Clinical Audit

Clinical audit is audit or review of the clinical care. 

Clinical audit work may be equated with the work of CA ( Chartered Accountant) in finance & accounts for example a Chartered accountant audits the accounts and finance according to the standards and financial rules, Similarly clinical audit is regarded as an important component of the “Clinical Governance”. Clinical audit is in practice in many countries but NHS in UK stresses on it and there is Clinical Audit Guidance Group in NHS in United Kingdom.

Clinical audit  aims to improve the clinical care of the patients.

Many descriptions are available online but the most relevant definition of Clinical Audit is given by National Institute of Clinical Excellance, UK in “ Principles of Best practice in Clinical audit”, NICE,2002.  

“ A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit standards and implementation of change”

The objectives of Clinical audit is to identify, compare the current quality of care of patients with established protocols of best evidence based clinical practice and then implement the required and necessary changes. Then re-audit is done to assess the improvement in patient outcome as a result of implementation of changes in clinical practice. This completes one cycle of the clinical audit.

Clinical audit ensures best possible care of patients according to the evidence based clinical practice and efficient use of resources.. It helps to improve multidisciplinary team work .  The clinical audit should be patient centric and should have positive impact over clinical outcome.


Anything relevant to patient care may be audited whether structural, procedural or outcome of any intervention.


It begins with selection of a topic and defining the objective of clinical audit. Then select standards followed by collected of data. Then the next step is analysis of the data and making recommendation. The last step is to implement the changes and reaudit.


Clinical audit should be impartial, pro active and involves team members who are concerned with patient care and wish to improve.

Not doing clinical audit indicated that you do not want or you do not know the impartial mechanism to improve . It is like playing a sport without a scoring board and without a system of reviewing our own or team's performance. So you keep on repeating the same mistakes and ignoring the areas where you or your team could improve. It is not a fault finding or punitive exercise But, the findings of clinical audit should be shared so that other team members also improvise.

The earliest contributions to the concept of clinical audit is contributed to Florence Nightingale ( 1820-1910) who worked during the Crimean war in Medical barracks Hospital in Scutari in 1854 and led a team of 38 nurses. She improved the care of the wounded persons and found that by improving the sanitation, cleanliness mortality was reduced from 40% to just 2%.

Later Ernst Codman ( 1869-1940) introduced the concept of Monitoring Surgical outcomes " end result idea" and he is regarded as Medical auditor.

Resources
Wikipedia, NICE guidelines, NHS, Journal of Clinical Audits ( www.clinicalaudits.com),

Health Quotient ( HQ )

I wish to coin a new term "Health Quotient."  It will denote the relative well being and health of a person as compared to the health of a normal person of that particular age. As IQ is of relevance in younger age group , this term HQ will be of particular value in people of older age groups.
Assessment of health quotient includes intelligence, memory, locomotor strength & physical well being, any co-mobidity or disability, activity of daily living, physical and emotional independence, interest & motivation. For example a 40 year person is expected to have normal locomotor activity, normal hearing and a good respiratory function but a diseased person may have poor cardiac and respiratory reserve due to chronic smoking, alcoholism, sedentary life style. So, the health quotient may a good marker of socio-economic productivity of a person.
This quotient is of immense value in present time because of increased life expectancy and better health of people even after the retirement age. The age old norms of retirement age are becoming irrelevant because people are healthy and eager to continue wor even after fficial retirement age. In some professions, in fact, people gain maturity and wisdom with time. Many physicians, entrepreneuers, politicians, businessmen are well respected and active when they surpass the age of retirement.
So, there should be an objective criteria to evaluate the health quotient of a person and he or she should be asked to continue active contribution to the society.