Clinical audit is a quality improvement process aimed at enhancing patient care by systematically evaluating healthcare practices against established criteria. It differs from research as it focuses on measuring compliance with best practices rather than discovering new knowledge. The process involves selecting areas of care for review, implementing changes, and continuously monitoring for improvements in healthcare delivery.

1. An Overview of Clinical Audit Yvonne Murray – Head of Clinical Audit Central Manchester University Hospitals NHS Foundation Trust

2. What is Clinical Audit? Clinical Audit is a quality improvement process that seeks to improve patient care and outcomes ……….. Aspects of the structure, processes, and outcomes of care are selected and systematically evaluated against explicit criteria . Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery. NICE 2002

3. Re-Audit Set/Implement Standards Agree changes needed Compare with Standards Introduce changes Measure practice Clinical Audit Cycle

4. What Clinical Audit is not.. Research Research is about determining best practice, audit is about measuring if best practice is being followed. Clinical audit is not merely collecting and analysing data Data is collected and analysed in terms of pre-defined standards… A tool to criticise the patient care provided Audit acts as a tool to assure the quality of multidisciplinary care.

5. RESEARCH CLINICAL AUDIT SERVICE EVALUATION The attempt to derive generalisable new knowledge including studies that aim to generate hypotheses as well as studies that aim to test them. Designed and conducted to produce information to inform delivery of best care. Designed and conducted solely to define or judge current care. Quantitative research – designed to test a hypothesis. Qualitative research – identifies/explores themes following established methodology. Designed to answer the question: “Does this service reach a predetermined standard?” Designed to answer the question: “What standard does this service achieve?” Addresses clearly defined questions, aims and objectives. Measures against a standard. Measures current service without reference to a standard. Quantitative research -may involve evaluating or comparing interventions, particularly new ones. Qualitative research – usually involves studying how interventions and relationships are experienced. Involves an intervention in use ONLY. (The choice of treatment is that of the clinician and patient according to guidance, professional standards and/or patient preference.) Involves an intervention in use ONLY. (The choice of treatment is that of the clinician and patient according to guidance, professional standards and/or patient preference.) Usually involves collecting data that are additional to those for routine care but may include data collected routinely. May involve treatments, samples or investigations additional to routine care. Usually involves analysis of existing data but may include administration of simple interview or questionnaire. Usually involves analysis of existing data but may include administration of simple interview or questionnaire. Quantitative research - study design may involve allocating patients to intervention groups. Qualitative research uses a clearly defined sampling framework underpinned by conceptual or theoretical justifications. No allocation to intervention groups: the health care professional and patient have chosen intervention before clinical audit. No allocation to intervention groups: the health care professional and patient have chosen intervention before service evaluation. May involve randomisation No randomisation No randomisation ALTHOUGH ANY OF THESE THREE MAY RAISE ETHICAL ISSUES, UNDER CURRENT GUIDANCE:- RESEARCH REQUIRES R.E.C. REVIEW AUDIT DOES NOT REQUIRE R.E.C. REVIEW SERVICE EVALUATION DOES NOT REQUIRE R.E.C. REVIEW

6. Why Do Audit? 1. Assures Patient Care Consistency of care & treatment Access/equity of healthcare Quality & effectiveness of care Patient satisfaction

7. Why Do Audit ? 2. Staff Development Professional development Multi-disciplinary team working Improve communication between staff Improve awareness of guidelines & procedures Identification of training needs Opportunity to publish

8. Why Do Audit ? 3. Management Strengthen professional self regulation Risk Management - reduction in litigation/complaints Supports bids for resources Improve cost/clinical effectiveness Informs need for organisational change

9. How to do it... Establish topic area Consult – involve ‘appropriate’ others Establish standards to measure Plan the audit process Pilot it Collect/Collate and analyse data Report/Action Plan Implement changes in practice Re-audit

10. Reasons Wide variation in practice High risk / cost / volume procedure Complex procedure Evidence of a serious quality problem Multi-professional need/involvement Reaction to a complaint Time consuming procedure Patient / Carer Communication Accessibility / Equity Acceptability Appropriateness Continuity Efficiency Timeliness Issues Topic/audit areas can be nationally, regionally or locally driven, but should be based on... Establish Topic Area…

11. Who should be involved? Depends on size and focus of project…but consider…. Areas / Professions involved in care A&E staff, Bed Manager, Nurse, Porters Those required for change to happen Senior Healthcare staff, Management… Patients / Carers Clinical Audit department Level of involvement

12. Aim & Objectives AIM - General intent of the audit Should be a single positive statement of intent “ To ensure compliance to NICE guidelines for Pre-operative Testing across the Surgical Division.” OBJECTIVES – Related to specific aspects of audit An audit can have several (relevant) objectives “ To quantify the appropriate use of chest x rays. “

13. A standard is: “ an explicit statement describing the quality of care to be achieved, which is definable & measurable” Clinical Audit Standards Q. Do I have to write them myself? Yes & No….. Research National/Local Guidelines NSF’s Policies / procedures Clinical Pathways Local agreement

14. Data Collection - Methodology Patient sample size - number, time period, consecutive/random Data collection considerations - retrospective / prospective Data source(s) - Case notes, Information Department, Patients (Questionnaires), Locally held databases/registers Who is going to collect the data?

15. Proforma Design - Key Points Confidentiality Devise questions in line with the standards Keep the proforma as short as possible Make the layout appropriate to the users Be explicit with the questions Consider availability of data Avoid subjective questions PILOT PILOT PILOT PILOT PILOT PILOT PILOT

16. Data Analysis Keep it simple! Results as a percentage Standard Result % 1. It should be indicated on the consent form that a ‘consent to treatment’ leaflet has been given to the patient. 78/100 78% 2. It should be indicated that a procedure-specific leaflet or tape has been provided for the patient on the consent form. 81/100 81%

17. Action Plan Realistic Achievable Appropriate Specific Valid / relevant Phrased as actions AGREEMENT Action Co-ordinator Timescale

18. Dissemination Presentations Letters Meetings Electronic Media Staff Newsletters Publications Posters Reports

19. Report and Feedback Written report should include the following: Audit aims/objectives Methods Standards Results Recommendations Action plan Present to fellow colleagues

20. To sum up... Should form part of routine clinical practice Patient Focused Based upon standards Requires commitment from all disciplines Professionally led Generates results which may be used to improve quality of care & outcomes Should be seen as part of educational process It does work !!!

21. Clinical Audit Department A team of Clinical Audit Facilitators who advise on & support audit activity Guidance & advice on audit design & process Help with analysis & presentation of data Obtain casenotes, x-rays, etc. Education & training Central site tel: 276 4172

22. Any Questions?