Medical Audit: Definition, Origin, Objectives, Types and MORE

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Obtaining and evaluating results within a specific area is essential for the advancement, growth and improvement of errors. Therefore, a Medical Audit it is so necessary to assess the quality of the medical act carried out by the institution.

Would you like to know everything about the subject? Its definition, objectives, types and more. Here we tell you!

Keep reading and know everything you need to know about a Medical Audit!

What is the Audit?

The audit is a systematic process of obtaining data and evaluating the patrimonial records, which both an individual and a company may have, to verify their financial status.

In this way, it helps to determine the reasonableness, integrity and reality of the financial statements, records and other accounting documents presented by management or direction. This in order to express improvements or suggestions towards the organization.

All this is carried out by an auditor, whose purpose will always be to analyze the accuracy and veracity of the records received, to propose the correction of errors, irregularities and other problems that could arise.

Although there are many types of audits, all of them basically start from the operation of Accounting. Likewise, they have other objectives such as issuing an opinion about the evolution of the company, evaluating the goals, its management and members, and effectively following up on the recommendations generated.

About the audit process, four basic stages are handled that must be materialized in writing. The first is planning, where the objectives and scope of the audit are determined, in addition to the activities to be analyzed, the necessary resources, field analysis, identification of critical areas, etc.

The second stage is the examination and evaluation of the collected information, which is where all the selected data is collected, interpreted and analyzed.

Then comes the presentation of results to the members of the company, which gives rise to the conclusions and recommendations. Finally, the written reports of the result are delivered, they are disclosed and the follow-up phase begins, which determines if the corrective actions are applied or not and if they really achieve the desired objectives.

What is the Medical Audit?

Now, speaking of a Medical Audit It is a process that involves carrying out internal or external reviews of the policies and procedures that are being carried out in a health entity to ensure that an efficient and error-free operation is being carried out.

Thus, it is about the evaluation of an activity or situation in order to determine the quality index in the medical act itself. This implies various procedures to follow, decisions, use of resources, results and the evaluation of the doctor-patient relationship.

The goal of the Medical Authorship is to ensure compliance with basic standards to contribute to improving the quality of health services. Therefore, it is in charge of supervising and analyzing different aspects as it is an interdisciplinary process.

Origin of the Medical Audit

The origin or history of the medical audit It goes back to the year 1910, when the Flexner report on the teaching of Medicine in the different universities in the USA emerged, but at the same time making a great criticism of the existing system, which ended with the non-accreditation of 47 medical schools.

Along these lines, seven years later the American College of Surgeons issued the Standards for hospital accreditation. However, it was not until 1950 that a pilot study was carried out in 15 hospitals and the procedure was institutionalized, overcoming the fear and suspicion of considering the audit as an instrument of control and punishment.

Already in 1980 it was considered as a basic procedure implanted in almost all American hospitals. A decade later, specifically in 1991, the Medical Audit was made official at the Guillermo Almenara Hospital.

After that, various and numerous committees were created, including the Medical Audit and Clinical History Committee, made up of doctors appointed by the General Directorate and proposed by the Medical Corps.

In this way, said entity carried out an arduous work of Medical Audit basically referred to Medical Records due to legal medical problems, possible cases of medical negligence or some of prolonged hospital stay.

Finally, this process was consolidated so much that the implementation of the Medical Audit is currently being proposed as a system for improving the quality of medical care and not one of strict control and supervision.

Objectives of the Medical Audit

One of the main objectives of a good and correct medical or health audit is to be able to provide a better and more efficient delivery of care and to improve the financial health of the medical provider.

It is important to note that in addition, the audits of medical records have the specific objective of evaluating the selection of the procedure and diagnosis code, always in accordance with what is determined by the doctor’s documentation.

Thus, once the weak areas are detected and revealed through an audit, the different findings can be presented and the multiple training opportunities within the health organization can be identified.

What is it done for?

A correct medical audit it is done for many purposes. However, the most relevant is that it can significantly improve the quality of the health service, by studying it carefully and detecting its flaws.

  • First, critical areas can be identified. Those that have errors and in turn propose solutions that favor both sides: both the medical staff and the patients.
  • Second, it immediately improves the quality of care and medical practice, minimizing the incidence of errors. For this, the transparency of the process is essential to find the faults.
  • Finally, at the educational level, it becomes an excellent teaching tool. Well, it enables not only the growth of the area, but also the training of better professionals.


After everything explained above about the medical audit, it was time to talk about their types. These vary and are explained below:

Random audit

In this type of audit they tend to focus more on the amount of money spent or received on different requests. This will give health auditors a glimpse into the whole issue as well as insight into whether the organization is doing well or needs to be reviewed in a more in-depth manner rather than in a random manner.

Comprehensive audit

Regarding this audit approach, it is noted that it does not take random samples, but rather focuses specifically on claims that had been audited before but in a closer way. In this way, the audit samples are chosen in two different ways, the first is electronic and the second is manual.

However, if the organization seeks a type of reimbursement because of its money spent, it typically relies more on this form of supervision than on the random audit approach.

Hybrid audit

This is a mix of the two types of audits explained above. Here samples are taken at random but also exhaustively.

The medical audit Hybrid is often more accurate when it comes to auditing different cases, various issues, and demands. Although, it eventually results in accurate and very useful statistics to be used in the future to compensate for money spent for no reason.

Quality improvement audit

Finally, in this type, they seek to obtain results that improve the treatment of the patient, reduce financial costs, increase quality and reduce the money spent on treatments.

Here, the basis is to select different patients before the restoration of their health so that they enroll in the audit process until they return to their normal condition. Thus, the medical audit focuses on providing more quality and improvements to both the patient and the hospitals.

The Medical Audit as a fundamental instrument

The medical audit it is a fundamental instrument to improve the quality of care offered to patients. For this reason, it invites the medical entity to answer the following questions:

  • What care is provided?
  • Did we fulfill what we planned and promised to do?
  • What should we have done or what could we have changed?
  • Are we doing what we really should do? Can we improve what we do?

Starting from this, without a doubt that the medical audit guarantee the technical skills of professionals, allow efficient use of available resources, and achieve patient satisfaction within the improvement of care

As mentioned above, the audit follows a cycle that ranges from the establishment of key criteria, the review of medical records, data collection, the analysis of results and findings, to the final monitoring of the changes made and required. .

The clinical record in the medical audit

Finally, as the last point of this article, it is relevant to highlight that in order to carry out a medical audit there is an essential document: the clinical record. This together with hospital statistics, the various standards and protocols, as well as the work of the auditor, allow a diligent analysis of medical work.

This document records all the medical benefits received by the patient. These, in addition to the exams carried out and everything that is required to be recorded. Of course, as long as it has to do with the patient’s pathology and the actions developed to obtain their cure.

For this reason, it is unique for the establishment, as it is a reserved document that constitutes a means of judicial evidence. In turn, it influences and must meet certain basic requirements. Among them are: uA clear and legible typeface, complete, timely and pertinent records and clear, concise and orderly information.

Thanks for reading!

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