinical Excellence All rights reserved.This material may be freely reproduced for educational and not for profit purposes within the NHS.No reproduction by or for commercial organisations is permitted without the express written permission of NICE. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. ISBN 1 85775 976 1 Typeset by Aarontype Ltd, Easton, Bristol Printed and bound by TJ International Ltd, Padstow, Cornwall Contents Contributing authors iv Acknowledgements v Foreword vi Clinical audit in the NHS: a statement from the National viii Institute for Clinical Excellence Introduction: using the method, creating the environment 1 Stage One: preparing for audit 9 Stage Two: selecting criteria 21 Stage Three: measuring level of performance 33 Stage Four: making improvements 47 Stage Five: sustaining improvement 59 Appendix I: glossary 69 Appendix II: online resources for clinical audit 73 Appendix III: national audit projects sponsored by the 93 National Institute for Clinical Excellence Appendix IV: further reading 97 Appendix V: key points and key notes 101 Appendix VI: checklists 105 Appendix VII: approach to examining clinical audit during a clinical
    [Show full text]
  • A Guide for Clinical Audit, Research and Service Review
    A Guide for Clinical Audit, Research and Service Review — An educational toolkit designed to help staff differentiate between clinical audit, research and service review activities Janet Brain, Jean Schofield, Kate Gerrish, Sue Mawson, Irene Mabbott, Dipak Patel and Paul Gerrish Sheffield Teaching Hospitals NHS Foundation Trust Clinical audit tool to promote quality for better health services Revised - minor changes to wording - November 2011 Previous versions: September 2009 (first publication) Next review: November 2012 Contents 1 Overview 1 1.1 Introduction 1 1.2 Background 1 1.3 Implications 2 1.4 Purpose of this guide 2 2 The Simple Rules 5 3 The Rule In questions 6 4 Clinical governance and project development 10 4.1 Ethical principles applicable to clinical audit and service review 10 4.1.1 Introduction 10 4.1.2 The ethical principles 10 4.2 Assurance of ethical consideration 13 5 Glossary of terms 16 6 Frequently asked questions about the toolkit 18 References 23 Further reading 24 Tables 1. The Simple Rules 5 2. Rule In question for clinical audit 6 3. Rule In questions for research 7 4. Rule In questions for practice/service development 8 5. Rule In questions for practice/service evaluation 9 6. Ethical principles applicable to clinical audit and service review 11 Appendices Appendix 1. Registration processes 25 Appendix 2. Where to go for help 26 Appendix 3. Example service review confirmation letter for publication or educational purposes 27 Appendix 4. Contributors 29 A Guide for Clinical Audit, Research and Service Review i of 29 1 Overview 1.1 Introduction The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices.
    [Show full text]
  • Clinical Audit - What Is It and How to Do It?
    Miscellany Clinical Audit - What is it and how to do it? Sandhya K Lokuarachchi Consultant Paediatrician, Karapitiya Teaching Hospital, Galle. There is much concern about the quality of care History provided to our patients and the standard of the Monitoring of patient outcomes had been carried care givers. Many instances of national publicity out as early as 1750 BC, during king Hammurabi and criticism regarding patient care in our hospitals of Babylon, with punishments for clinicians for were seen commonly in recent past. Society has poor performance [3]. However, the first clinical become very vigilant and critical about the standard audit is considered to have been carried out by of patient outcomes. Florence Nightingale during the Crimean war of There is no doubt that all attempts should be made 1853-5, when improvement of standards following to give best quality care to our patients. To achieve an “ audit” on cleanliness remarkably reduced the this there should be a systematic way of mortality rates in hospital patients [4]. Ernest identifying the deficiencies honestly with genuine Codman is known as the first true medical auditor attempts at improving the shortcomings. following his work on monitoring surgical outcomes in 1912. Since then process of evaluating patient Clinical audit is the process that supports care remained static for many years. First move continuous quality improvement programmes [1]. to integrate clinical audit in professional health It is one way in which we can work to retain trust care in United Kingdom was the introduction of and respect of patients, in an increasingly critical the white paper, in 1997 [4].
    [Show full text]