THE DEVELOPMENT OF CLINICAL AUDIT IN UK
Clinical audit is a quality and improved process of taking good care of patients through the systematic procedural review of the care system that they have used in order to choose the best methods that needed changes or development. The structure and outcome of selected cares are evaluated before proper implementation, basic determinants and consideration including testing and monitoring is used for the confirmation so that the improvement of healthcare are delivered. In order to ensure that the implementation and delivery of such clinical audit will not be restrained nor delayed the provision of guided framework must be met. To its success clinical auditing and its principles have been incorporated mostly in most countries of United Kingdom, Europe, United States of America and other Countries and Regions.
Clinical auditing has been a critical issues from various clinical and hospital care until its further development process. Basically Florence Nightingale has been the pioneer co- existence to use the clinical audit system within a year of 1853 to 1855 during the Crimean War in Scutari Hospital where Florence and other medical practitioners are assigned. The Hospital or clinic was near the barracks of most soldiers so that they can be easily reached when they are injured or suffering different medical diseases but during their treatment there were issues and controversies that some soldiers may have died not just in the battle but because of their unsanitary medical equipments and practices but they believed that they have applied the best sanitary hygienic purpose. The medical team has not expected such issues.
In order to apply a solution and answers to the dilemma Florence and the team has created a stricter sanitary hygiene upon the participation and treatment of soldiers they have also meticulous recording and analysis of mortality rates in order to reclaim such process to soldiers and other in house patients involved in war. Unbelievably the mortality rates has decreased considerably by more than fifty percent and so occasionally they kept on watching the same procedures and added a little changes and development while needed. The team advocacy has been praised for a job well done. This statistical recovery has become recognized by most medical practitioner during those times because of their systematic approach in health care. They have been recorded and recognized as one of the pioneer in clinical audit practices.
Ernest Codman a surgeon was another popular and early clinical audit pioneer because he has initiated contemporary approach to quality assurance and monitoring system in as early as 1912 but most of his works was not eventually recognized since he is just an ordinary medical practitioner in their town in Massachusetts. What he does is to keep track of the patients via “End Results Cards” that is used to follow on the medical history of patients in their previous years of medical recovery the patients will be followed up at least within a year. Ernest record keeping has become the basis of modern medical practices since the records are historical and scientific findings.
The errors in medical practices have also been anticipated through his records and they have found many valuable applications such as accountability and efficient management of resources in such system that Codman has been recognized in “Hospital Efficiency”. His works has made several contributions in other medical fields including in radiology, oncology, orthopedic, anesthesiology and other medical science. The combination of the development of clinical auditing by both Codman record management and Florence epidemiological auditing although in contrast have created a phenomenal methodologies that has become a basic in the improvement of services, they have become a guiding principles in the development of best health care practices.
Although the critical attribution has been founded earlier the implementation and adaptation of the process that these geniuses has been created has taken quite a while in discovery and usefulness of such process and only few medical practitioners have long believed and trusted such process. The conceptualization of such process was somehow disregarded until 1989 when finally the integration of such system has evolved and the ideas and development combining both systems was further developed and enhanced by the White Paper working for patients and the National Health Service trust (NHS trust) acts in 1990. This an authoritative reports than can solve many medical problems of patient and history and background can be easily trace within the white paper to educate doctors and patients and make a good recommendations and decisions that they need to make.
The records can also be used in investigations by the public, the government, business and other institution whoever may need to research or request such records. UK was the first to standardize such clinical auditing system that includes the diagnosis and treatment as well as the outcome of the patient’s condition. In the process this has been called the medical audit system and later evolved its name and also become popular in medical terms as the clinical audit. The long history of its name and where it has been derived is not much of importance but the function and its full integration to the contemporary healthcare and its benefit has been largely emphasized.
To further emphasize the development and the history of clinical audit in UK the National Institute for Health and Clinic Excellence (NICE) one the most popular health authority in UK they have promoted several medical development practices including new found medicines, new discovery system, treatment and procedures etc. and this includes the development of Clinical audit. Later in 1997 White Paper made a Reinforcement and basically a little additional development in the system that they believed that this is more dependable position in the practice of medical benefits and health services and more so in 1998 White Paper has confirmed another First Class Service to call on the participation of most hospital doctors to engage their practices in this clinical auditing program which they believed to be very important.
Furthermore within a year or so, White Paper has once again made A Plan for Investment, A Plan for Reform that introduced significant changes requiring the immediate implementation of such plans for all healthcare and medical practitioner. The (NICE) has so much believed in the effectiveness of such plans that they have mandated its application medically as final. In 2001 the General Medical Council has made their request that the systematic medical and clinical audit must include honesty in their procedure. The UK Central Council for Nursing Midwifery and Visiting also has the same opinion that the management of quality assurance system including the implementation of clinical auditing should be highly exercised.
The participation of such organizations varies a wide acceptance of the system in this field that such recommendation is indeed an effective tool for medical growth that should not be disregarded. In the latest addition last 2007 White Paper Trust Assurance and Safety has developed a more intense visual representation in a graphical procedure the continuous improvement in patient health care and delivery system. And most recently in 2008 White Paper State Secretary for Health Andrew Lansley has recognized clinical audit as the key driving force for their vision for the National Health Service trust (NHS trust). This means that high quality services are deserved by all patients all over the world if they only take advantage of the system.
Most basically this has been the history and evolution of the recurring trend in clinical audit in UK that has been adapted and highly used within the medical industry. In a more systematic approach the evolution is called the standard based “Audit Cycle” through which the system can be easily identified and configured the cycle is a universal guidelines that is easy to follow. It also enhances and point the basic theory and actual practices needed and it can even intensify the claim for a continuous improvement of the system if further attention is required or depending on the setup of the hospital. The cycle involved the basic methodology, to view this cycle please visit this website; http://www.google.com.ph/search?q=clinical+audit+cycle&hl=en&biw=1024&bih=677&prmd=imvns&tbm=isch&tbo=u&source=univ&sa=X&ei=fRqgTujPHcyRiQe90cXeBg&sqi=2&ved=0CCoQsAQ.
Upon viewing the cycle you can easily understand the simplicity and importance of such system that it has served medical practitioner as a guide map quality improvement system to distinguish, analyze and implement even by intern and medical students who have realized its importance and benefits of clinical audit that includes specifically the following pillars in clinical governance;
· The system creates a real benefit for the patient and nurses and institution in safekeeping and retrieval of records for easy history tracing
· It can further developed openness and participation to changes
· Clinical efficiency and effectiveness through the development of guidelines and basic protocol that is highly required by most medical healthcare service.
· Scientific based history evidences of medical records of patients from around the world is possible, the development of medical transcription as a sample.
· Eliminating various error formation that can harm the health of patient severely is minimized and controlled rather than neglected nor misinterpret so that various complaints, grievances and criticism can be eliminated.
· The expectation of patients and the service of health centers are met upon proper implementation and exercises of such system in clinical auditing.
References; ( http://www.nice.org.uk/media/796/23/BestPracticeClinicalAudit.pdf ) ( http://www.west-middlesex-hospital.nhs.uk/our-services/a-z-of-clinical-services/clinical-audt/ ) ( http://www.west-middlesex-hospital.nhs.uk/our-services/a-z-of-clinical-services/clinical-audt/ ) (http://en.wikipedia.org/wiki/Clinical_audit )
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