85-624: The Healthcare Quality Improvement Partnership ( HQIP ) was established in April 2008 to promote improvement in health services, by increasing the impact that clinical audit has on healthcare quality in England and Wales and, in some cases other devolved nations. It is led by a consortium of the Academy of Medical Royal Colleges and the Royal College of Nursing . The Partnership holds
170-412: A postmortem examination or an obduction , is a medical procedure that consists of a thorough examination of a human corpse to determine the cause and manner of a person's death and to evaluate any disease or injury that may be present. It is usually performed by a specialized medical doctor called a pathologist . Autopsies are either performed for legal or medical purposes. A forensic autopsy
255-558: A coma. In the case of sleep, electroencephalograms (EEGs) are used to tell the difference. The category of "brain death" is seen as problematic by some scholars. For instance, Dr. Franklin Miller, a senior faculty member at the Department of Bioethics, National Institutes of Health, notes: "By the late 1990s... the equation of brain death with death of the human being was increasingly challenged by scholars, based on evidence regarding
340-409: A concept of an afterlife that may hold the idea of judgment of good and bad deeds in one's life. There are also different customs for honoring the body, such as a funeral , cremation , or sky burial . After a death, an obituary may be posted in a newspaper, and the "survived by" kin and friends usually go through the grieving process . The concept of death is the key to human understanding of
425-472: A culture of audit to participating hospitals inside and outside of the UK, and can provide advice on audit topics. Stage 2: Define criteria and standards Decisions regarding the overall purpose of the audit, either as what should happen as a result of the audit, or what question you want the audit to answer, should be written as a series of statements or tasks that the audit will focus on. Collectively, these form
510-446: A definition of the moment of death is required, doctors and coroners usually turn to "brain death" or "biological death" to define a person as being dead; people are considered dead when the electrical activity in their brain ceases. It is presumed that an end of electrical activity indicates the end of consciousness . Suspension of consciousness must be permanent and not transient, as occurs during certain sleep stages, and especially
595-429: A former organism normally begin to decompose shortly after death. Death eventually and inevitably occurs in all organisms. Some organisms, such as Turritopsis dohrnii , are biologically immortal ; however, they can still die from means other than aging . Death is generally applied to whole organisms; the equivalent for individual components of an organism, such as cells or tissues , is necrosis . Something that
680-425: A living being can survive all calamities but eventually dies due to causes relating to old age. Conversely, premature death can refer to a death that occurs before old age arrives, for example, human death before a person reaches the age of 75. Animal and plant cells normally reproduce and function during the whole period of natural existence, but the aging process derives from the deterioration of cellular activity and
765-605: A number of national and professional leadership bodies and organisations including the Care Quality Commission (CQC), NHS England and Health Data Research UK, among others. A list of all former HQIP programmes is available on the HQIP website . Clinical audit Clinical audit is a process that has been defined as a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and
850-406: A patient. Following the investigation, the first medical licensing examination has been introduced, and only physicians who pass the exam can practice medicine. According to Ibnu Al-Ukhuwwa in his book, Ma'alim al-Qurba: fi Ahkam al-Hisba, "If the patient is cured, the physician is paid. If the patient dies, his parents go to the chief doctor, they present the prescriptions written by the physician. If
935-488: A person has definitively died has proven difficult. Initially, death was defined as occurring when breathing and the heartbeat ceased, a status still known as clinical death . However, the development of cardiopulmonary resuscitation (CPR) meant that such a state was no longer strictly irreversible. Brain death was then considered a more fitting option, but several definitions exist for this. Some people believe that all brain functions must cease. Others believe that even if
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#17327946232621020-401: A previous miscarriage, and the use of abortion can increase the chances of having a miscarriage. An abortion may be performed for many reasons, such as pregnancy from rape , financial constraints of having a child, teenage pregnancy , and the lack of support from a significant other . There are two forms of abortion: a medical abortion and an in-clinic abortion or sometimes referred to as
1105-402: A surgical abortion. A medical abortion involves taking a pill that will terminate the pregnancy no more than 11 weeks past the last period , and an in-clinic abortion involves a medical procedure using suction to empty the uterus; this is possible after 12 weeks, but it may be more difficult to find an operating doctor who will go through with the procedure. Senescence refers to a scenario when
1190-478: A talent for mathematics and statistics , and she and her staff kept meticulous records of the mortality rates among the hospital patients . Following these changes the mortality rates fell from 40% to 2%, and the results were instrumental in overcoming the resistance of the British doctors and officers to Nightingale's procedures. Her methodical approach, as well as the emphasis on uniformity and comparability of
1275-441: A vegetative state or coma, in that the former situation describes a state that is beyond recovery. EEGs can detect spurious electrical impulses, while certain drugs, hypoglycemia , hypoxia , or hypothermia can suppress or even stop brain activity temporarily; because of this, hospitals have protocols for determining brain death involving EEGs at widely separated intervals under defined conditions. People maintaining that only
1360-408: Is a finite supply presented at birth. Later, Goldstone proposed the concept of production or income of adaptation energy which may be stored (up to a limit) as a capital reserve of adaptation. In recent works, adaptation energy is considered an internal coordinate on the "dominant path" in the model of adaptation. It is demonstrated that oscillations of well-being appear when the reserve of adaptability
1445-427: Is almost exhausted. In 2012, suicide overtook car crashes as the leading cause of human injury deaths in the U.S., followed by poisoning, falls, and murder. Accidents and disasters, from nuclear disasters to structural collapses , also claim lives. One of the deadliest incidents of all time is the 1975 Banqiao Dam Failure , with varying estimates, up to 240,000 dead. Other incidents with high death tolls are
1530-494: Is an irreversible process where someone loses their existence as a person. Historically, attempts to define the exact moment of a human's death have been subjective or imprecise. Death was defined as the cessation of heartbeat (cardiac arrest) and breathing , but the development of CPR and prompt defibrillation have rendered that definition inadequate because breathing and heartbeat can sometimes be restarted. This type of death where circulatory and respiratory arrest happens
1615-501: Is carried out when the cause of death may be a criminal matter, while a clinical or academic autopsy is performed to find the medical cause of death and is used in cases of unknown or uncertain death, or for research purposes. Autopsies can be further classified into cases where external examination suffices, and those where the body is dissected and an internal examination is conducted. Permission from next of kin may be required for internal autopsy in some cases. Once an internal autopsy
1700-438: Is complete the body is generally reconstituted by sewing it back together. A necropsy, which is not always a medical procedure, was a term previously used to describe an unregulated postmortem examination. In modern times, this term is more commonly associated with the corpses of animals. Death before birth can happen in several ways: stillbirth , when the fetus dies before or during the delivery process; miscarriage , when
1785-405: Is critical to the successful outcome of an audit process – as it verifies whether the changes implemented have had an effect and to see if further improvements are required to achieve the standards of healthcare delivery identified in stage 2. Results of good audit should be disseminated both locally via the strategic health authorities and nationally where possible. Professional journals, such as
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#17327946232621870-883: Is determined by the rate of aging for a species inherent in its genes . A recognized method of extending maximum lifespan is calorie restriction . Theoretically, the extension of the maximum lifespan can be achieved by reducing the rate of aging damage, by periodic replacement of damaged tissues , molecular repair , or rejuvenation of deteriorated cells and tissues. A United States poll found religious and irreligious people, as well as men and women and people of different economic classes, have similar rates of support for life extension, while Africans and Hispanics have higher rates of support than white people. 38% said they would desire to have their aging process cured. Researchers of life extension can be known as "biomedical gerontologists ." They try to understand aging, and develop treatments to reverse aging processes, or at least slow them for
1955-594: Is far more profitable in this situation and should be encouraged by the Clinical Audit lead and manager. Re-audit: Sustaining Improvements After an agreed period, the audit should be repeated. The same strategies for identifying the sample, methods and data analysis should be used to ensure comparability with the original audit. The re-audit should demonstrate that the changes have been implemented and that improvements have been made. Further changes may then be required, leading to additional re-audits. This stage
2040-619: Is good practice; this should include who has agreed to do what and by when. Each point needs to be well defined, with an individual named as responsible for it, and an agreed timescale for its completion. Action plan development may involve refinement of the audit tool particularly if measures used are found to be inappropriate or incorrectly assessed. In other instances new process or outcome measures may be needed or involve linkages to other departments or individuals. Too often audit results in criticism of other organisations, departments or individuals without their knowledge or involvement. Joint audit
2125-481: Is known as the circulatory definition of death (CDD). Proponents of the CDD believe this definition is reasonable because a person with permanent loss of circulatory and respiratory function should be considered dead. Critics of this definition state that while cessation of these functions may be permanent, it does not mean the situation is irreversible because if CPR is applied fast enough, the person could be revived. Thus,
2210-406: Is more of a process than a single event. It implies a slow shift from one spiritual state to another. Other definitions for death focus on the character of cessation of organismic functioning and human death, which refers to irreversible loss of personhood. More specifically, death occurs when a living entity experiences irreversible cessation of all functioning. As it pertains to human life, death
2295-606: Is not considered an organism, such as a virus , can be physically destroyed but is not said to die , as a virus is not considered alive in the first place. As of the early 21st century, 56 million people die per year. The most common reason is aging , followed by cardiovascular disease , which is a disease that affects the heart or blood vessels . As of 2022, an estimated total of almost 110 billion humans have died, or roughly 94% of all humans to have ever lived. A substudy of gerontology known as biogerontology seeks to eliminate death by natural aging in humans, often through
2380-669: Is now seen as a process, more than an event: conditions once considered indicative of death are now reversible. Where in the process, a dividing line is drawn between life and death depends on factors beyond the presence or absence of vital signs . In general, clinical death is neither necessary nor sufficient for a determination of legal death . A patient with working heart and lungs determined to be brain dead can be pronounced legally dead without clinical death occurring. Life extension refers to an increase in maximum or average lifespan , especially in humans, by slowing or reversing aging processes through anti-aging measures. Aging
2465-423: Is often neglected in the history of health care assessment , Codman's work anticipated contemporary approaches to quality monitoring and assurance , establishing accountability, and allocating and managing resources efficiently. Whilst Codman's 'clinical' approach is in contrast with Nightingale's more ' epidemiological ' audits, these two methods serve to highlight the different methodologies that can be used in
2550-501: Is something humans share with cetaceans called the mammalian diving reflex . As medical technologies advance, ideas about when death occurs may have to be reevaluated in light of the ability to restore a person to vitality after longer periods of apparent death (as happened when CPR and defibrillation showed that cessation of heartbeat is inadequate as a decisive indicator of death). The lack of electrical brain activity may not be enough to consider someone scientifically dead. Therefore,
2635-483: Is the most common cause of death worldwide. Aging is seen as inevitable, so according to Aubrey de Grey little is spent on research into anti-aging therapies, a phenomenon known as pro-aging trance . The average lifespan is determined by vulnerability to accidents and age or lifestyle-related afflictions such as cancer or cardiovascular disease . Extension of lifespan can be achieved by good diet , exercise, and avoidance of hazards such as smoking . Maximum lifespan
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2720-440: Is to be audited must be established from the outset. These include: Sample sizes for data collection are often a compromise between the statistical validity of the results and pragmatical issues around data collection. Data to be collected may be available in a computerised information system, or in other cases it may be appropriate to collect data manually or electronically using data capture solutions such as Formic , depending on
2805-478: Is used to confirm improvement in healthcare delivery." Clinical audit was incorporated within Clinical Governance in the 1997 White Paper , " The New NHS : Modern, Dependable ", which brought together disparate service improvement processes and formally established them into a coherent Clinical Governance framework. Clinical audit can be described as a cycle or a spiral, see figure . Within
2890-463: Is viewed as problematic by some scholars, there are proponents of it that believe this definition of death is the most reasonable for distinguishing life from death. The reasoning behind the support for this definition is that brain death has a set of criteria that is reliable and reproducible. Also, the brain is crucial in determining our identity or who we are as human beings. The distinction should be made that "brain death" cannot be equated with one in
2975-586: The 1931 China floods , which killed an estimated 4 million people, although estimates widely vary; the 1887 Yellow River flood , which killed an estimated 2 million people in China; and the 1970 Bhola cyclone , which killed as many as 500,000 people in Pakistan. If naturally occurring famines are considered natural disasters, the Chinese famine of 1906–1907 , which killed 15–20 million people, can be considered
3060-547: The BMJ and the Nursing Standard publish the findings of good quality audits, especially if the work or the methodology is generalisable. While clinical audit makes great sense, there can be problems in persuading hospitals and clinicians to undertake and apply clinical audit in their work. Nonetheless, in the UK clinical audit is one of the corpus of clinical governance measures that are required to be enacted throughout
3145-525: The Wanggongchang explosion (when a gunpowder factory ended up with 20,000 deaths), a collapse of a wall of Circus Maximus that killed 13,000 people, and the Chernobyl disaster that killed between 95 and 4,000 people. Natural disasters kill around 45,000 people annually, although this number can vary to millions to thousands on a per-decade basis. Some of the deadliest natural disasters are
3230-458: The brainstem is still alive, the personality and identity are irretrievably lost, so therefore, the person should be considered entirely dead. Brain death is sometimes used as a legal definition of death. For all organisms with a brain, death can instead be focused on this organ. The cause of death is usually considered important and an autopsy can be done. There are many causes, from accidents to diseases. Many cultures and religions have
3315-485: The embryo dies before independent survival; and abortion , the artificial termination of the pregnancy. Stillbirth and miscarriage can happen for various reasons, while abortion is carried out purposely. Stillbirth can happen right before or after the delivery of a fetus. It can result from defects of the fetus or risk factors present in the mother. Reductions of these factors, caesarean sections when risks are present, and early detection of birth defects have lowered
3400-454: The neo-cortex of the brain is necessary for consciousness sometimes argue that only electrical activity should be considered when defining death. Eventually, the criterion for death may be the permanent and irreversible loss of cognitive function, as evidenced by the death of the cerebral cortex . All hope of recovering human thought and personality is then gone, given current and foreseeable medical technology. Even by whole-brain criteria,
3485-453: The 20th century and could kill 1 billion people worldwide in the 21st century, a World Health Organization report warned. Many leading developed world causes of death can be postponed by diet and physical activity , but the accelerating incidence of disease with age still imposes limits on human longevity . The evolutionary cause of aging is, at best, only beginning to be understood. It has been suggested that direct intervention in
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3570-534: The NHS there is a clinical audit guidance group in the Clinical audit comes under the clinical governance umbrella and forms part of the system for improving the standard of clinical practice. The first recorded medical audit was done by Sinan Ibnu Thabit, Chief Physician of Baghdad dan Abu Batiha al-Muhtasib (market inspector) at the request of Abbasid Caliph Al-Muqtadir after medical malpractice resulted in death of
3655-481: The NHS. Outside the UK, hospital accreditation schemes, such as the Trent Accreditation Scheme , have promoted the development and execution of clinical audit as a part of clinical governance in places such as Hong Kong and Malta. Death Death is the end of life ; the irreversible cessation of all biological functions that sustain a living organism . The remains of
3740-702: The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in 1980. They concluded that this approach to defining death sufficed in reaching a uniform definition nationwide. A multitude of reasons was presented to support this definition, including uniformity of standards in law for establishing death, consumption of a family's fiscal resources for artificial life support, and legal establishment for equating brain death with death to proceed with organ donation . Aside from
3825-550: The United Nations Special Reporter on the Right to Food, 2000 – Mar 2008, mortality due to malnutrition accounted for 58% of the total mortality rate in 2006. Ziegler says worldwide, approximately 62 million people died from all causes and of those deaths, more than 36 million died of hunger or diseases due to deficiencies in micronutrients . Tobacco smoking killed 100 million people worldwide in
3910-404: The aging process may now be the most effective intervention against major causes of death. Selye proposed a unified non-specific approach to many causes of death. He demonstrated that stress decreases the adaptability of an organism and proposed to describe adaptability as a special resource, adaptation energy . The animal dies when this resource is exhausted. Selye assumed that adaptability
3995-414: The application of natural processes found in certain organisms. However, as humans do not have the means to apply this to themselves, they have to use other ways to reach the maximum lifespan for a human, often through lifestyle changes, such as calorie reduction , dieting , and exercise . The idea of lifespan extension is considered and studied as a way for people to live longer. Determining when
4080-444: The arguments for and against the CDD boil down to defining the actual words "permanent" and "irreversible," which further complicates the challenge of defining death. Furthermore, events causally linked to death in the past no longer kill in all circumstances; without a functioning heart or lungs, life can sometimes be sustained with a combination of life support devices, organ transplants , and artificial pacemakers . Today, where
4165-439: The array of biological functioning displayed by patients correctly diagnosed as having this condition who were maintained on mechanical ventilation for substantial periods of time. These patients maintained the ability to sustain circulation and respiration, control temperature, excrete wastes, heal wounds, fight infections and, most dramatically, to gestate fetuses (in the case of pregnant "brain-dead" women)." While "brain death"
4250-429: The audit criteria . These criteria are explicit statements that define what is being measured and represent elements of care that can be measured objectively. The standards define the aspect of care to be measured, and should always be based on the best available evidence. Stage 3: Data collection To ensure that the data collected are precise, and that only essential information is collected, certain details of what
4335-501: The brain must have completely ceased. However, in other jurisdictions, some follow the brainstem version of brain death. Afterward, a death certificate is issued in most jurisdictions, either by a doctor or by an administrative office, upon presentation of a doctor's declaration of death. There are many anecdotal references to people being declared dead by physicians and then "coming back to life," sometimes days later in their coffin or when embalming procedures are about to begin. From
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#17327946232624420-424: The chief doctor judges that the physician has performed his job perfectly without negligence, he tells the parents that death was natural; if he judges otherwise, he tells them: take the blood money of your relative from the physician; he killed him by his bad performance and negligence. In this honourable way they were sure that medicine is practiced by experienced, well-trained persons." One of first clinical audits
4505-471: The concept of information-theoretic death has been suggested as a better means of defining when true death occurs, though the concept has few practical applications outside the field of cryonics . The leading cause of human death in developing countries is infectious disease . The leading causes in developed countries are atherosclerosis ( heart disease and stroke), cancer, and other diseases related to obesity and aging . By an extremely wide margin,
4590-481: The contract to commission, manage, and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). This consists of more than 40 clinical audits, registries and confidential enquiries that cover a range of health conditions. Their purpose is to engage clinicians in systematic evaluation of their clinical practice against standards (often set by NICE), and to encourage improvement in
4675-462: The cycle there are stages that follow the systematic process of: establishing best practice; measuring against criteria; taking action to improve care; and monitoring to sustain improvement. As the process continues, each cycle aspires to a higher level of quality. These processes are related to change management methodology and use the techniques of PDSA cycles, LEAN , Six Sigma , root cause analysis and process mapping . Stage 1: Identify
4760-550: The deadliest natural disaster in recorded history. In animals, predation can be a common cause of death. Livestock have a 6% death rate from predation. However, younger animals are more susceptible to predation. For example, 50% of young foxes die to birds , bobcats , coyotes , and other foxes as well. Young bear cubs in the Yellowstone National Park only have a 40% chance to survive to adulthood from other bears and predators. An autopsy, also known as
4845-424: The definitions which sought to encapsulate and explain the idea. These changes generally reflect the movement away from the medico-centric views of the mid-Twentieth Century to the more multidisciplinary approach used in modern healthcare . It also reflects the change in focus from a professionally centred view of health provision to the view of the patient-centred approach. These changes can be seen from comparison of
4930-556: The determination of brain death can be complicated. At present, in most places, the more conservative definition of death (irreversible cessation of electrical activity in the whole brain, as opposed to just in the neo-cortex) has been adopted. One example is the Uniform Determination Of Death Act in the United States. In the past, the adoption of this whole-brain definition was a conclusion of
5015-440: The exception criteria for the standard in future, or will suggest a focus for improvement measures. In theory, any case where the standard (criteria or exceptions) was not met in 100% of cases suggests a potential for improvement in care. In practice, where standard results were close to 100%, it might be agreed that any further improvement will be difficult to obtain and that other standards, with results further away from 100%, are
5100-439: The figure to be closer to 800. In cases of electric shock , cardiopulmonary resuscitation (CPR) for an hour or longer can allow stunned nerves to recover, allowing an apparently dead person to survive. People found unconscious under icy water may survive if their faces are kept continuously cold until they arrive at an emergency room . This "diving response," in which metabolic activity and oxygen requirements are minimal,
5185-434: The flaws in this approach is that there are many organisms that are alive but probably not conscious. Another problem is in defining consciousness, which has many different definitions given by modern scientists, psychologists and philosophers. Additionally, many religious traditions, including Abrahamic and Dharmic traditions, hold that death does not (or may not) entail the end of consciousness. In certain cultures, death
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#17327946232625270-480: The following definitions. In 1989, the white paper , Working for patients , saw the first move in the UK to standardise clinical audit as part of professional healthcare. The paper defined medical audit (as it was called then) as "the systematic critical analysis of the quality of medical care including the procedures used for diagnosis and treatment, the use of resources and the resulting outcome and quality of life for
5355-483: The implementation of change The key component of clinical audit is that performance is reviewed (or audited), to ensure that what should be being done is being done, and if not, it provides a framework to enable improvements to be made. It had been formally incorporated in the healthcare systems of a number of countries, for instance in 1993 into the United Kingdom's National Health Service (NHS), and within
5440-483: The issue of support of or dispute against brain death, there is another inherent problem in this categorical definition: the variability of its application in medical practice. In 1995, the American Academy of Neurology (AAN) established the criteria that became the medical standard for diagnosing neurologic death. At that time, three clinical features had to be satisfied to determine "irreversible cessation" of
5525-487: The jellyfish Turritopsis dohrnii , the hydra , and the planarian . Unnatural causes of death include suicide and predation . Of all causes, roughly 150,000 people die around the world each day. Of these, two-thirds die directly or indirectly due to senescence, but in industrialized countries – such as the United States, the United Kingdom, and Germany – the rate approaches 90% (i.e., nearly nine out of ten of all deaths are related to senescence). Physiological death
5610-476: The largest unifying cause of death in the developed world is biological aging, leading to various complications known as aging-associated diseases . These conditions cause loss of homeostasis , leading to cardiac arrest, causing loss of oxygen and nutrient supply, causing irreversible deterioration of the brain and other tissues . Of the roughly 150,000 people who die each day across the globe, about two thirds die of age-related causes. In industrialized nations,
5695-440: The local medical ethics committee. Stage 4: Compare performance with criteria and standards This is the analysis stage, whereby the results of the data collection are compared with criteria and standards. The end stage of analysis is concluding how well the standards were met and, if applicable, identifying reasons why the standards weren't met in all cases. These reasons might be agreed to be acceptable, i.e. could be added to
5780-583: The mid-18th century onwards, there was an upsurge in the public's fear of being mistakenly buried alive and much debate about the uncertainty of the signs of death. Various suggestions were made to test for signs of life before burial, ranging from pouring vinegar and pepper into the corpse's mouth to applying red hot pokers to the feet or into the rectum . Writing in 1895, the physician J.C. Ouseley claimed that as many as 2,700 people were buried prematurely each year in England and Wales, although some estimates peg
5865-466: The moment when life ends. Determining when death has occurred is difficult, as cessation of life functions is often not simultaneous across organ systems. Such determination, therefore, requires drawing precise conceptual boundaries between life and death. This is difficult due to there being little consensus on how to define life. It is possible to define life in terms of consciousness. When consciousness ceases, an organism can be said to have died. One of
5950-447: The other hand, believe that the rule does not uphold the best interests of the donors and that the rule does not effectively promote organ donation. Signs of death or strong indications that a warm-blooded animal is no longer alive are: The stages that follow after death are: The death of a person has legal consequences that may vary between jurisdictions. Most countries follow the whole-brain death criteria, where all functions of
6035-443: The outcome being measured. In either case, considerations need to be given to what data will be collected, where the data will be found, and who will do the data collection. Ethical issues must also be considered; the data collected must relate only to the objectives of the audit, and staff and patient confidentiality must be respected – identifiable information must not be used. Any potentially sensitive topics should be discussed with
6120-499: The paper Principles for Best Practice in Clinical Audit , which defines clinical audit as "a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structure, processes, and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team, or service level and further monitoring
6205-490: The patient." Medical audit later evolved into clinical audit and a revised definition was announced by the NHS Executive : "Clinical audit is the systematic analysis of the quality of healthcare, including the procedures used for diagnosis, treatment and care, the use of resources and the resulting outcome and quality of life for the patient." The National Institute for Health and Clinical Excellence (NICE) published
6290-420: The phenomenon. There are many scientific approaches and various interpretations of the concept. Additionally, the advent of life-sustaining therapy and the numerous criteria for defining death from both a medical and legal standpoint have made it difficult to create a single unifying definition. One of the challenges in defining death is in distinguishing it from life. As a point in time, death seems to refer to
6375-445: The priority targets for action. This decision will depend on the topic area – in some 'life or death' type cases, it will be important to achieve 100%, in other areas a much lower result might still be considered acceptable. Stage 5: Implementing change Once the results of the audit have been published and discussed, an agreement must be reached about the recommendations for change. Using an action plan to record these recommendations
6460-562: The problem or issue This stage involves the selection of a topic or issue to be audited, and is likely to involve measuring adherence to healthcare processes that have been shown to produce best outcomes for patients. Selection of an audit topic is influenced by factors including: Additionally, audit topics may be recommended by national bodies, such as NICE or the Healthcare Commission , in which NHS trusts may agree to participate. The Trent Accreditation Scheme recommends
6545-532: The process of improvement to patient outcome. Despite the successes of Nightingale in the Crimea and Codman in Massachusetts , clinical audit was slow to catch on. This situation was to remain for the next 130 or so years, with only a minority of healthcare staff embracing the process as a means of evaluating the quality of care delivered to patients. As concepts of clinical audit have developed, so too have
6630-628: The proportion is much higher, approaching 90%. With improved medical capability, dying has become a condition to be managed . In developing nations , inferior sanitary conditions and lack of access to modern medical technology make death from infectious diseases more common than in developed countries . One such disease is tuberculosis , a bacterial disease that killed 1.8 million people in 2015. In 2004, malaria caused about 2.7 million deaths annually. The AIDS death toll in Africa may reach 90–100 million by 2025. According to Jean Ziegler ,
6715-552: The quality of care. This programme is gradually being extended to other areas of healthcare, working with clinical, patient and professional advisory groups. HQIP also hosts the National Joint Registry which was set up to collect information in England and Wales on joint replacement operations and to monitor the performances of implants, hospitals and surgeons. Additionally, the Partnership works closely with
6800-673: The rate of stillbirth. However, 1% of births in the United States end in a stillbirth. A miscarriage is defined by the World Health Organization as, "The expulsion or extraction from its mother of an embryo or fetus weighing 500g or less." Miscarriage is one of the most frequent problems in pregnancy, and is reported in around 12–15% of all clinical pregnancies ; however, by including pregnancy losses during menstruation , it could be up to 17–22% of all pregnancies. There are many risk-factors involved in miscarriage; consumption of caffeine , tobacco , alcohol , drugs, having
6885-473: The results of health care, is recognised as one of the earliest programs of outcomes management. Another notable figure who advocated clinical audit was Ernest Codman (1869–1940). Codman became known as the first true medical auditor following his work in 1912 on monitoring surgical outcomes. Codman's "end result idea" was to follow every patient's case history after surgery to identify errors made by individual surgeons on specific patients. Although his work
6970-722: The ruination of regular functioning. The aptitude of cells for gradual deterioration and mortality means that cells are naturally sentenced to stable and long-term loss of living capacities, even despite continuing metabolic reactions and viability. In the United Kingdom, for example, nine out of ten of all the deaths that occur daily relates to senescence, while around the world, it accounts for two-thirds of 150,000 deaths that take place daily. Almost all animals who survive external hazards to their biological functioning eventually die from biological aging , known in life sciences as "senescence." Some organisms experience negligible senescence , even exhibiting biological immortality . These include
7055-433: The rule: there must be an official declaration of death in a person before starting organ procurement, or that organ procurement cannot result in the death of the donor. A great deal of controversy has surrounded the definition of death and the dead donor rule. Advocates of the rule believe that the rule is legitimate in protecting organ donors while also countering any moral or legal objection to organ procurement. Critics, on
7140-414: The total brain, including coma with clear etiology, cessation of breathing, and lack of brainstem reflexes. These criteria were updated again, most recently in 2010, but substantial discrepancies remain across hospitals and medical specialties. The problem of defining death is especially imperative as it pertains to the dead donor rule , which could be understood as one of the following interpretations of
7225-520: Was undertaken by Florence Nightingale during the Crimean War of 1853–55. On arrival at the medical barracks hospital in Scutari in 1854, Nightingale was appalled by the unsanitary conditions and high mortality rates among injured or ill soldiers. She and her team of 38 nurses applied strict sanitary routines and standards of hygiene to the hospital and equipment; in addition, Nightingale had
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