|EVIDENCE BASED DATA
|Year : 2009 | Volume
| Issue : 6 | Page : 700-701
The Value of An Audit
Senior Prof. & Head, Department of Anaesthesiology, R.N.T.Medical College, Udaipur (Raj.), India
|Date of Web Publication||3-Mar-2010|
25, Polo Ground, Udaipur (Raj.)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bajaj P. The Value of An Audit. Indian J Anaesth 2009;53:700-1
The value of audit and feedback, with reference to their effects on professional practice and health care outcomes, was recently the topic of a Cochrane Review  : Providing healthcare professionals with date about their performance (audit and feedback) may help improve their practice. Audit and feedback can improve professional practice, but the effects are variable. When it is effective, the effects are generally small to moderate. The relative effectiveness of audit and feedback is likely to be greater when baseline adherence to recommended practice is low and when feedback is delivered more intensively. The results of this review do not support mandatory or unevaluated use of audit and feedback as an intervention directed at changing practice. However, it must be stressed that only 118 studies have been considered for this review and that many of these had some methodological weakness. Therefore, the conclusion must tend more towards : "There must be more and better audit-research performed !" than towards "Forget it, it is worthless."
Another study has demonstrated the value of clinical audit in the establishment of acute pain services  : the authors performed a survey of current practice in different hospitals, implemented an educational programme for staff and patients on pain and its management combined with formal assessment of pain and an algorithm to allow more flexible, yet safe, intramuscular opioid analgesia and, after that, a repeat survey of clinical practice. They found a marked reduction in the proportions of patients experencing severe pain at rest and on movement : from 32% to 12 % and from 37% to 13% , respectively.
A published audit deals with the successful implementation of measures to prevent perioperative hypothermia  : in this study the authors demonstrated that the more frequent use of intraoperative measures to prevent hypothermia (heat and moisture exchanger, circle breathing system, foil hat, forced air warmer) led to a highly significant (p<0.0001) increase in core temperature on arrival in the recovery room from 35.5 0 C to 36.6 0 C, although on average the procedures lasted about 20 min longer (154.7 vs 133.5 min) in the second audit.
These are some examples show different aspects of the (possible) impact of audits in anaesthesiology on structures, processes and outcomes. There are many unsolved problems in daily anaesthesiological patient care, which should also be addressed.
Whilst the aspects of structures, processes and outcomes can also easily be transferred to innumerable topics in the ICU setting, too, there is one recent paper describing a different methodological approach to auditing in the setting of an ICU a technique called a "realtime patient safety audit", which is derived from industrial methods providing timely error detection, including feedback to the responsible person in the frontline  . It is obviously not always necessary to perform longlasting studies with complex observations, but even the use of a brief checklist reminding the members of the care staff of the existing standards can improve healthcare outcomes and avoid disasters : in one study of ICU a 36- item checklist was used, which focused on errors associated with delays in care, equipment failure, diagnostic studies, information transfer and noncompliance with hospital policy. This checklist revealed a lot of errors in a short period of time; for example, unlabelled medication was used at the bedsides, some of the patients had no ID bands and the alarms settings of the pulse oximerter were inappropriate. Based on these findings many policies were changed and many educational initiatives were launched, with the intention of making patient care in this ICU setting much safer.
Auditing is a cyclic business and part of a continuous improvement and educational programme which ultimately will lead to a cultural change in a hospital or department. Therefore, it is mandatory not only to detect the "weak points" of a process, but also to try to improve them by education and training and later to check whether this training has been successful by reauditing. 
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|4.||Gallagher GA, McLintock T, Booth MG. Closing the audit loop - prevention of preoperative hypothermia : audit and reaudit of perioperative hypothermia. Eur J Anaesthesiol 2003;20:750-752. |
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