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Tracing Medical History: How did the earliest medical audits come about?
Medical auditing, a quality improvement process, has been known since ancient times to improve patient care and outcomes. The core of a medical audit is to systematically evaluate medical services and ensure that the performance of medical institutions meets expectations based on clear standards. In addition, medical audits provide a framework for improvement when internal assessments identify deviations, which has allowed countries to gradually incorporate the concept of medical audits into their health care systems. As early as 1993, the British National Health Service (NHS) began to formally introduce these concepts, which greatly improved the overall quality of medical services.
History of medical review
Tracing back to the history of medical review, the first people we want to mention are Baghdad’s chief doctors, Sinan Ibnu Thabit and Abu Batiha al-Muhtasib. They conducted an early medical review at the behest of the Abbasid caliph, Muktadir, in the context of an incident in which a patient died due to medical negligence. After this investigation, the first medical licensing examination was implemented, and only doctors who passed the examination could practice medicine.
"If the patient recovers, the doctor gets paid; if the patient dies, his relatives need to ask the chief doctor."
Since then, Florence Nightingale’s clinical review during the Crimean War in 1853 has also become a milestone in the history of medical review. When she arrived at Scutari Military Hospital, she found the environment there was extremely harsh, with the mortality rate among injured or sick soldiers reaching as high as 40%. Nightingale and her team of nurses emphasized hygiene standards and kept records of procedures, ultimately reducing the mortality rate to 2%. Her medical reforms not only saved lives, but also broke through the resistance of British doctors and military officers to her measures and promoted the improvement of medical quality.
Medical audit in modern medicine
Although the work of Nightingale and Codman demonstrated the importance of medical review, the process did not become popular on a large scale over the next 130 years. As the concept of medical review has evolved, its definitions and interpretations have also evolved, particularly from the professional-centered perspective of the mid-20th century to a patient-centered, multidisciplinary approach. This change is reflected in various new definitions of modern medical delivery.
"Clinical auditing is a quality improvement process designed to improve patient care and outcomes through systematic assessment of quality of care."
For example, in the British White Paper "Working for Patients" in 1989, the concept of medical audit was clarified for the first time, and it was included in clinical governance in 1997. Over time, clinical audits have become an important means of improving medical quality. It is not limited to drug treatment, but is also widely used in surgeries and crisis events, and various audit methods have gradually formed, such as adverse event inspections, peer reviews, etc.
Implementation process of medical review
Medical review can be viewed as a cyclic or spiral process, divided into several stages:
- Issue Identification: Identify topics or issues to review.
- Define Criteria: Set the criteria and metrics to be evaluated.
- Data Collection: Ensure data is accurate and necessary.
- Performance Comparison: Analyze and compare collected data to predetermined standards.
- Implement changes: Develop improvement plans based on audit results and ensure ongoing monitoring of results.
Conclusion
Through a systematic medical review process, healthcare systems in various countries are continuously improved, ultimately improving patient care and outcomes. This historical evolution is not only an advancement of technology, but also a reflection of the professional responsibility of medical personnel. However, there are still many challenges to be overcome, and we cannot help but ask, how will future medical audits adapt to the rapidly changing medical environment to better meet the needs of patients?
