Clinical Audit

Clinical Audit

CLINICAL AUDIT Practical Considerations for Allied Health Professionals www.unisa.edu.au/cahe Clinical Audit Clinical effectiveness Process for comparing Improving standards of care

Clinical Audit Clinical audit is 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, process 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. Principles of Best Practice in Clinical Audit Goals of Clinical Audit Improve patient care Improve health outcomes Translate research into practice

Why do a clinical quality audit? Benefits all stakeholders in health care Monitor clinical performance Continuous improvement in the standards of patient care Used as a change management tool Allows for the best use of resources Overall improved satisfaction from consumers

5 The Audit Cycle Answers 3 key questions 1. What are you trying to accomplish? 2. What changes can be made to produce an improvement? 3. How will you know that such changes have produced an improvement?

6 Audit & feedback cycle Review of current practice AUDIT (Problem identification)

Modify if necessary Analyse findings FEEDBACK Set standards of care protocols (clinical indicators)

Improved practice Implementation Monitor practice AUDIT Problem Identification Focus on areas that there is perceived inadequacy

Look at research evidence Clinical governance Complaints New standards/guidelines are made available Setting Standards Evidence-based research Consensus-based standards

Gold standard Measurement Structure Criteria What is needed to implement the standard Process Criteria What needs to be done to implement the standard

Outcome Criteria What is the expected to be achieved by implementing the standard Patient Perspective and Input Satisfaction measures Experience measures Outcome measures

Clinical indicators Also called process indicators, performance indicators They define your standards of care by setting a specific and objective measure. They describe an element of clinical care Example: PEG insertion prior to head/neck cancer surgery Can be a measure of compliance only, or include

timeliness or other elements Auditable clinical indicators Make your clinical indicators auditable Retrospective audits - the information must routinely be in medical records Prospective audits - information collected on purpose built data sheets as you go (harder to set up) Write the clinical indicator carefully make sure you can

measure it. Auditable clinical indicators Define eligibility - the patients who will /will not be expected to get the care. Are there exceptions? For instance if patient admitted over a weekend do you expect the same timeliness of care? Define the compliance standards for eligible patients

(% compliance) Audit data What audit data will you collect? Keep it simple = manageable. What do you really need to know? What demographics are important? (often none)

Enable double checking if required How to sample Sample size? Often dont need many for an in-house quality audit. Consider the proportion of your patients (10 patients may be 20% of your annual patient population if n=50) Sample bias dont cherry pick. Consecutive admission is good and simple.

Data management Collect data onto specifically developed tables/ spread sheets Set it out in an order that makes auditing easier & time efficient Achieving Change Developing an action plan

Training System-wide change Behavioural change Reflection post-audit Clinical audit must be cyclical Sustainability of change Share your success story!

How can iCAHE help? ASPIRE The ASPIRE for quality is an evidence-based tool developed by the International Centre for Allied Health Evidence to evaluate clinical service performance in South Australian Local Health Networks. Lizarondo L, Grimmer K, Kumar S. Assisting allied health in performance evaluation: a systematic review. BMC health services research. 2014;14(1):572. http://www.unisa.edu.au/Research/Sansom-Institute-for-Health-Res

earch/Research/Allied-Health-Evidence/Quality-Care/ASPIRE-for-q uality / Acknowledgments We would like to recognise the contributions of Dr Julie Luker Ms Deb Kay

21 References 1. 2. 3. 4. Buckingham, R., J. Potter, and A. Wagg, Clinical Audit of Healthcare, in Pathy's Principles and

Practice of Geriatric Medicine. 2012, John Wiley & Sons, Ltd. p. 1673-1685. Johnston, G., et al., Reviewing audit: barriers and facilitating factors for effective clinical audit. Qual Health Care, 2000. 9(1): p. 23-36. Patel, S., Identifying best practice principles of audit in health care. Nurs Stand, 2010. 24(32): p. 40-8; quiz 49. Seddon, M. and J. Buchanan, Quality improvement in New Zealand healthcare. Part 3: achieving effective care through clinical audit. N Z Med J, 2006. 119(1239): p. U2108.

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