Care provided in the emergency department is not just challenging and complex but also uh time dependent. Too many and too complex things are happening at the same time and any wrong decision making or untimely decision making can put patients care at risk. The clinical care in the emergency department often feels like a race against time so it is very important for the department to pause reflect and have an understanding that they are delivering the best possible care with the resources available. The best way to know this is through having a clinical audit.
What is a Clinical Audit?
A clinical audit is a structured process in which we’ll look into our current clinical practices and compare it with either an established standard, a guideline or a benchmark or sometimes we compare it to our own practices over the course of years. It is different from research where we usually ask what should we be doing call mom the audit asks “are we doing it right”.
For example, if national or departmental guidelines recommend that patients with chest pain should receive an ECG within 10 minutes of arrival, an audit will tell you how closer are you to your goal.
Why are Audits Important in the ED?
There are several reasons for a department to conduct audit and especially to do it in succession and each time you also measure the difference that it had created in the working of the department. Follow few reasons will give you some idea about the audit:-
- Documenting clinical capability:
Your department may be doing a good job in providing clinical care to your patients. By doing a clinical audit you actually document your capabilities and see the areas which needs improvement after comparing it to the benchmark. - Improving Patient Care:
Emergency departments are high-stakes environments where complex treatment algorithms are at work. Any delays or errors can have serious consequences. Audits help identify gaps in care—such as delays in sepsis recognition, incomplete documentation, or missed pain reassessment—and provide an opportunity to fix them. - Closing the Loop:
An audit is usually part of an audit cycle and it’s not just pointing the problem. Through the audit cycle we measure performance, implement changes hand then confirm that some degree of improvement has occurred. This cycle ensures continuous quality improvement rather than one-time fixes. - Standardization of Practice:
through an audit we also look at the practices happening in that department and see how standardized it is when compare different times and different people practicing emergency medicine. In a busy ED, different clinicians may have different approaches to similar problems. Audits align practice with evidence-based guidelines, reducing unnecessary variation in care. - Accreditation and Accountability:
Hospitals and governing bodies increasingly require evidence of quality improvement activities. Audits provide the data that demonstrate safe, effective, and accountable emergency care.
Common Audit Topics in Emergency Medicine
A good department should be doing periodic clinical audits as well as non clinical audits to make sure there it has taken into account all sources of steps to improve the quality of care both from a clinical standpoint as well as non clinical standpoint. Following is the examples of some of the topics that any department can do audits on:
- Door to CT head in patients with stroke.
- Time-to-ECG for chest pain patients
- Door-to-needle time in stroke or STEMI
- Documentation of pain scores and analgesia use
- Response of trauma team for the trauma call.
- Adherence to sepsis bundles
- Reassessment after critical interventions
Clinical audits may not feel as exciting as a major trauma resuscitation, but they are just as vital to patient safety and departmental excellence. For an EM resident, participating in or leading audits is a way to influence the quality of care far beyond a single patient encounter. All the staff engaged in audit activity should do it with open minds as this is one of the best tool to document your own practices as well as identify the areas of improvement so that the care provided by the department it’s continuously improving through the work of a whole audit cycle.