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The State of Clinical Audit

The State of Clinical Audit. Results of CASC’s Annual Survey, 2012. www.clinicalauditsupport.com. Familiarise you with the findings of the December 2012 CASC online survey (and show trends across 3 years of work). Aim. Why? How? When? Who? So what? What next?. Objectives. Why?.

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The State of Clinical Audit

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  1. The State of Clinical Audit Results of CASC’s Annual Survey, 2012 www.clinicalauditsupport.com

  2. Familiarise you with the findings of the December 2012 CASC online survey (and show trends across 3 years of work) Aim

  3. Why? • How? • When? • Who? • So what? • What next? Objectives

  4. Why?

  5. REINVIGORATION Why? – national direction

  6. CASC ran annual ‘2020’ national conferences in 2007, 2008 and 2009 • Short surveys given to all delegates • Focus on topical issues: - local/national audit - future of audit (hopes/concerns), etc. Why? – old CASC surveys

  7. Feedback from meetings • Comments on discussion boards, e.g. NCAF • Debates at our training sessions • Reflective comments via accredited course • Personal evidence, e.g. Tracy’s ex-audit team in North Staffs halved in size, PCAG closed, CASNET on ‘life support’ in 2010 Why? - CASC perceptions

  8. Why? – the auditors habit

  9. Established business by 2010 • Independent organisation • Good relations with target audience • Limited vested interested, e.g. CASC never involved in national audits Why? – CASC’s position

  10. How?

  11. Used ‘2020’ surveys as a starting point • Asked respected peers for input • Based survey on our personal beliefs: - no more than 10 minutes to complete - anonymity assured - headline results available within 2 weeks - full report to be transparent/inclusive and comprehensive How? – survey design

  12. How? – I.T. support

  13. E postcards sent out to CASC eNews list • Promoted via CASC eNews and website • Via NCAF and Clinical Audit Tools website • Alerted HQIP to cascade • Alerted NAGG to cascade to regional groups How? – gaining engagement

  14. When?

  15. Who?

  16. Response rate 182 158 137

  17. 63% clinical audit professionals • 21% clinical governance professionals • 10% clinicians with audit interest/duties • 6% other Who? – classification (2012)

  18. Audit and governance 92.3% 87.9%

  19. 47% acute care respondents in 2012 • Consistent with previous surveys • Experience in audit results often varied • For 2012: 37% 1-5 years, 32% 6-10, 16% 11-15 and 15% 16 years+ • Consistent with previous surveys Who? – other

  20. So what?

  21. Q: Do you still intend to work in CA/have responsibilities in 5 years time? 75.1% 68.8%

  22. 2012 result: Local clinical audits 86.9% National clinical audits 13.1% Q: In your opinion, which are more effective at improving patient care?

  23. The ‘rise’ of local audits 78.4% 84.1%

  24. 2012 result: Excellent 1% Good 35% Moderate 42% Poor 12% Very poor 11% Q: Overall, how would you rate the quality of NCA’s you have taken part in?

  25. NCA Trends

  26. 2012 result (in votes): Stroke* (SSNAP and SINAP) 20 MINAP 9 POHM 8 Falls and Bone Health 5 Dementia/Schizophrenia 3 Q: What do you consider to be the most effective NCA?

  27. Tracking positions over 3 years: Stroke* (SSNAP and SINAP) 1st – 1st – 1st MINAP 2nd – 2nd – 2nd POHM 4th – 6th – 3rd Falls and Bone Health 3rd – 3rd – 4th Dementia NP – J4th – J5th Schizophrenia NP – J6th – J5th Q: What do you consider to be the most effective NCA?

  28. ‘MINAP has been amazing’ ‘POHM-UK audits – they are excellent’ ‘National Sentinel Stroke Audit – do actually see improvements’ ‘Sentinel Stroke Audit. It is multidisciplinary with clear standards and has moved care forward’ ‘Diabetes National Audit very effective’ Feeling the love for NCA’s

  29. 2012 result (in votes): Heavy Menstrual Bleeding 11 Continence Care 4 Diabetes 3 MINAP 2 Q: What do you consider to be the least effective NCA?

  30. Tracking positions over 3 years: Heavy Menstrual Bleeding NP – 2nd – 1st Continence Care 1st – 1st – 2nd Falls and Bone Health 2nd – 3rd– NP Q: What do you consider to be the least effective NCA?

  31. ‘All are a waste of time and money. Results take forever to arrive’ ‘Lot of input for hardly any output’ ‘Rumble on year after year. Little feedback received or opportunity to implement change before re-audit’ ‘Continence Care Audit was awful and our Trust audit team agreed. Many NCA’s seem not to follow best practice in audit’ ‘The HMB audit is one of the worst pieces of audit I have seen’ Lacking in love for NCA’s

  32. Rated top 4 for mosteffective NCA across 2010 to 2012 • Rated top 3 for leasteffective NCA in 2010 and 2011 Falls and Bone Health NCA

  33. NCA’s have never been far off NAGCAE’s radar • Ditto NAGG • HQIP 2011 survey underlined ongoing issues: - results do not provide enough local detail - lack of support for change at local level - timetabling of data collection needs better co-ordination Focus on NCA’s

  34. 2012 result: NICE website 96% HQIP website 87% CASC website 79% Local/regional meetings 76% HQIP eBulletin 72% Q: Which of the following clinical audit resources do you use?

  35. 2011 result: HQIP website 80% CASC eNewsletter 79% HQIP eBulletin 78% NICE website 65% Local/regional meetings 63% Q: Which of the following do you use to keep up-to date with what is happening in the world of clinical audit?

  36. Changing the question clearly had an impact and over represented the use of NICE website by respondents • Question changed as we also asked respondents to rate resources they used • Discounting the NICE ‘blip’ in 2012 would mean the HQIP website rated most used resource in 2010, 11 and 12 2012 anomaly

  37. 2012 result: CASC website 4.21 HQIP website 4.18 Clinical Audit Tools website 4.17 Local/regional meetings 4.10 HQIP eBulletin 4.05 Results for rating CA resources* *(respondents used 5 point likert scale)

  38. IT tools usedto conduct audit • Approaches – cost savings/re-audit • Patient involvement • Resourcing Local focus - questions

  39. 2012 result: Excel 94% Access 34% Survey Monkey 24% Snap 19% Formic 19% SPSS 15% Q: How is clinical audit managed in your organisation? (e.g. data entry/analysis) *This was a ‘tick all that apply’ question

  40. Excel - undisputed king The monkey is climbing! Trends

  41. Q: To your knowledge or best approximation, what proportion of local audits initiated in your organisation result in a financial cost saving (after time spent conducting the audit project has also been accounted for) ?A: 15% did not reply

  42. 2012 result: 0-20% 71% 21-40% 20% 41-60% 9% 61-80% 1% 81%+ 0% Of those who replied

  43. 2012 result: 0-20% 32% 21-40% 28% 41-60% 26% 61-80% 9% 81%+ 5% Q: To your knowledge or best approximation, what proportion of local clinical audits in your organisation result in a re-audit being carried out?

  44. Re-audit rate (0-40% combined) 57.8% 57.6%

  45. Dr Suarez (Medical Director at Mid Staffs) ‘I think that there were a lot of people doing a lot of audits, some more effectively than others. What we didn’t have for some time was anybody in the clinical audit lead role pulling all this together, asking whether we had re-audited in several areas, whether we had a general purpose and sense of where we were going with clinical audit’

  46. Q: Over the last 12 months, how would you rate the level of patient involvement in clinical audits you have taken part in/facilitated? 59.4% 34.6%

  47. DH ‘Evolution of CA’ report stated patients should be directly involved in audit • Data from CA Barometer shows teams rate involving patients in audit No1 barrier (2nd is gaining senior staff interest in audit) • Lots of conversation but limited effective action and few examples of real success PPE = Painful, Problematic, Endeavour

  48. Q: Over the last 12 months, what change has there been in the way clinical audit is resourced in your organisation? 43.7% 17.0%

  49. Resourcing trends

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