EFFECTIVENESS OF CLINICAL AUDITS: USAGE OF A PDSA CYCLE Dr. Abdulmalik Al Senafy KBA-PGY4

Outline History Definition Why audits Audit vs research PDSA

History 1853 Florence Nightingale standards of hygiene 1868 Ernest Codman  surgical outcomes ----------------------------------------------------------------------------------------------------- 1989 standardized clinical audit 1993 first multidisciplinary clinical audit 2002 NICE published “The Principles for Best Practice in Clinical Audit” 2011 HQIP published “New Principles of Best Practice in Clinical Audit”

Clinical audit “Clinical audit can be described as a quality improvement cycle that involves measurement of the effectiveness of healthcare against agreed and proven standards for high quality, and taking action to bring practice in line with these standards so as to improve the quality of care and health outcomes.” Healthcare Quality Improvement Partnership 2011

Every clinical audit: Looks at your own practice Follows a systematic process Has standards you can measure your practice against Involves everyone in the team

A good clinical audit: Looks at an aspect of care from patient point of view Multidisciplinary

Why audits?

Proven method for implementation of quality improvement Allows continuous assessment & improvement of healthcare Allows comparability to healthcare standards Improves patient care & experience

Ensures that what should be done is being done If not done  provides framework to enable changes to be made

Audit vs Research

Audits vs research Audit Research Existing knowledge applied Seeks new knowledge Comparison between current and best practice Experimental methods e.g. RCT

Simple descriptive statistics A range of statistics Audit Research Simple descriptive statistics A range of statistics Related to specific area Can be generalized Application of guidelines and policies Evidence for clinical guidelines and policies

Clinical audit cycle Identify problem/ issue Set criteria & standards Observe practice/ collect data Compare data with standards Implement changes

PDSA model

Model for improvement Simplified framework Test changes on a small scale Structured testing

https://improvement.nhs.uk

Plan Formulate a strategy Objective & Goal What factors are to be tested? Plan roles & tasks

Do Carry out plan Document all observations including unanticipated problems data collection

Study Complete data analysis Compare to predictions Summarize the experience including pitfalls

Act Implementing changes and recommendations Plan for next cycle

“The smallest change can make the biggest difference” Remember “The smallest change can make the biggest difference”