Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology

Abstract

Evaluation and improvement of quality of care provided to the patients are of crucial importance in the daily clinical practice and in the health policy planning and financing. Different tools have been developed, including incident analysis, health technology assessment and clinical audit. The clinical audit consist of measuring a clinical outcome or a process, against well-defined standards set on the principles of evidence-based medicine in order to identify the changes needed to improve the quality of care. In particular, patients suffering from chronic renal diseases, present many problems that have been set as topics for clinical audit projects, such as hypertension, anaemia and mineral metabolism management. Although the results of these studies have been encouraging, demonstrating the effectiveness of audit, overall the present evidence is not clearly in favour of clinical audit. These findings call attention to the need to further studies to validate this methodology in different operating scenarios. This review examines the principle of clinical audit, focusing on experiences performed in nephrology settings.

Keywords: Clinical audit, Evidence-based medicine, Quality improvement, Nephrology, Hemodialysis

Core tip: Clinical audit is a part of the continuous quality improvement process. It consists in measuring a clinical outcome or a process against well-defined standards, established using the principles of evidence-based medicine. The comparison between clinical practice and standards leads to the formulation of strategies, in order to improve daily care quality. This review examines the basis of clinical audit and the data about the efficacy of this methodology, focusing on nephrology issues. We think that clinical audit could offer to the modern Nephrologists a useful tool to monitor and advance their clinical practice.