临床审计作为加沙地带的质量改进工具：审计之审计

Clinical audit as a quality improvement tool in the Gaza Strip: an audit of audits.

作者信息

Alyacoubi Said, Böttcher Bettina, Albarqouni Loai, Elessi Khamis

机构信息

Department of General Surgery, University College London Hospital, London, UK.

Faculty of Medicine, Islamic University of Gaza, Gaza, Occupied Palestinian territory.

出版信息

Lancet. 2021 Jul;398 Suppl 1:S13. doi: 10.1016/S0140-6736(21)01499-9.

DOI:10.1016/S0140-6736(21)01499-9

PMID:34227944

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8617315/

Abstract

BACKGROUND

Clinical audit plays a fundamental role in improving the quality of patient care and hence, is considered a cornerstone of clinical governance. This quality improvement tool is newly introduced in the health-care system of the Gaza Strip. Although the number of audits completed in Gaza has been increasing over the past few years, little evidence is available of subsequent quality improvements in practice.

METHODS

An online survey was used to collect information on the audit team, location, applied methods, outcomes, presentation of data, and reaudit. Medical students and health-care professionals who had conducted audits between 2015 and 2018 were invited to complete the survey from Oct 12 to Nov 2, 2018.

FINDINGS

Data on 62 audits were collected. Training in clinical governance was received by 55 auditors (89%) and a senior supervisor was available in 56 audits (90%). Audits were performed across different hospitals and specialties: 18 (29%) in obstetrics, 16 (26%) in medicine, and 11 (18%) in each of surgery and paediatrics, with six (10%) in other specialties. A clear trend of increasing numbers of audits was observed, with four (6%) having been done in 2015, 12 (19%) in 2016, 22 (35%) in 2017, and 24 audits (39%) in 2018. Students were involved in 46 audits (74%) whereas practising doctors were involved in only 29 audits (47%). 17 (27.4%) audits were done at more than one health-care facility and the remaining audits were done at one of 13 other main hospitals or community centres across the Gaza Strip. Clear standards were identified in 54 audits (90%) while eight audits (13%) reported not setting standards at all. Improvement of documentation was recommended in 44 audits (71%), development of national guidelines in 37 (60%), and staff training in 32 (52%). Only 32 audits (51.6%) were presented to the local staff. The audit cycle was completed in 13 projects (20.9%) with only seven of them reporting subsequent improvements in practice.

INTERPRETATION

A rise in the numbers of audits reflects a growing awareness of their key role in health care and patients' safety. However, completion of audit cycles and the actual implementation of recommendations are lagging. Therefore, more focused efforts supported by both clinical and administrative leaderships are needed to implement changes and ensure continuous evaluation of their effectiveness.

FUNDING

None.

摘要

背景

临床审计在提高患者护理质量方面发挥着基础性作用，因此被视为临床治理的基石。这种质量改进工具最近才引入加沙地带的医疗系统。尽管过去几年加沙完成的审计数量一直在增加，但几乎没有证据表明实际质量随后得到了改善。

方法

采用在线调查收集有关审计团队、地点、应用方法、结果、数据呈现和重新审计的信息。邀请了在2015年至2018年期间进行过审计的医学生和医疗保健专业人员于2018年10月12日至11月2日完成该调查。

结果

收集了62项审计的数据。55名审计人员（89%）接受了临床治理方面的培训，56项审计（90%）有高级监督员。审计在不同医院和专科进行：产科18项（29%），内科16项（26%），外科和儿科各11项（18%），其他专科6项（10%）。观察到审计数量有明显的增加趋势，2015年进行了4项（6%），2016年12项（19%），2017年22项（35%），2018年24项（39%）。学生参与了46项审计（74%），而执业医生仅参与了29项审计（47%）。17项（27.4%）审计在多个医疗机构进行，其余审计在加沙地带的13家其他主要医院或社区中心之一进行。54项审计（90%）确定了明确的标准，而8项审计（13%）报告根本没有设定标准。44项审计（71%）建议改进文件记录，37项（60%）建议制定国家指南，32项（52%）建议进行人员培训。只有32项审计（51.6%）向当地工作人员进行了汇报。13个项目（20.9%）完成了审计周期，其中只有7个项目报告随后实际有所改进。