This document discusses clinical audit services and provides examples of clinical audits. It describes the process of developing, designing, and conducting clinical audits. Clinical audits measure care quality against standards, identify areas for improvement, and provide recommendations. They also track changes in care over time. The document uses the National Diabetes Audit as a case study. It measures various aspects of diabetes care and outcomes and involves many stakeholders. Reports provide benchmarked data to identify high-risk patients and drive quality improvements. An example is provided of how the audit found more patients were receiving a kidney test, leading to earlier detection and treatment of complications.

1. Clinical Audit Service
Supporting better care
EHI Live 2013

2. Clinical Audit Development
• Clinical Leadership and Engagement
• Inclusive Approach
- Patient and Carer representatives
- AHPs and Care Team representatives
• Audit Measurement
- Existing standards?
- Baseline and variability?
- Indicator Development and Assurance

3. Clinical Audit Design
• NICE Quality Standards
• Professional and Clinical Standards
• Information Standards
• Data Standards
• Statistical Standards

4. Clinical Audit Considerations
• Mandated or not?
• Considering the burden
• How to present findings and feedback
• Support for improvement activities
• Re-auditing

5. Clinical Audit and Improving Quality
• Audit Findings, Feedback and Recommendations
• NICE Quality Standards
• Outcomes Frameworks
- NHS OF
- CCG Outcomes Indicator Set
• Regulation, Professional Validation and Inspection
- CQC
- Royal Colleges

6. Clinical Audit and Improving Quality
• Local ownership – CCGs, Boards, Clinical
Senates, Strategic Clinical Networks, Action
Teams, Patient Groups, Health and Wellbeing
Boards, Healthwatch etc
• Transparency
- Methodology
- Findings
- Recommendations
- Outliers
- Indicator Construction
- Data

7. Case Study: National Diabetes Audit
• Worlds largest clinical audit - over 2.4 million people with diabetes
• 90 per cent of GP practices in England and Wales participate
• Clinically led and patient focused
• Assessment of full integrated diabetes patient care pathway from GP
practices to hospitals
• Links patient records from multiple sources
• Measures care against NICE clinical guidelines and quality standards
• Provides benchmarked practice specific and hospital specific reports
• Identifies diabetes patients with multi-morbidities and increased cardio
vascular risk
• Provides clinical recommendations for quality improvements

8. What Aspects of Diabetes Care and Outcomes are Measured?
GP care
Patient
Inpatient Care
Mortality
test results
Outpatient care
Cardiovascular
Complications
Pregnancy care
Kidney
disease

9. Who is Involved in the NDA?
• The NDA is a fully collaborative clinical audit that
brings together:
- Patients
- GPs
- Diabetologists
- Physicians
- Nurses
- Midwifes
- Commissioners
- Informaticians
- Governance specialists
- Analytical methodologists

10. What Reports are Available?
• NDA publishes national, CCG and Trust reports
and provides GPs with practice specific reports
Reports contain
• Compliance with NICE clinical guidelines and quality
standards
• Clinical recommendations for quality improvement
• Benchmarked analysis
• Increased risk of adverse outcomes and cardiovascular
complications
• Increased risk of mortality
• Equity of care measures

11. Clinical Improvements
NICE updated clinical guidelines in 2008 to recommend that people
with diabetes have a urine albumin: creatinine ratio (ACR) test
annually. Urine ACR test is used to detect and monitor kidney disease
Early detection and treatment can prevent or delay the progression of
chronic kidney disease (CKD), reduce or prevent the development of
complications and reduce the risk of cardiovascular disease
In 2010 the NDA reported that 65 per cent of people with diabetes were
receiving the NICE recommended Urine ACR test. The NDA initiated a
programme of communication and improvement to highlight these
issues. In 2 years the percentage of people with diabetes receiving the
test rose to 75 per cent
This means that an additional 200,000 people with diabetes are
receiving this test that identifies and monitors kidney disease

12. National Lung Cancer Audit
Audit Finding: not enough patients with small cell lung
cancer receive chemotherapy
Recommendation: chemotherapy rates below 65 per cent for
this group of patients should be reviewed
West Suffolk NHS Trust
This trust identified that patients were waiting too long for
treatment and therefore the cancer was too advanced for
chemotherapy
An alert system was established to flag up patients with the
very aggressive small cell lung cancer, which allowed fast
track booking of oncology appointments

13. West Suffolk NHS Trust

14. West Suffolk NHS Trust
The Trust then followed this up by assessing whether
this reduction in waiting times meant that more
patients were able to receive treatment before they
deteriorated and became too ill for chemotherapy
The treatment rates for Small Cell Lung Cancer were
between 50 and 60 per cent prior to improvement
activities
Following the quality interventions this increased to
over 70 per cent

15. Connect with us
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@hscic
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