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On Sep 2018




Prof. Somashekhar Nimbalkar

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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Postgraduate Education
Year : 2011 | Month : June | Volume : 5 | Issue : 3 | Page : 679 - 682

Basics in Research Methodology- the Clinical Audit

ASHWINI NAVEEN SHANKAR, VEMANNA NAVEEN SHANKAR, VEMANNA PRAVEENA

Department of of Oral and Maxillofacial Surgery, Kothiwal Dental College Research Centre and Hospital, Kanth Road. Moradabad

Correspondence Address :
V. Naveen Shankar. MDS (Oral Medicine and Radiology)
No#110. 5th Ward
National College Road, Bagepalli, 561207
Chikkaballapur. Karnataka, India
Phone: +00919286731312. 00919844363084.
E-mail - vnaveenshankar@gmail.com

Abstract

Health care organisations regularly undergo quality assurance for safe and effective patient care. Such quality improving programs are considered as audit. The purpose of audits is to generate findings that will benefit patients and their programmes of care. Audits should be regularly carried out in a systematic manner as patient welfare is at the heart of any audit process. Auditprocess should maintain professional and ethical perspectives also. However, clinical audits are often poorly carried out and consequently have minimal effect on improving patient care. Health care organizations should encourage clinicians to participate in regular clinical audit. This review explains the basics of audit and describes in detail how a clinical audit should be performed and monitored.

Keywords

Research, Health Technology, Quality, Data.

Healthcare delivery organisations globally are utilising various quality indicators to measure the efficacy of specific interventions as well as to identify the healthcare improvement opportunities. These quality indicators are further being used for performance and outcome measurements as a means to measure, monitor and improve the quality of the care and services of these organisations (1).

‘‘Audit’’ means to evaluate (1). The standard definition of clinical audit is ‘‘a quality improvement process that seeks to improve the patient care and outcomes through a systematic review of care against explicit criteria and the implementation of change (2). Clinical audit explicitly entails the review of the clinical performance against the agreed standards and the subsequent improvement of the practice, followed by further audit to continually drive up the standards. Its aim is to improve the quality of the care which is delivered. It is different from other types of audit that may be conducted in the clinical workplace such as a financial or organisational audit.(3)

WHY CLINICAL AUDIT
The purpose of audits is to generate findings that will benefit patients and the programmes of care for them. Patient welfare is at the heart of audits and so, from both the professional and ethical perspectives, healthcare organisations should not stint on the audit activities (4).

Clinical audit is one of the key elements of clinical governance .Clinical governance is a system through which healthcare organisations are accountable for continuously improving the quality of their services. It is described as ‘‘a framework through which organizations are accountable to continue to improve the quality of their services and to safeguard their high standards of care by creating an environment in which the excellence in clinical care would flourish and would be central to the modernisation plans of the National Health Service (NHS)". The provision of safe, high-quality care is a statutory obligation for the healthcare organisations which are under the Health Act, and clinical governance (3),(5). Clinical audit is central to these quality improvement principles. It provides the means to review(2).The quality of the care which is given to the patients with common conditions.The health screening activities.

• Significant events. Audits are time consuming and if the staff perceives them as chores which are required by the management that attract little or no feedback, they can become demoralised. In such cases, the staff will not perceive any benefits in audits and will engage in them only reluctantly. This leads to frustration all round (6).

There are also examples within the dental practice such as the impact of clinical audit on antibiotic prescribing in the general dental practice across the east of England which led to significant improvements in the appropriate prescription of antibiotics, an overall reduction in the total number of prescriptions which were made over comparable timeframes, and a significant increase in error-free prescriptions. In addition to these tangible outcomes that can directly affect patient care, other commentators have described less overt benefits (7). One review of clinical audit found evidence from across the healthcare professions of professional benefits to those personnel who were participating in the audit, including a better team communication, job satisfaction, learning from the behaviour of colleagues and an increase in the staff enthusiasm (2). It is important to understand that while clinical audit and research share some common features, they are distinct disciplines and therefore are not the same. Research is concerned with the creation of new knowledge. Clinical audit ensures that this knowledge is being applied appropriately (1),(3).

THE DEVELOPMENT OF AUDIT
As early as 1750 BC, King Hammurabi, the 6th king of Babylon, instigated audits for the clinicians. In modern medicine, one of the first clinical audits was undertaken by Florence Nightingale during the Crimean War of 1853–1855; she applied strict sanitary routines and hygiene standards that decreased the mortality rates from 40% to 2%. Another famous figure who advocated clinical audit was Ernest Codman (1869–1940), an orthopaedic surgeon at Harvard Medical School. He became known as the first true medical auditor following his work in 1912 on monitoring surgical outcomes. Despite the early work of these pioneers, clinical audit is relatively new to the modern medical practices.

In 1989, the Department of Health published a white paper which was entitled ‘Working for Patients’. The paper proposed several measures, one of which was that the arrangements ‘for whatdoctors call medical audit’ be extended throughout the health service.

A working paper on medical audit was published the following year to provide the details as to how the proposals had to be taken forward (1),(2),(3),(7).

By 1994, the term ‘clinical audit’ appeared to have largely replaced the earlier term ‘medical audit’. Benchmarking schemes, which share similarities with clinical audits have been in existence in the USA for many years. Benchmarking is the process of measuring products, services and practices against the leaders in a field. Thus allowing the identification of the best practices that lead to a sustained and improved performance (1),(8).

The audit team: A structured approach, with an effective leadership and a working team, will underpin a successful audit. The team may be unidisciplinary or multidisciplinary. It is imperative to engage at the planning stage, all those who will be involved centrally or peripherally and all those who may be affected by the audit, whether they are colleagues or service users.

It will be difficult to achieve any change in the practice following the audit if the colleagues have not been committed to the project from the outset. Also, patient involvement is an essential part of the clinical governance framework. Note that a clinical audit requires funding and it may increase costs and require protected time (3),(9).

THE AUDIT CYCLE (5).
STAGE 1: SELECT THE AUDIT TOPIC: Any topic which is selected for clinical audit - perhaps an investigation, treatment or procedure - should be chosen on the basis of its relevance to improve the patient outcomes and not to satisfy the personal curiosity. The topics may be selected from the reports of adverse incidents, activities which are identified as high risk, expensive treatments or perhaps, evidence-based interventions. Senior topics like the awareness about the brushing habits, dental caries, priodontities and antibiotics for dental infection can be useful for a better health care management. The examples of some topics are given in the Table below (10). (Table/Fig 1)

STAGE 2:IDENTIHCATION:
The next step is to identify as to what aspects of the best practice should be included in the audit. Local and national guidelines, national service frameworks and research papers can help to determine as to what is considered as the best practice. A useful structure for planning audits is to ask what, why, who, where, when and how, in which: * ‘What’ concerns the subject area or the specific topic of an audit.

* ‘Why’ concerns the objectives for conducting the audit with respect to what people wantto find out. * ‘Who’ concerns the population or the sample group. * ‘Where’ concerns the location or setting in which the audit is going to be conducted. * ‘When’ specifies the time in which the audit will take place, and how it will be a part of the ongoing data collection with a review of the findings in an established audit cycle. * ‘How’ relates to the data collection techniques and the strategies.

STAGE 3: AGREE WITH THE CRITERIA AND THE STANDARDS
The use of the terms ‘criteria’ and ‘standards’ in a clinical audit is often misunderstood. The audit criteria will provide a statement on what should be happening and the standards will set the minimum acceptable performance for those criteria. The criteria and standards must be specific and measurable. In selecting the criteria, one should carefully consider exactly what he/she wants the audit team to achieve. It may be helpful to phrase the aim as a question which is to be answered or a statement about how the topic should be. A common understanding among the team will support the quality of the audit. Simplicity is important -bear in mind the acronym KISS (‘Keep It Simple, Stupid’). Remember that the standards may need to be revised, to reflect a new evidence for an intervention or an activity. Some criteria and standards are so important that 100% achievement is required but this is likely to be unusual.

STAGE 4: COLLECT THE DATA
Collect only the data that are specifically related to the audit criteria. Decide on prospective or retrospective audit and on how to collect the data -- for example, on a pro forma, by direct entry into a computer or by searching on the Read codes. Undertake a small pilot audit to ensure that the tool is robust and is collecting appropriate data. If someone is searching the patient records and the practice team has not been using the templates for data entry or has been making free-text entries, it will be difficult or impossible to retrieve the required information.

The data which is collected must be relevant, accurate and representative. Most of the audit data are collected by using either manual data collection forms or they are recorded by using electronic computer software such as the Microsoft applications, Excel and Access. A careful review is necessary to ensure that the data which were collected are representative and that the correct data were collected.

For the assessment of the effectiveness, diffusion and equity in health technology (HT), we have classified the routine data into three broad groups: Group I datasets: which identify both the HTs and the health states. Group II datasets: which identify the HTs but not the health states Group III datasets: which identify the health states but not the HTs Clearly, the datasets in group I are the most promising, although there are occasional potential uses of the groups II and III at the population level enquiries and in adjunctive roles. Group I datasets can be further classified into (a) clinical registries, (b) clinical–administrative datasets and (c) population-oriented datasets. Group III datasets can be divided into (a) adverse event reporting and confidentialenquiries, (b) disease-only registers and (c) health surveys. Group I datasets can be used not only to assess the effectiveness but also to assess the diffusion and equity. By contrast, the databases in group II (HT only) can only help in assessing diffusion. Those in group III (patient health- related characteristics only) have restricted the scope for assessing the HTs except for the analysis of adverse events.

Patient Data: Caldicott Principles:3 In March 1996, The Caldicott Committee was established for the protection and the use of patient information,

The Caldicott principles for using patient information are: * Justify the purpose. * Don’t use patient-identifiable information unless it is absolutely necessary. * Use the minimum necessary patient-identifiable information. * The access to the patient-identifiable information should be on a strict need-to-know basis. * Everyone should be aware of their responsibilities. * Understand and comply with the law.

STAGE 5: ANALY SE THE DATA
Analysis involves interpreting the collected data to discover how the current practice compares to the agreed criteria and the standards. It identifies the areas both of underperformance, which should be reviewed in detail to identify why the care falls below the desired levels and how it can be improved, and of over performance.

STAGE 6: IMPLEMENT THE NECESSARY CHANGES:
Implementing changes that will improve the poor results is often the hardest part of any audit project. All the team members should be involved in discussions about what changes should take place, so that all the possible solutions are explored. These changes invariably depend on the specific circumstances of the audit, but often include staff training and the introduction of* better systems of practice or new protocols and guidelines.

STAGE 7: CONDUCT A RE-AUDIT
Re-audit is another key part of the audit cycle which should be carried out within a year of implementing the changes. Re-audit involves collecting a second set of data to and review the progress after the changes have been implemented to identify whether further improvement is needed. The numbers which have been audited should be comparable to those from the first data collection phase.

STAGE 8: WRITE AND DISSEMINATE AN AUDIT REPORT
This being the final stage of the audit cycle is intended to create a record for the auditor, the team and the organization which is involved. This report should also be shared with the colleagues who have taken part in the work, so they can see what effects the audit has had on their practice. Sharing audit reports widely also helps those who want to conduct clinical audits by using the same methodology. Audit feasibility scoring grid (11),(12). * Does the audit address a problem that is relevant to patient care? * Is the topic a priority for the team or the organisation?

* Can the data be collected quickly, ideally in less than a month? * Is there confidence that the data will be reliable and accurate? * Could the changes which were recommended as a result of the audit be implemented?

Scoring In answering the questions, award two points for a ‘Yes’, one point for a ‘Not Sure’ and no points for a ‘No’. Audits that score five or less are unlikely to succeed, those that score six or seven are worth considering and those that score eight or more will usually succeed.

In the Indian scenario for example, whether the prescription of antibiotics for the patients by the doctors is correct or not, can be adited. First, select the topic i.e. antibiotic prescription by the doctor. The next step is to have the best practice. For example, the drugs which are prescribed, their dosage, strength duration, whether there is a set criteria as to whether the drugs were prescribed in their correct dosages and their strength and whether or not their correct duration is being followed or not should be evaluated. Collect the data which were followed for the drug prescription at regular intervals. The collected data should be analyzed for their efficacy in the process of the clinical audit. If there are any shortfalls in the process that should be corrected, then necessary changes should be implemented. Again the data should be analyzed and the report of the findings should be formulated, as to whether the audit has met the set criteria or not. These findings should be implemented for a better outcome in the clinical practice.

In a study which was conducted by Andrew and Alan, the audits on clinical record-keeping standards were performed by using the 7 domains of the case history which are Personal details, History recording, Dental Examination, Periodontal examination, Radiographs, Record of the review of the radiographs and Notewriting. The audits revealed a wide variation between the dentists in clinical record-keeping. The recording of the soft tissues (36%), periodontal status (30%), radiographicalreview (27%), and notetaking (25%), all fell below the standards that had been set.(10)


TEN TIPS FOR SUCCESSFUL AUDITS.(3)

1. Start small clinical audit projects. 2. Involve the team members. Audits are most effective when they are carried out by teams. All the staff should be asked to suggest suitable topics and they should be told about the results. 3. Distinguish between research and clinical audits. Remember that research is undertaken to find out what the best practice should be,audits are undertaken to find out whether the best practice is taking place. 4. Learn from the completed projects of others. . 5. Select audit topics that relate to the current work. 6. Gather support. The local support for the clinical audits varies but some trusts have audit teams. 7. Plan the audits properly. Simple audit calendars which are used to map out the audit activities over the course of a year for example are useful. 8. Pilot the audits. A small number of data collection forms should be tested to make sure that they are providing all the information that is required. 9. Re-audit is vital. Without undertaking re-audit, there is no way of knowing whether the changesthat have been made have improved the patient care or the service delivery.

10. Get the most out of clinical audits. Although audits deal with the identification of the weaknesses and the improvement of the patient care, they can also be used as an example to improve the teamwork or communication.

Conclusion

Audits are a part of the continuous quality improvement in the health care systems. Audit is a cyclical process: it compares the practice of standards, measures performance, makes improvements and, most importantly, involves a re-audit after a time period to ensure that the improvement is sustained.

References

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Johnston G, Crombie IK, Davies HT, et al. Reviewing audit: barriers and facilitating factors for effective clinical audit. Qual Health Care 2000;9:23–36.
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Kraszewski, Sarah. Clinical audit in general practice. Practice Nurse 2005: 30(10):51-55
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Grainger, Angela. Clinical audit: shining a light on good practice. Nursing Management 2010:17(4):30-33.
5.
Ashmore, Stephen, Ruthven, Tracy Clinical audit: a guide. Nursing Management. 2008: 15(1):18-22.
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Phillip J Cannell, Evaluation of the End User (Dentist) Experience of Undertaking Clinical Audit in a PCT-Led NHS Modernisation Agency Pilot Scheme. Primary Dental Care 2009;16(4):168-178
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Chate R, White S, Hale L, Howat A, Bottomley J, Barnet-Lamb J, et al. The impact of clinicalaudit on antibiotic prescribing in general dental practice. Br Dent J. 2006;201:635-41.
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Burke, John V., Leucke, Randall W. Identifying best practices for audit committees. Healthcare Financial Management :1996: 50 (6) :
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Copeland G (2005) A Practical Handbook for Clinical Audit. NHS Clinical Governance SupportTeam.http://www.cgsupport.nhs.uk/ downloads/PracticalClinical_Audit_Handbook_v1_1.pdf
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Andrew Cole and Alan McMichael. Audit of Dental Practice Record- Keeping: A PCT-Coordinated Clinical Audit by Worcestershire Dentists. Primary Dental Care 2009;16(3):85-93.
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Allan D. Spigelman, Judith swan. Measuring clinical audit and peer review practice in a Diverse health care setting. anz j. Surg.2003;73: 1041–1043.
12.
J Raftery, P Roderick and A Stevens. Potential use of routine databases in health technology assessment. Health Technology Assessment 2005; 9(20).

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[Table / Fig - 1]
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