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The quality of published paediatric audits and their standards
Gráinne C Larkin1, Sinead A Mulroy1, Tomasz Nabialek1
1Department of Paediatrics, Mayo University Hospital, Castlebar, Ireland.
Insights
Many published paediatric healthcare articles are mislabeled as audits. This study found that only 11.4% met the full definition of an audit, highlighting a need for clearer standards in healthcare quality improvement research.
Area of Science:
- Healthcare quality improvement
- Medical audit standards
- Paediatric healthcare research
Background:
- Audits are crucial for evaluating and enhancing health service performance.
- Resources defining audit elements exist in Ireland and the UK.
- The precise definition and application of audit in paediatric healthcare require evaluation.
Purpose of the Study:
- To assess the adherence of published paediatric healthcare articles to the definition of an audit.
- To evaluate the quality of evidence used in paediatric audits.
- To identify discrepancies in the common usage versus the formal definition of audit.
Main Methods:
- Searched PUBMED, MEDLINE, and CINAHL databases for English-language articles (2007-2020).
- Reviewed articles for key audit criteria: paediatric topic, practice review, specified standard, intervention, and repeated data collection.
- Assessed the quality of evidence for true audits using the Oxford Centre for Evidence-Based Medicine Levels of Evidence.
Main Results:
- Out of 1230 articles, only 144 (11.4%) met the full criteria for an audit.
- A significant portion of true audits (38.9%) relied on low-quality evidence (Level 5, expert opinion).
- Conversely, 43.8% of true audits utilized high-quality evidence (Level 1a/1b, guidelines).
Conclusions:
- A notable gap exists between the common understanding and the formal definition of audit in healthcare.
- Many publications presented as audits do not meet the established criteria for an audit.
- The evidence base supporting the standards used in published paediatric audits is inconsistent.
Objective:
Audit is a recognised tool for evaluating the performance and improving the quality of health services. In Ireland and the UK, clear resources are available outlining audit elements. This study was undertaken to evaluate paediatric audits published from 2007 to 2020 to determine the adherence level to the definition of audit and to assess the quality of audit standards.
Design:
PUBMED, MEDLINE and CINAHL databases were searched to identify relevant articles published in the English language. Each was reviewed to assess whether the following criteria were met: (1) a paediatric healthcare topic was described, (2) practice was reviewed, (3) the standard was specified, (4) an intervention was made and data collection was repeated to assess improvement. The quality of the standard for each true audit was graded utilising the Oxford Centre for Evidence-Based Medicine Levels of Evidence.
Results:
Of 1230 published paediatric healthcare articles reviewed, 144 (11.4%) fulfilled the full criteria of an audit. Sixty-three (43.8%) true audits used the highest quality of evidence (level 1a and 1b), predominantly international or national guidelines. Fifty-six (38.9%) audits used the lowest quality of evidence (level 5), predominantly expert opinion.
Conclusions:
There is a mismatch between the common usage of the term audit, and the definition, despite its incorporation into training curricula and institutional support. Many articles published as audits do not adhere to the definition of audit. There are variable levels of evidence supporting the standards utilised in published true audits.
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