What are the effects of internal audits on quality and safety of hospital care?

We examine the current internal audits of the Radboud University Nijmegen Medical Centre; are they a valid, reliable and responsive diagnostic instrument to analyze the safety of patient care? And we want to know what the results of the internal audits of the Radboud University Nijmegen Medical Centre are on the safety of patient care in (academic) hospitals. We use a mix method approach (quantitative and qualitative research methods) to measure the effects of internal audits on different levels: patient, professional and department level. To measure the effects of internal audits on patient safety in clinical hospital care we use a before-and-after design. The null hypothesis is that there is no difference of patient safety of healthcare between the measurement before and after the internal audit and between departments with and without an internal audit. The alternative hypothesis is that internal audits improve the patient safety of healthcare in the Radboud University Nijmegen Medical Centre. In this study we perform a determinant analysis to correct statistical for potential confounders. And we also perform a process analysis to explain certain (un)expected effects of internal audits.
This study takes place in the Netherlands.

The objective of this thesis is to get insight into the effects of internal audits on patient safety and on health care professional’s behavior in an academic hospital at ward level.

Primary outcome:

Complications and adverse events in hospital care are measured by structured retrospective patient record review of hospital admissions 3 months before and 15 months after an internal audit.



Secundairy outcomes:

1. The patient safety culture whitin a team of health care givers is measured by the Dutch Questionnaire COMPaZ 3 months before and 15 months after an internal audit;

2. The team climate is determined by the Team Climate Inventory 3 months before and 15 months after an internal audit;

3. Patients experiences with hospital care are measured with the Consumer Quality Index of Hospital Admission 3 months before, 9 and 15 months after an internal audit;

4.+ 5. The SMR and the data of unintended prolonged hospital stay are derived monthly from the hospital registry database and the national medical registration (LMR);

6. The learning effects of health care givers and department leaders are gathered retrospective by in-depth questionnaires and for this study developed questionnaires.

Internal audits.