Background: A clinical audit is a method of addressing the clinical environment to bring about change and improvement.
This paper describes the obstacles encountered while carrying out a clinical audit in a national referral teaching hospital in
Botswana.
Method: A record was kept over a period of three months of reasons for the referral and admission of patients to the
intensive care unit (ICU) and of major obstacles that could not be overcome during a clinical audit. This paper discusses the
obstacles that may be faced in this regard.
Results: The following obstacles were found when carrying out the clinical audit. The medical records were difficult to find,
both in the unit and in the medical records department. This led to abandonment of a retrospective pilot of the audit. When
the medical records were available, the documentation was poor and unsatisfactory for the purposes of the study. Lack of
local criteria and guidelines for ICU admission resulted in inappropriate referrals. Proposed guidelines had still not been
adopted after 10 years. There was a fear by the many departments that refer patients to ICU of being “audited”, which
resulted in reluctance to participate in the audit without assurance from hospital management.
Conclusion: Although the problems that were faced during our audit are not novel to the auditing process, it is important
that they are resolved in order to develop an audit culture.