Clinical audit: A critical patient safety ally
Auditing clinical processes helps organizations take a proactive approach to identifying and mitigating risks associated with patient safety. Clinical audits also can strengthen the organization’s ability to comprehensively assess root causes of adverse events.
Operational auditors can touch on clinical areas but might not see the whole picture. One reason is because a traditional internal audit team typically does not include members with clinical backgrounds. Clinicians can help provide the internal audit team with the knowledge and expertise needed to fully analyze clinical processes from start to finish, which can identify safety risks and aid in prevention of never events. Without intervention, a never event might ultimately lead to a sentinel event. A never event is a medical error that should never occur, such as performing the wrong surgery on a patient. Never events are reportable, and access to this information is available to the public. Never events that occur with any level of frequency can present great risks to a healthcare organization’s reputation and quality of care outcomes.
Patient safety and prevention of never events are the responsibility of everyone within a healthcare organization. Internal auditors help bolster efforts because they are experts at gathering and analyzing data, using the data to measure clinical performance against the organization’s targeted metrics, and presenting an overall picture of potential risks, which can guide the organization’s efforts to improve safety processes. In this role, internal auditors help to make sure that the information shared with staff members, executives, and board members related to patient safety is transparent, objective, and fair. Auditing certain clinical processes can identify gaps in safety controls and, with appropriate action from leadership, can help prevent never events and sentinel events from occurring.
Planning clinical audits: A checklist
For those organizations not already conducting clinical audits, or those that are but want to enhance and strengthen those audits, several steps can help start the process.
- Understand what audits are already occurring at the organization. Many organizational departments might already be auditing certain patient safety risk areas. For example, the Quality and Infection Prevention teams might be auditing hand hygiene or central line-associated bloodstream infections (CLABSIs). Surveillance of and checklists related to catheters likely already exist. The clinical internal audit plan should incorporate all information about surveillance and monitoring related to care safety, quality, and infection prevention that is happening organizationwide.
- Lean on data from multiple sources. Organizations most likely are already tracking metrics related to patient safety, such as hospital-acquired conditions (HACs), CLABSIs, Clostridium difficile (C. diff) infections, and other patient safety indicators, and occurrence reports for incidents such as falls or near misses. Such data can highlight opportunities to improve safety – and what should be included in the audit plan. Also, organizations should not underestimate the importance of coding data. Although it is often associated with revenue, this particular data can provide insight about an organization’s care quality and patient safety. In addition, reviewing coding data can help internal audit teams get ahead of HACs and other patient safety incidents.
- Have ongoing communication about the clinical audit plan. Setting up a clinical audit plan is not a one-time discussion. As with operational and other internal audits, the clinical portions of the audit plan should be revisited at least annually (or more frequently if necessary). Individuals who were invited to develop the original audit plan should be included in future clinical risk assessments and audits. The internal audit team should be sure to set up recurring meetings to share updates and reports regarding clinical audit.
Focus on patient safety efforts
With adverse events still unfortunately occurring in healthcare today, organizations should consider including clinical audits in their internal audit plans. If you would like help reviewing your organization’s audit plans and boosting patient safety efforts now and for the future, contact our specialists.
