Elsevier

Clinica Chimica Acta

Volume 280, Issues 1–2, 1 February 1999, Pages 47-57
Clinica Chimica Acta

Clinical audit and the contribution of the laboratory to clinical outcome

https://doi.org/10.1016/S0009-8981(98)00197-1Get rights and content

Abstract

Medical and clinical audit are tools introduced in an attempt to assess clinical performance. Clinical audit implementation in practice should follow that of the audit and the learning cycles. Ideally, audit should assess the outcome of clinical care. However, many audit projects concentrate on the process of care, which is more amenable to review. One of the cornerstones of audit is the setting up of agreed standards of care. This takes the form of clinical practice guidelines derived, preferably from the outcome of randomised double-blind controlled trials as the basis of evidence-based medicine. The assessment of the contribution of the clinical laboratory to patient outcome could be seen as a further extension of clinical audit in the practice of laboratory medicine. Areas where this contribution may be assessed include validity and usefulness of diagnostic tests, the assessment of analytical goals in relation to patient outcome, variation in inter-laboratory performance and its effect on decision limits and whether any measurement or set of measurements contribute to improved outcome. The practice of clinical audit and the application of evidence-based medicine are seen as powerful educational tools, though there is much work to be done to assess their contribution to clinical outcome. Randomised clinical trials could form the basis for the assessment of the value and contribution of the laboratory to the outcome.

Introduction

Over the last few years the health profession in the UK has seen a drive towards more emphasis on medical audit, clinical audit, clinical effectiveness, evidence-based medicine and clinical outcome. In the USA, on the other hand, medical audit and quality assurance programs have been in routine use in hospitals for more than two decades [1]. These concepts appear to form part of the continued attempts to introduce ways of assessing clinical performance and the contribution of health care measures to patient outcome. Audit as a performance review has also been carried out by formal review of organisational performance. Examples of this exist in the form of Professional Standards Review Organisations (PRSO) in the USA and Clinical Pathology Accreditation (CPA) and the King's Fund Centre Organisational Audit in the UK 2, 3.

Section snippets

Assessment of clinical performance

In an attempt to assess clinical performance, medical audit was introduced as part of the White Paper health reforms of the National Health Service in the UK and later on expanded to clinical audit to include all health care professionals and not just doctors [4]. Clinical Audit has been defined as “the systematic and critical analysis of the quality of care, including the procedures used for the diagnosis, treatment and care, the associated use of resources and the resulting outcome and

Clinical outcome in relation to the laboratory

The clinical laboratory function has to be seen as an extension of the clinical activity that starts with a consultation at outpatient department or an inpatient clinical assessment, As a process in the aid of diagnosis or monitoring of intervention, it is justifiable for the activity to come under the scrutiny of clinical audit as well. However, many would now accept that there is to be more emphasis in future on the contribution of the laboratory, as a clinical information system, to patient

Linking clinical audit to improved patient outcome

Clinical audit and the assessment of performance of clinical services are going through a difficult period. In the UK, and after the initial hype following the publication of the White Paper, many have started to question the role and effectiveness of clinical audit 24, 36. Clinical audit is one of these concepts which everyone thinks is a good idea but no one knows what is the best way to implement it in practice or agree that it is good value for money. Clinical audit is being increasingly

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