Traditional methods of performing audit
Shaw in Frostick et al.’s Medical Audit: Rationale and Practicalities (1993)
describes the traditional views of medical audit in terms of the
‘characteristics of effective audit’ and the ‘methods’.
The characteristics can be summarised as:
• explicit criteria for good clinical practice — guidelines for
practice;
• objective measurement of patterns of current practice
—looking at identified groups or activities;
• comparison of results amongst
peers — acceptable published data;
• explicit identification of corrective action — agreed action
and its implementation;
• documentation of procedure and
results — a formal report of the proceedings and action required.
The methods that Shaw outlines are basically
very simple and can be undertaken by a small group (i.e. a directorate) or on a
larger scale. Examples of the usual types of audit that can and are performed
include:
• workload and case mix;
• appropriateness of care;
• access to care;
• outcomes of care;
• quality of records;
• efficiency.
The advantages of a traditional approach to
audit are as follows.
• It is simple and cheap.
• Data should be easy to acquire and their accuracy can be
checked.
• The cycles and so the effectiveness of the audit can be
repeated at short time intervals.
• There are simple educational outcomes which are derived from
regular, small and well-run audit meetings.
The disadvantages of traditional audit are as
follows.
• Meetings may occur but are not repeated so the audit cycle is
not completed.
• Standards may not be easy to define in an objective way.
• The onus often falls on the most junior person on the firm to
acquire and present the data.
• Morbidity and mortality meetings can be embarrassing and
destructive.
• The education may be by guided ‘shaming’ not by guided
learning.