评审审核:有效临床审核的障碍与促进因素。

G Johnston, I K Crombie, H T Davies, E M Alder, A Millard
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引用次数: 305

摘要

目的:回顾有关临床和医疗审计的利弊的文献,并评估进行审计过程的主要促进因素和障碍。设计:以“审核”、“审核的审核”、“审核的评价”为关键词,对Medline和CINAHL数据库进行全面的文献综述,并手工检索相关期刊的索引,查找关键论文。结果:回顾了93篇文献的研究结果。这些研究包括对个别审计项目的个案研究,通过对部门审计计划的回顾性审查,以及对初级保健和二级保健之间的接口项目的研究。所审查的研究纳入了各种临床医生的经验,从医疗顾问到与医学相关的专业人员,以及参与单一学科和多学科项目的人员。审计的好处包括改善同事和其他专业团体之间的沟通,改善患者护理,提高专业满意度和更好的管理。审计的一些缺点被认为是减少临床所有权、害怕诉讼、等级和领土怀疑以及专业孤立。临床审计的主要障碍可分为五大类。这些问题包括缺乏资源,缺乏项目设计和分析方面的专业知识或建议,小组和小组成员之间的问题,缺乏审计的总体计划以及组织障碍。还确定了促进审计的关键因素:它们包括现代医疗记录系统、有效的培训、敬业的工作人员、受保护的时间、结构化的方案以及购买者和提供者之间的共享对话。结论:临床审计对任何旨在提高卫生保健质量及其提供的方案都是有价值的协助。然而,如果没有旨在培养有效审计的连贯战略,就会失去宝贵的机会。仔细注意审查中强调的专业态度可能有助于审计履行其部分承诺。
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Reviewing audit: barriers and facilitating factors for effective clinical audit.

Objective: To review the literature on the benefits and disadvantages of clinical and medical audit, and to assess the main facilitators and barriers to conducting the audit process.

Design: A comprehensive literature review was undertaken through a thorough review of Medline and CINAHL databases using the keywords of "audit", "audit of audits", and "evaluation of audits" and a handsearch of the indexes of relevant journals for key papers.

Results: Findings from 93 publications were reviewed. These ranged from single case studies of individual audit projects through retrospective reviews of departmental audit programmes to studies of interface projects between primary and secondary care. The studies reviewed incorporated the experiences of a wide variety of clinicians, from medical consultants to professionals allied to medicine and from those involved in unidisciplinary and multidisciplinary ventures. Perceived benefits of audit included improved communication among colleagues and other professional groups, improved patient care, increased professional satisfaction, and better administration. Some disadvantages of audit were perceived as diminished clinical ownership, fear of litigation, hierarchical and territorial suspicions, and professional isolation. The main barriers to clinical audit can be classified under five main headings. These are lack of resources, lack of expertise or advice in project design and analysis, problems between groups and group members, lack of an overall plan for audit, and organisational impediments. Key facilitating factors to audit were also identified: they included modern medical records systems, effective training, dedicated staff, protected time, structured programmes, and a shared dialogue between purchasers and providers.

Conclusions: Clinical audit can be a valuable assistance to any programme which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at nurturing effective audits, valuable opportunities will be lost. Paying careful attention to the professional attitudes highlighted in this review may help audit to deliver on some of its promise.

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