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Audit

Audit

Why Audit?
WhyAudit?
Theaimofclinicalauditin
dentistryaimstoencourage
dentists to selfassess
dentiststoself
assessdifferent
different
aspectsoftheirpractice,
implement changes and monitor
implementchanges,andmonitor
themwithaviewtoimproving
serviceandpatientcare.
d

What is clinical audit?


Whatisclinicalaudit?
Theprocessofcomparinginformation
Th
f
i i f
i
inthemedicalrecordandin
i f
informationsystems
i
againstthestandardprotocolsor
criteriaforthedeliveryofagivencare
item.Thedatacollectedthroughthis
processcanbeusedtoidentifywhatis
neededtoimprovepatientcare,andto
assesschangesovertime

Clinical Audit
ClinicalAudit

Theaimofclinicalauditistoimprovepatient
treatment by improving professional practice
treatmentbyimprovingprofessionalpractice
andthequalityofservicesdelivered.
Thisisachievedthroughacontinuousprocess
g
p
wherebyhealthcareprofessionalsreviewpatient
careagainstagreedstandardsandmake
changes where necessary to meet those
changes,wherenecessary,tomeetthose
standards.Theauditisthenrepeatedtoseeif
thechangeshavebeenmadeandthequalityof
g
q
y
patientcareimproved.Thisisoftencalledthe
auditcycleorspiral.

The Audit Cycle


TheAuditCycle

Thebasicframeworkuponwhichallaudit
projectsarebased.
j
b d
Theauditcycleemphasizestheneedtocompare
onesownclinicaltreatmentwiththatcurrently
regardedastheGoldStandards
Shortcomingsareidentified,andchangeis
implementedtoimproveclinicaltreatment
p
p

Select a Topic

Accept a Standard of Practice


(e.g. from research)

Implement
Change

PDSA

Compare your practice


with the standard

Observe your
Practice
(i.e. Audit)

Evaluation of Clinical Guidelines


EvaluationofClinicalGuidelines

Allguidelines,atwhateverlevel;should
g
,
;
thereforebeassessedaccordingtothelevelsof
evidence on which they are based
evidenceonwhichtheyarebased.
(SIGN)ScottishInterCollegiateNetwork

Level

TypeofEvidence

la

Evidenceobtainedfrommetaanalysisor
Evidence
obtained from meta analysis or
randomizedcontroltrials.

lb

Fromatleastonerandomizedcontroltrial

lla

Obtainedfromatleastonewelldesigned
Obtained
from at least one well designed
controlstudyw/orandomization

llb

Obtainedfromatleastoneothertypeofwell
Ob
i df
l
h
f ll
designedquasiexperimentalstudy

lll

Fromwelldesignednonexperimental
descriptivestudies,suchascomparative
studies,correlationandcasecontrolstudies
Fromexpertcommitteereportsoropinions
p
p
p
and/orclinicalexperienceofrespected
authorities

lV

Meta Analysis
MetaAnalysis

MetaAnalysis:Afurtherrefinementof
theprocess;whichusesastatistical
technique to sum up the results of several
techniquetosumuptheresultsofseveral
studiesintoasingleestimate;whilegiving
weight to larger studies
weighttolargerstudies.

4 Evaluation of Clinical Guidelines


4.EvaluationofClinicalGuidelines
Theneachrecommendationisassessed
g
accordingtothelevelofevidenceavailable
andscoredA,BorC.

Grading
g of recommendations
Grade

Recommendations

A
(Evidencelevelsla,lb)

Requiresatleastonerandomizedcontrolledtrialas
part of the body of the literature of overall good
partofthebodyoftheliteratureofoverallgood
qualityandconsistenceaddressingthespecific
recommendations

B
(
(Levelslla,
l ll llb,lll)
llb lll)

Requiresavailabilityofwellconductedclinical
studiesbutnorandomizedclinicaltrialsonthetopic
ofrecommendation

Requiresevidencefromexpertcommitteereports
oropinionsand/orclinicalexperienceofrespected
authorities.Indicatesabsenceofdirectlyapplicable
th iti I di t
b
f di tl
li bl
studiesofgoodquality

( Evidence Level lV)


(EvidenceLevellV)

ElementsoftheEBD

5 Elements
5Elements

1.
2.
3.
4.
5
5.

Question Developingaclearquestionbasedonthepatients
clinicalproblem.
Find Findingthe latestevidencethroughefficientsearchingfor
information.
Appraise
pp
Criticallyappraisingtheevidencetoassessitsvalue.
y pp
g
Act Actingontheevidenceyoufind,ifappropriateandrelevant
totheclinicalsituation toprovidetreatmentforthepatients.
Evaluation Eachaspectofyourperformanceinthisprocesscan,
Each aspect of your performance in this process can
andshouldbeevaluatedandthisisincreasinglyrelevantwiththe
developmentofcontinuingprofessionaldevelopment

Identify Clinical problem

Search for Evidence

Discard
Poor Evidence
Make sense of Evidence

Update
Evidence

Store
Good Evidence

Act on Good Evidence

Review
cycle

WhatisGoodEvidence

BEST
Asystematicreviewof2ormoregoodrandomized
controlled trials
controlledtrials
Arandomizedcontrolledtrial
Acohortstudyy
Acasecontrolstudy
Adramaticuncontrolledexperiment
Respectedauthoritiesexpertcommittees
Someonetoldme..

WORST

RandomizedControlledTrials
Randomized
Controlled Trials
RCT

RCTsinvolvetherandomallocationofdifferent
interventions (or treatments) to subjects. This
interventions(ortreatments)tosubjects.This
ensuresthatknownandunknownconfounding
factors(externalvariables)areevenly
distributedbetweentreatmentgroups.
Trialsareusedtoestablishaverageefficacyofa
treatmentaswellaslearnaboutitsmost
frequentlyoccurringsideeffects

Rules for RCT


RulesforRCT

Aflowchartdescribingpatientprogressthroughthetrial
Truerandomizationofpatientsintotestandcontrol
True randomization of patients into test and control
groups
Shouldbeclearlyfocusedonaspecifiedintervention
y
p
Thepatient,doctorsandobserversshouldbeblindedin
regardstothetreatment
Atleast80%ofthepatientsshouldcompletethetrialto
theend

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