Introduction
Clinical audits play a fundamental role in improving the quality of clinical practice and patient safety 12 3. The audit cycle involves observing practice, setting standards, comparing practice with standards, implementing changes and finally observing new practice4 5 6. Closing the audit cycle is essential to achieve sustainable improvements in healthcare 2 7 8. In practice, the cycle is often not completed, and the problems are left unresolved, which can potentially result in clinical auditing being a time- and resource-wasting activity 910 11 12.
Clinical audit was implemented relatively recently as a quality improvement (QI) tool in the healthcare system of the Gaza Strip. For example, teaching concepts of QI work and clinical audit were only introduced into the curriculum of local medical schools in 2015. This led to the completion of a number of audit projects by medical students for the first time in 2015 13 1415. A notable rise of QI work conducted by medical students was observed in the following years. In 2017, the Palestinian Ministry of Health (MoH) and the Palestinian Medical Council (PMC) introduced a general requirement for healthcare professionals, including interns and residents, to partake in QI activities. These measures sparked a wider engagement in audit activities as well as a broad awareness of the importance of QI work amongst medical students and healthcare professionals. However, evidence of monitoring of audit activities and subsequent improvements in clinical practice is still lacking. Consequently, concerns were raised regarding the effectiveness of clinical audits in improving the quality of patient in Gaza Hospitals.
Therefore, we decided to track and evaluate the clinical audits that were conducted in the Gaza Strip between 2015 and 2018. We also aimed to identify factors that would contribute towards producing more impactful audits in order to improve the quality of patient care in Gaza hospitals.