Clinical Audit Overview


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An overview of clinical audit. Talk by Yvonne Murray as part of the Fastbleep Academic Masterclasses 2011.

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  • Key thing to remember is that audit should be done for a reason. Not going to spend long on this slide but just to run through these are some of the reasons which may be of concern. E.g. wide variation in practice, may be high risk or something done frequently The issues for audit really consider the aspect of care that you want to look at. Accessibility / equity – Is treatment avail to all pts Appropriateness – right treatment Efficiency – achieving desired outcomes Timeliness – delivered at right time
  • What we are going to cover in the rest of the session Going to talk about each of these in more detail
  • Confidentiality – of patients and staff. Use an audit ID and keep personal details on a separate list Devise questions in line – with standards – don’t collect data you don’t need (data protection) Short and sweet Layout appropriate to user – if several diff people collecting data – divide into sections for each person - Put questions in an order so that you are not flicking back and forth through case notes PILOT – Very important – you will find out if you are collecting all the data you need etc.
  • Data analysis – should not be doing any more than counts and %’s, if you are it is likely to be research
  • Whole reason for doing the audit is to act on the findings and ensure that care is of the quality specified by the standards Important to formally lay out what is going to be done 1 st step – discuss the results with your steering group, or staff in that area of care eg. Presentation/discussion of a draft report You should all agree on specific actions, people who are to undertake them and the timescale for which it is to be completed. Should be set out like this – actions should be: 1. Realistic and achievable - Don’t agree actions that aren’t likely to happen in practice either because their too ambitious or because they are medically / managerially impossible. 2. Appropriate - Ensure appropriate people are assigned with app timescales I.e. consider role of person and authority 3. Valid / relevant - This means that the action should relate to your audit results 4. Phrased as actions - This goes back to what we've just discussed by naming a SPECIFIC target. Its easy to phrase things as statements.
  • Once all are happy with the audit results and an action plan has been agreed appropriate dissemination should take place. Note this is final dissemination - any sort of circulation of results up until this point should be emphasised as draft The reason for dissemination is to ensure there is ownership of the results by those in the area of care. All obviously need to informed and made aware of the action plan. This will help ensure successful implementation of actions. It is also impt for re-audit purposes as you need a record of the audit. Methods for doing this are listed on the slide -(some of these methods may also be used at the action planning stages such as presentations) The most common /useful method are reports which I’ll talk about in more detail. I’ll just pick out a couple of the others which you may find useful : Letters and staff newsletters are good to summarise findings / actions particularly for people who are v.busy. Similarly they can be sent to a wider no people Meetings - minutes of meetings will allow the relevant people to see summaries of the results and find out how the action plan came about. Electronic media - as you’ll be aware there is a big shift to this within the NHS. E-mail is an option to highlight action plans. Also many organisations have an intranet system which could be used to display summaries. Publications & posters are more for disseminating examples of projects or practice with a wider dissemination possibly locally / nationally. Its impt that there is agreement that the project can be shared in this way
  • Clinical Audit Overview

    1. 1. An Overview of Clinical Audit Yvonne Murray – Head of Clinical Audit Central Manchester University Hospitals NHS Foundation Trust
    2. 2. What is Clinical Audit? <ul><li>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. </li></ul><ul><li>NICE 2002 </li></ul>
    3. 3. Re-Audit Set/Implement Standards Agree changes needed Compare with Standards Introduce changes Measure practice Clinical Audit Cycle
    4. 4. What Clinical Audit is not.. <ul><li>Research </li></ul><ul><ul><li>Research is about determining best practice, audit is about measuring if best practice is being followed. </li></ul></ul><ul><li>Clinical audit is not merely collecting and analysing data </li></ul><ul><ul><li>Data is collected and analysed in terms of pre-defined standards… </li></ul></ul><ul><li>A tool to criticise the patient care provided </li></ul><ul><ul><li>Audit acts as a tool to assure the quality of multidisciplinary care. </li></ul></ul>
    5. 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. 6. Why Do Audit? <ul><li>1. Assures Patient Care </li></ul><ul><li>Consistency of care & treatment </li></ul><ul><li>Access/equity of healthcare </li></ul><ul><li>Quality & effectiveness of care </li></ul><ul><li>Patient satisfaction </li></ul>
    7. 7. Why Do Audit ? <ul><li>2. Staff Development </li></ul><ul><li>Professional development </li></ul><ul><li>Multi-disciplinary team working </li></ul><ul><li>Improve communication between staff </li></ul><ul><li>Improve awareness of guidelines & procedures </li></ul><ul><li>Identification of training needs </li></ul><ul><li>Opportunity to publish </li></ul>
    8. 8. Why Do Audit ? <ul><li>3. Management </li></ul><ul><li>Strengthen professional self regulation </li></ul><ul><li>Risk Management - reduction in litigation/complaints </li></ul><ul><li>Supports bids for resources </li></ul><ul><li>Improve cost/clinical effectiveness </li></ul><ul><li>Informs need for organisational change </li></ul>
    9. 9. How to do it... <ul><li>Establish topic area </li></ul><ul><li>Consult – involve ‘appropriate’ others </li></ul><ul><li>Establish standards to measure </li></ul><ul><li>Plan the audit process </li></ul><ul><li>Pilot it </li></ul><ul><li>Collect/Collate and analyse data </li></ul><ul><li>Report/Action Plan </li></ul><ul><li>Implement changes in practice </li></ul><ul><li>Re-audit </li></ul>
    10. 10. Reasons <ul><li>Wide variation in practice </li></ul><ul><li>High risk / cost / volume procedure </li></ul><ul><li>Complex procedure </li></ul><ul><li>Evidence of a serious quality problem </li></ul><ul><li>Multi-professional need/involvement </li></ul><ul><li>Reaction to a complaint </li></ul><ul><li>Time consuming procedure </li></ul><ul><li>Patient / Carer </li></ul><ul><li>Communication </li></ul><ul><li>Accessibility / Equity </li></ul><ul><li>Acceptability </li></ul><ul><li>Appropriateness </li></ul><ul><li>Continuity </li></ul><ul><li>Efficiency </li></ul><ul><li>Timeliness </li></ul>Issues Topic/audit areas can be nationally, regionally or locally driven, but should be based on... Establish Topic Area…
    11. 11. Who should be involved? <ul><li>Depends on size and focus of project…but consider…. </li></ul><ul><ul><li>Areas / Professions involved in care </li></ul></ul><ul><ul><li>A&E staff, Bed Manager, Nurse, Porters </li></ul></ul><ul><ul><li>Those required for change to happen </li></ul></ul><ul><ul><li>Senior Healthcare staff, Management… </li></ul></ul><ul><ul><li>Patients / Carers </li></ul></ul><ul><ul><li>Clinical Audit department </li></ul></ul><ul><ul><li>Level of involvement </li></ul></ul>
    12. 12. Aim & Objectives <ul><li>AIM - General intent of the audit </li></ul><ul><li>Should be a single positive statement of intent </li></ul><ul><li>“ To ensure compliance to NICE guidelines for </li></ul><ul><li>Pre-operative Testing across the Surgical Division.” </li></ul><ul><li>OBJECTIVES – Related to specific aspects of audit </li></ul><ul><li>An audit can have several (relevant) objectives </li></ul><ul><li>“ To quantify the appropriate use of chest x rays. “ </li></ul>
    13. 13. <ul><li>A standard is: </li></ul><ul><li>“ an explicit statement describing the quality of care to be achieved, which is definable & measurable” </li></ul>Clinical Audit Standards Q. Do I have to write them myself? Yes & No….. <ul><li>Research </li></ul><ul><li>National/Local Guidelines </li></ul><ul><li>NSF’s </li></ul><ul><li>Policies / procedures </li></ul><ul><li>Clinical Pathways </li></ul><ul><li>Local agreement </li></ul>
    14. 14. Data Collection - Methodology <ul><li>Patient sample size </li></ul><ul><li>- number, time period, consecutive/random </li></ul><ul><li>Data collection considerations </li></ul><ul><li>- retrospective / prospective </li></ul><ul><li>Data source(s) </li></ul><ul><li>- Case notes, Information Department, Patients (Questionnaires), Locally held databases/registers </li></ul><ul><li>Who is going to collect the data? </li></ul>
    15. 15. Proforma Design - Key Points <ul><li>Confidentiality </li></ul><ul><li>Devise questions in line with the standards </li></ul><ul><li>Keep the proforma as short as possible </li></ul><ul><li>Make the layout appropriate to the users </li></ul><ul><li>Be explicit with the questions </li></ul><ul><li>Consider availability of data </li></ul><ul><li>Avoid subjective questions </li></ul>PILOT PILOT PILOT PILOT PILOT PILOT PILOT
    16. 16. Data Analysis <ul><li>Keep it simple! </li></ul><ul><li>Results as a percentage </li></ul>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. 17. Action Plan <ul><li>Realistic </li></ul><ul><li>Achievable </li></ul><ul><li>Appropriate </li></ul><ul><li>Specific </li></ul><ul><li>Valid / relevant </li></ul><ul><li>Phrased as actions </li></ul>AGREEMENT Action Co-ordinator Timescale
    18. 18. Dissemination <ul><li>Presentations </li></ul><ul><li>Letters </li></ul><ul><li>Meetings </li></ul><ul><li>Electronic Media </li></ul><ul><li>Staff Newsletters </li></ul><ul><li>Publications </li></ul><ul><li>Posters </li></ul><ul><li>Reports </li></ul>
    19. 19. Report and Feedback <ul><li>Written report should include the following: </li></ul><ul><ul><li>Audit aims/objectives </li></ul></ul><ul><ul><li>Methods </li></ul></ul><ul><ul><li>Standards </li></ul></ul><ul><ul><li>Results </li></ul></ul><ul><ul><li>Recommendations </li></ul></ul><ul><ul><li>Action plan </li></ul></ul><ul><ul><li>Present to fellow colleagues </li></ul></ul>
    20. 20. To sum up... <ul><li>Should form part of routine clinical practice </li></ul><ul><li>Patient Focused </li></ul><ul><li>Based upon standards </li></ul><ul><li>Requires commitment from all disciplines </li></ul><ul><li>Professionally led </li></ul><ul><li>Generates results which may be used to improve quality of care & outcomes </li></ul><ul><li>Should be seen as part of educational process </li></ul><ul><li>It does work !!! </li></ul>
    21. 21. Clinical Audit Department <ul><li>A team of Clinical Audit Facilitators who advise on & support audit activity </li></ul><ul><li>Guidance & advice on audit design & process </li></ul><ul><li>Help with analysis & presentation of data </li></ul><ul><li>Obtain casenotes, x-rays, etc. </li></ul><ul><li>Education & training </li></ul><ul><li>Central site tel: 276 4172 </li></ul>
    22. 22. Any Questions?