Clinical Audit as Evidence for Revalidation

Dr David Scott, GMC Associate, Consultant Paediatrician and Clinical Lead for Children’s Services,

East Sussex Healthcare NHS Trust

and

Former Chairman BMA CC Medical Managers Sub-committee

Topics to be Covered

• assessing the evidence for revalidation: how much of the information should be provided by the Trust and how much by the individual

• how do you evidence both participation and reflection on clinical audit findings?

Topics to be Covered

• clinical auditing your practice to provide evidence for revalidation

• the role of clinical audit staff in supporting clinicians to prepare for revalidation

• supporting individuals to prepare for revalidation

Purpose of revalidation

• To confirm that licensed doctors practice in accordance with the GMC’s generic standards (relicensing)

• For doctors on specialist/GP register, to confirm that they meet the standards appropriate for their speciality (recertification)

• To identify for further investigation, and remediation, poor practice where local systems are not robust enough or do not exist

Clinical Audit• A quality improvement process that seeks to improve

patient care and outcomes through systematic review of care against explicit criteria and the implementation of change.

• 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.

The Standards (Explicit Criteria)

• Professional – standards that are set for the profession that determine a registrant’s ‘fitness to practise’.

• Subjective – the patient’s point of view.

• Objective – those facts that are observable and measurable by a nurse or other clinician.

Good Medical Practice

– Knowledge, skills and performance

– Safety and quality– Communication,

partnership and team work

– Maintaining trust

Types of Supporting Information for Revalidation

• Continuing Professional Development

• Quality improvement activity

• Significant events• Feedback from

colleagues• Feedback from patients

(where applicable)• Review of complaints

and compliments

History of Audit

• 1956 - medical audit.

• 1989 - Kenneth Clarke, then Secretary of State for Health: “systematic, critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome and quality of life for the patient.”

Clinical Audit Project (1)

1. Registration of project– Agreement of criteria for comparison– Lead auditor should be named.– There should be an entry referring to the size of

the impact, the trigger, and the desired performance, and a credible (named) source.

– The presentation date and venue will be decided at this stage.

– An audit reference number should be issued.

Clinical Audit Project (2)

2. Data are made available. The lead auditor should describe the methodology of inclusion and exclusion criteria and lost data. This technique should mirror the rigour of data handling in research projects.

3. Data analysis and interpretation. Statistical methodology should be made clear.

Clinical Audit Project (3)

4. Presentation of the project, with recommendations for implementation.

5. Trust certification of completed audit should be provided to all participants.

6. Incorporation of the findings from the project into a protocol should be considered.

7. Registration for re-auditing, as per (1.) above.

http://www.hqip.org.ukHealth Quality Improvement Partnership

Clinical Audit and Revalidation• What activities can be

considered clinical audit.

• Principles for the use of clinical audit in revalidation

• Criteria and key indicators for demonstrating involvement by a doctor in the process of clinical audit

• Criteria and key indicators for demonstrating reflection and action in response to the results of clinical audit

• Agree the criteria and indicators of a good clinical audit project.

Audit Standards - Revalidation

• Participation in High Quality Clinical Audit

• Reflection on the results of Clinical Audit

• Taking action on the results of Clinical Audit

Academy of Medical Royal Colleges (2009)

Trust Audit Programme

• National

• Regional

• Local

• Departmental

• Individual

Audit Activity

• Audit meetings• Mortality and

morbidity meetings• Serious case

reviews• Root cause analysis

(RCA)• Professional review

meetings

• Risk management meetings

• National audits relating to your specialty

• Medical record audits

• Peer review

National Audit Projects

Medical Record Audit Tool

Evidence of participationActivity Standard Evidence

Attendance at meetings Attend 2/3 meetings Meeting Register

Audit presentation Presentation at Audit Meeting

Copy of presentation

Medical record review RCP standards Audit report

Serious case reviews Internal/external ‘experts’

Copies of anonymised minutes

Peer reviews NICE Guidance, Protocols & guidelines

Extracts from reports

Out-patient clinic review

Peer opinion Reflections on case discussions

Feedback from Colleagues

Feedback from Patients

Appraisal Discussion

• Standards• Evidence• Contributory factors• Probity• Improvement• Personal

development• Remediation

Performance of Doctors

Adapted from : Birch K, Scrivens E & Field S (1999)

Insight

“I shut my

eyes in order

to see”

Paul Gaughuin (1848-1903)

The Role of Clinical Audit Staff

• Support and advice• Manage database of

clinical audits• Arrange and support

audit meetings• Participate in

networks

Support for Revalidation

• Activity data• Outcome data• Complication rates• Mortality & morbidity

data• Serious incidents• Patient satisfaction

data

Conclusion

• Participation in an enhanced appraisal process combined with effective audit of your clinical practice should satisfy and reassure patients, lead to greater job satisfaction and a recommendation for revalidation.

Future Reading

• Academy of Medical Royal Colleges. Clinical Audit and Revalidation - Report and Recommendations. https://www.p-cat.org.uk/downloads/Clinical-Audit-Revalidation.pdf

• Royal College of Physicians. What is meant by ‘clinical audit’ for the purposes of revalidation? http://www.rcplondon.ac.uk/faqs/what-meant-clinical-audit-purposes-revalidation