Clinical AuditSession 2 7th March 2016 USSKAR Practice and Communication of Science Dr Viv RolfeBSc PhD (intestinal physiology) Associate Head of Department of BBAS National Teaching Fellow Principal Fellow of the Higher Education Academy
Learning Outcomes • By the end of these sessions you will understand: • What clinical governance and clinical audit is. • Why they are important and the cultural challenges facing the NHS and other large organisations. • What is audit and what is research? • Go and perform your own mini-audit! (optional) • The audit cycle. • How audit is important in medicine and the growing professions around clinical auditor. • Some audit case studies and the cycle of improvement.
Timeline of Audit Development 1984-1995 Bristol medical and 2005 – 2007 Bristol care atrocities (plus others e.g. Beverley Allitt and Harold Shipman serial killers) 1989 “Working for Patients” NHS White Paper (policy document proposing legislation) 1993 Move from the term “medical audit” to “clinical audit” 1998 Scally and Donaldson define clinical governance 2001 “Learning from Bristol review of medical care”. Public inquiry 2012 “Winterbourne View Hospital review of social care”. Report 2012 “Health and Social Care” Act (law) 2015 National Institute for Health and Care Excellence (NICE) Parliament Glossary (2016).
Care Quality Commissionhttp://www.cqc.org.uk/content/clinical-audits-measure-success Monitor Regulatorhttps://www.gov.uk/government/organisations/monitor NHS Litigation Authorityhttp://www.nhsla.com/Pages/Home.aspx
EXAMPLE A2: CLINICAL AUDIT OF ACCIDENT AND EMERGENCY PRESENTATION AND ADMISSION OF CHILDREN WHO MISUSE DRUGS AND ALCOHOL • Literature review • Levels of teenage alcohol/drugs abuse has increased in the UK and globally. • We don’t know how many A&E admissions are related to this, or whether children are receiving the right services. http://www.rcpsych.ac.uk/pdf/clinauditchap3.pdf
EXAMPLE A2: AIMS • To establish the incidence of casualty presentations and admissions related to drug and alcohol misuse; and • To examine whether young people misusing drugs and alcohol were being referred appropriately by staff for further psychosocial intervention. http://www.rcpsych.ac.uk/pdf/clinauditchap3.pdf
EXAMPLE A2: STANDARDS • This audit was used to COMPILE new standards. • 1. whether reference to drugs or alcohol was present or absent in the casualty notes • 2. whether in the admission case notes of children admitted with alcohol intoxication there had been referral to social work, child psychiatry http://www.rcpsych.ac.uk/pdf/clinauditchap3.pdf
EXAMPLE A2: METHODS/RESULTS • RETROSPECTIVE AUDIT. • Casualty notes of one week’s attendance at A&E, of 11–15 year olds (n= 73). • Case notes of one year’s admissions of under-16s with alcohol intoxication (n=10). • RESULTS • In the one-week sample (n=73) there was no reference to drugs or alcohol in any of the cases. • Of the cases (n=10) the notes were unavailable (n=1), definite / possible referrals (n=6) or no referrals (n=3). http://www.rcpsych.ac.uk/pdf/clinauditchap3.pdf
EXAMPLE A2: FEEDBACK AND CHANGE • Findings discussed with a range of hospital services. • A process for gathering data and referring intoxicated children was agreed with A&E staff. • All agreed the audit should be completed yearly. http://www.rcpsych.ac.uk/pdf/clinauditchap3.pdf
Ethical Approval? • Decide if your project is research or audit? • Is it improving a service or generating new knowledge? • Discuss with your supervisors and NHS R&D unit (research and development) whether NHS ethics is required – this can vary from trust to trust. • Even if you don’t need ethics – the principles apply! (UHBristol NHS Trust Report).
. There were no standards for evaluating performance. There was confusion throughout the NHS as to who was responsible for monitoring the quality of care. It is an account of a hospital where there was a ‘club culture’; an imbalance of power, with too much control in the hands of a few individuals. “Learning from Bristol” 2001.
Listening / Viewing • BBC Radio 4 (2015). From the Cockpit to the Operating Theatre. Available:http://www.bbc.co.uk/programmes/b05y16mv • Video by Libor Hurt Medical Student: https://www.youtube.com/watch?v=CbeN8ztcIb8 • Video by Talha Haroon Clinical Auditor:https://www.youtube.com/watch?v=SF_helzrhLc
Reading • Royal College of Psychiatrists (n.d). Examples of clinical audits. Available: http://www.rcpsych.ac.uk/pdf/clinauditchap3.pdf • University Hospitals Bristol NHS Trust (n.d.). How To: Apply Ethics to Clinical Audit. Available: http://www.uhbristol.nhs.uk/files/nhs-ubht/10%20How%20To%20Ethics%20v3.pdf
Learning Outcomes • We have explored: • What clinical governance and clinical audit is. • Why they are important and the cultural challenges facing the NHS and other large organisations. • What is audit and what is research? • Go and perform your own mini-audit! (optional) • The audit cycle. • How audit is important in medicine and the growing professions around clinical auditor. • Some audit case studies and the cycle of improvement.
Clinical Audit USSKAR Practice and Communication of Science Dr Viv RolfeBSc @vivienrolfe