Medical Audit: A Veritable Tool for Improving Standards in Clinical Practice

Audit in medical practice has conventionally been taken to refer to self-accounting on the part of medical professionals or health care institutions to assess the effectiveness and efficiency of the services they render to the community. Its ultimate purpose is to improve standards in clinical care and encourage efficient utilisation of resources. In structure, medical audit takes two main forms - an outcome review to assess the quality of care being received by patients, and a utilisation review to assess the cost-effectiveness of the approaches being used to deliver care. The essential components of the audit process have been pared down to five main steps. These are the identification of an area of enquiry, interest or concern in healthcare and the outlining of specific criteria of what is regarded as good quality or outcome; measurement of current practice through data collection, setting targets for improvement; introduction of new measures to correct any deficiencies identified; and evaluation of the effectiveness of the new measures through further targeted data collection. This approach, also known as criteria-based audit, can be applied to improve the standard of clinical practice in the developing world, as the experiences from Uganda and Nigeria that are related here demonstrate. A structured programme of medical audit in the countries of the developing world is long overdue and criterion-based audit offers a practical and effective way of employing this veritable tool for improving the standards of clinical practice.