One of the first clinical audits ever undertaken was during the Crimean War of 1853-1855. Florence Nightingale was appalled at the unsanitary conditions and the high mortality rates of soldiers in the hospital at Scutari. She and her team of 38 nurses applied strict sanitary routines and standards of hygiene to the hospital and equipment. Miss Nightingale, who had a gift for mathematics and statistics, began to keep meticulous records of the mortality rates amongst the hospital patients. Following the change of regime the mortality rates fell from 40% to 2% and were instrumental in getting Florence’s procedures accepted by the Officers and Doctors. Her methodical approach, as well as the emphasis on uniformity and comparability of results of healthcare, is recognised as one of the earliest programmes of outcomes management.
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