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

2. Outline
History
Definition
Why audits
Audit vs research
PDSA

3. 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”

4. 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

5. 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

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

7. Why audits?

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

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

10. Audit vs Research

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

12. 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

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

14. PDSA model

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

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

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

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

21. Act
Implementing changes and recommendations
Plan for next cycle

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