Clinical Audit

Jill Warn, Audit & IT Lead

Dr John Guy, Clinical Lead

What .....

do you hope to achieve today?

experience have you had of audit?

Today we will look at…...

Enhancing your understanding of Audit

Getting Audit right for Revalidation

The benefits of Audit in Primary Care

Implementing change

Please ask questions / interrupt

A small change in practice is better

than a major discussion of the

possibilities

What is Audit?

Some Definitions Audit is a process used by health professionals

to assess, evaluate and improve the care of patients in a systematic way in order to enhance their health and quality of life.

OR

Deciding what you should be doing, looking at what you are doing, deciding whether you can do it better, implementing any changes and then making sure the changes have worked!

What do we audit?

Structure

Process

Outcome

Why do an audit?

Bring about change

Best use of resources Improve standards Stimulate education Reduce errors (clinical and organisational)

GMC advice

all doctors should take part in systematic audit and be familiar with the principles and practice of clinical audit

It is about

Auditing your own practice!

What to consider when choosing a subject.

Is your topic appropriate?

Does it reflect the care undertaken by you the practitioner?

Is it evidence based?

QOF areas will not be acceptable

Which topics to choose?

For principals / static salaried doctors

For sessional docs

Principals

Sessional

When Planning an Audit

Measure care against a set standard or criteria

Take action to improve care

Monitor to sustain improvement

DDIAY

Consider

Being a Learning Organisation

Look at the skills within the teamEmpowermentHow might this work?

Audit and Revalidation At least one full clinical audit cycle during

a revalidation period

Significant Events Audit

A GP’s portfolio is expected to contain an analysis of at least ten significant events over a 5 year period

Clinical Audit

At least one full audit cycle during a revalidation period

Initial audit results

Change implemented for the GPs’ patients

Re-audit – demonstrating improvement by the

GP

The Audit Cycle

Audit Cycle

Objective / Standard

What are we trying to achieve?

Method Data Collection

Are we achieving it?

Data AnalysisIf not why are we not achieving it?

Implementing Change

Doing something to make things better

Re-evaluate /Review

Have we improve things?

What is an Effective Audit?

An educational activity Promotes understanding Resource effective Raises standards Promotes change Source of information

Writing up your Audit

The great coffee audit

Found on Google:Gloucestershire PCCAG

The great coffee audit

Problem: The doctors feel that their coffee isn’t hot enough after slogging through morning surgery

The great coffee audit

Problem:

Criteria:

The doctors feel that their coffee isn’t hot enough after slogging through morning surgery

The coffee shall be hot and satisfying to the hard pressed docs

The great coffee audit

Problem:

Criteria:

Standards:

The doctors feel that their coffee isn’t hot enough after slogging through morning surgery

The coffee shall be hot and satisfying to the hard pressed docs

The coffee shall be served at a temperature of 85-90C on 80% of occasions and there will be 90% satisfaction level expressed by the docs

The great coffee audit

Methods: The junior receptionist shall check the temperature of the coffee daily for two weeks and circulate a questionnaire to the partners asking them to score a coffee satisfaction level between 1 and 10. The practice manager shall visit Tesco’s and interview the manager about the availability, costs, quality and sell-by dates of the coffee brands available.

The great coffee audit

Review: After a rather tense audit team meeting it was found that the coffee temperature fell below 37C on at least 33% of occasions and reached the standard on only 10% of occasions. The doctors scored the coffee at an average 3/10 and two expressed it undrinkable. The practice manager reported the results of her Tesco’s visit.

The great coffee audit

Change: It was agreed to replace the aged coffee maker (after agreeing suitable redundancy terms for the senior receptionist) with a shiny new machine from Argos. As an additional ‘quality initiative’, cream cakes would be served after surgery. The coffee contract would be switched from the corner shop to Tesco PLC Trust.

The great coffee audit

Re-audit:For a further two weeks it was agreed to measure the coffee temperature and re-circulate the questionnaire. It was gratifying to find 100% correlation with agreed standards with the exception of one partner who didn’t like coffee anyway.

The great coffee audit

Re-audit:

Future Audit:

For a further two weeks it was agreed to measure the coffee temperature and re-circulate the questionnaire. It was gratifying to find 100% correlation with agreed standards with the exception of one partner who didn’t like coffee anyway.

Cost implications of standard maintenance

Cholesterol assays for partners

KISS

Writing Criteria

A criterion is a statement of what should be happening.

Evidence based Measurable Clear, unambiguous

Setting the Standard

A standard is a number Usually quoted as a percentage One for each criterion Where you think you should be Use group discussion, journals and press,

financial targets, last year’s results.

Collecting the Data

Consistent

information

Dedicated time for

audit

Team Approach

Sharing of

information

Collecting Data

Be Organised. Collect essential information only.

Think of different possible sources of data.

Comparing the Results with the Standard

Straight comparison If the standard is not met, what can be

done to improve things?

We may not be quite as good as we think we are!

Onset of diabetes (a)

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Onset of diabetes (b)

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Onset of diabetes (c)

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Onset of diabetes (d)

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Making the Changes

Is this something you have direct control over?

Does patient opinion come into this? Who needs educating? Selling your changes to your colleagues How long will the changes need?

What can we do to improve things?

‘For every fatal shooting, there were roughly three non-fatal shootings. And, folks, this is unacceptable in America. It's just unacceptable. And we're going to do something about it.’

George W. Bush

Have the Changes Worked?

Collect a second set of data Allow time for the changes to take effect Have the changes made a difference? Has the target now been reached? Can further changes be put in place? Is this going to be reviewed again in the

future?

Presenting Results

Results must be clear and understandable Present data in a visual way Avoid complex statistical analysis Quote the numbers before the % for less

than 50 pieces of data Be tactful with difficult results

Why do we use graphs?

The number of asthmatic patients attending for annual review varies according to age, with patients in the 16-24 age group least likely to attend.

0

20

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% Asthmatics Attending Review

Types of Graph: Pie Chart

Percentage of patients discharged from hospital with either complete, incomplete or no discharge letter

Types of Graph: Bar ChartPatient who had a Health Check

Types of Graph: Line Chart

Diabetic Patients attending for Annual Review

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%

Writing it up for revalidation!

Title Reason for choice Dates of first and second data collections Criteria and standards with justification Results of first data collection – reflection Summary of discussion and changes

agreed

Changes implemented Results of second data collection – reflection Quality improvement achieved Reflections

Knowledge skills performanceSafety and qualityCommunication partnership teamworkMaintaining trust

Quality improvement projects

Significant event audit

The audit should be:

transparent

It should not be confrontational or judgemental

It is not an opportunity to name, shame and

blame.

It should be something in which you are involved

It should be discussed in a meeting Changes involve you

Reports should not identify the patients

Should include

Title of event Date of event Date of meeting Description of event What went well? What could have been done differently?

and

Reflections What changes were proposed

For me? For the team?

What changes were implemented and their effect?

Topics to pick

Some ideas

New cancer diagnoses INR >8

What about sharing across health economy?

ANY QUESTIONS?