Clinical Audit and the Audit Cycle

What we are going to cover today The audit cycle Criteria and standards Structure, process and outcome An audit example Problems with audit How audit fits into ‘Clinical Governance’

A definition of audit “The 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” Working for Patients 1989

Effective audit An educational activity Promotes understanding Resource effective Raises standards Promotes change Source of information Peer led Involves patients

The audit cycle Problem or objective identified Criteria agreed and standards set Re-audit Make necessary changes Audit (Data collected) Identify areas for improvement

Another way of expressing the audit cycle Determine which aspects of current work are to be considered Describe and measure present performance Develop explicit standards Decide what needs to be changed Negotiate change Mobilise resources for change Review and renew the process

Criteria and standards Criteria are those aspects of care that you wish to examine Standards are the pre-stated or implicit levels of success that you wish to achieve

Structure, process and outcome Structure refers to resources you have available (including current knowledge, skills and attitudes) Process refers to what you actually do, e.g. a protocol Outcome refers to the health benefits, cost effectiveness or person satisfaction

The great lunch audit Problem Criteria Standards The service user feels that their meals are cold on arrival from the kitchen because they are plated up in advance The meals will be hot and satisfying to the service users The meals shall be plated up once service users are sat at the table

The great lunch audit Methods A member of the care staff will work with the kitchen staff for two weeks to check that the meals are not plated until the service users are ready to eat. They will then conduct group interviews with the SUs to assess the improvement and produce feedback.

Contents of an audit Background Literature review Criteria and standards Methods or protocol Results Recommendations for change Recommendations for further audit

Why audit Useful clinically Encourages teamwork Improves patient/service user care Financial benefits (sometimes!)

Problems with audit Audit and research Statistical verification Outcome measures and proxies Protocols Closing the loop - introducing change and re-audit

Activity Choose an area in your workplace which you would like to change. Using the clinical audit cycle, identify the problem, criteria and standards and the outcome you would like to achieve.

http://www.youtube.com/watch?v=q4xrfH9AeTs

A word about clinical governance “A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards by creating an environment in which excellence in clinical care will flourish” A First Class Service 1998

‘Clinical Governance’ Practice accreditation Practice development plans Research Postgraduate medical education Special interest groups Evidence based medicine Audit Personal development plans Dissemination of guidelines

‘Clinical Governance’ Accountability

Reference www.glospccag.nhs.uk/userfiles/docstore/pdf/.../auditcycle Morrell, C and Harvey, G.(2003) The clinical Audit handbook. London. Bailliere Tindell