[Clinical audit as method of quality improvement of healthcare in patients with diabetes, stroke and in cesarean section].

INTRODUCTION: Clinical audit is used as a term for any kind of audit leaded by professionals in health care, and should not be complicated or unpleasant job. AIM: The aim of this work is to demonstrate the variations in practice between doctors working in a health care organization and the institutions (health centers - DZ and hospitals). Variations in practical work show the difference in quality of work between the doctors and the institutions, as well as variations in the use of resources and expenditure costs. METHODS: Three different questionnaires had been developed for three different clinical entities: diabetes, cesarean section, and stroke. The questionnaires had been created in collaboration with experts from each of those medical entities and based on research of literature, and valorized by the questionnaire for creating audits and calculations of ACQ (Audit Criteria Questionnaire) score. RESULTS: Diabetes--The hugest disproportion is in not measuring (none evidencing) regular annual screenings for retina and foot, but albumin and creatinin are being controlled in very high percentage. Stroke: In hospital A in checked medical records side of cerebral lesion was evidenced regularly, what was different in hospital B, while in hospital B 100% of swallowing disorders were evidenced. Cesarean section: In hospital A the average period of preoperative length of stay is four days, while in hospital B it is 0.4 days, while the postoperative length of stay for both hospitals is 6 days. DISCUSSION: Clinical audit is a systematic analysis of quality of health care and as per the Accreditation standards for hospitals, published by the Federal Agency for Health Care Quality and Accreditation-AKAZ; it is mandatory to perform the clinical audit in 3-5 areas twice, in the year precedes the accreditation survey. CONCLUSION: Using small sample, authors proved big variations in practice among doctors and among health institutions as well. It has direct consequence on quality and costs and can be solved using AKAZ accreditation standards. It is very difficult to improve the quality of health care without regularly performed and documented clinical audits.