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Clinical audits – A quality improvement tool in transfusion medicine

A clinical audit is a quality improvement process that seeks to improve services and outcomes through a systematic review of care against explicit criteria. It is now a recognized tool for improving clinical quality of care. However, in transfusion medicine, they have been utilized in a limited manner. This review intends to discuss the methodology of carrying out a clinical audit systematically. Clinical audit is not research and focuses on the improvement of ordinary and routine practices. Various methodologies for selecting and prioritizing a good audit topic can be employed. Based on the Donabedian model, process-based audits from donor selection to the actual bedside transfusion could be audited to bring in improvement. Likewise, transfusion processes can be audited based on the dimensions of quality in the context of timeliness, effectiveness, and appropriateness. Prioritization of a topic can be done through a quality impact assessment. The objectives help quantify the aim of the audit, while the standards include criteria that are quantified against targets, based on the current evidence for the best possible care. A snapshot sample (20–50 cases) is sufficient to carry out a clinical audit. Where targets are not met, root-cause analysis and quality improvement tools guide the implementation of changes in transfusion practices. To ensure that change is implemented and internalized, it is necessary to have the entire team and the management on board; communication with all stakeholders is key. Re-audit, after the change has been internalized, is an essential part of all clinical audits. Meticulously planning and proper implementation ensure improvement of the care that transfused patients receive.