Copyright © Healthcare Quality Quest, 2013. Proposed standards for a national clinical audit — How we got involved and what we have learned.

Copyright © Healthcare Quality Quest, 2013

Proposed standards for a national clinical audit — How we got involved and what we have learned

• • • • Method and problems encountered

Background• • • •

Proposed standards• • • •

• • • • Applying the standards — lessons learned

The way forward• • • •

• • • • Method and problems encountered

Background• • • •

Proposed standards• • • •

• • • • Applying the standards — lessons learned

The way forward• • • •

We aim to help healthcare organizationsto improve the quality of patient care

Teach clinical audit process — over 30,000 clinical staff and over 1000 clinical audit facilitators

Carry out or supervise a number of large-scale clinical audits, usually technically challenging

Teach clinical audit process to clinicians outside the UK — 8 countries

Background — HQQ

Sold over 2500 copies of book for clinicians

Background

HQQ was asked to evaluate a national clinical audit

HQQ needed an objective basis for the evaluation

There were no published standards internationally for a national clinical audit or equivalent activity

We needed to develop the standards in order to do the job of evaluating the national clinical audit

• • • • Method and problems encountered

Background• • • •

Proposed standards• • • •

• • • • Applying the standards — lessons learned

The way forward• • • •

Method

Searchstrategy

Literature databasesWebsitesJournalsProfessional organizationsSearch engines

Included Any document that described an expectation related to the design or conduct of a national clinical audit

Sources screened and abstracted by one reviewer and validated by another

Limitations Much literature about local clinical auditsSome descriptions not available

Problems encountered

Finding ‘evidence’ of good practice — Often deeply embedded in the description of a project; not easily accessible

Language — Many different terms used in different countries

Meaning — Clinical audit as large-scale data collection and collation versus quality improvement

Little crossover with large-scale quality improvement studies — Much evidence was in the context of a national or large-scale quality improvement study

Small benefits of knowing American and international language and practices

Recognizing terms used in other countries

National clinical audits

National outcomes studies

National or international quality indicators measurement

Activities included

National performance indicator monitoring

National quality improvement studies

Registries

• • • • Method and problems encountered

Background• • • •

Proposed standards• • • •

• • • • Applying the standards — lessons learned

The way forward• • • •

Proposed standards for a national clinical audit — Structure

Ethical basis The subject has an ethically based justification

Governance There is continuous and effective governance

Stakeholder involvement

All key stakeholders are actively involved, including patients

Resources Resources allow for appropriate, valid and reliable measurement and proactive facilitation of improvement

Roles and responsibilities and project plan

Roles and responsibilities at national and local levels are definedThere is a published project plan for all aspects of the audit

Proposed standards for a national clinical audit — Process

Recruitment The audit is continuously proactive in recruitment

Improvement objectives

The stated aims reflect an intention to drive improvement in quality

Population or sample

The population or sample is suitable for drawing valid conclusions and minimizing bias

Data collection strategy

The data collection strategy is suitable for the stated objectives

Quality-of-care measures

Measures used meet criteria established by the governance board and are capable of producing valid and reliable data

Proposed standards for a national clinical audit — Process

Data elements and data sources

Data permit judging compliance with quality-of-care measures but do not place a data collection burden

Data collection protocol

The protocol describes in detail all aspects of data collection and analysis

Protection of patient identity

The audit keeps patient identity protected in all stages

Identification of ethics issues

Any ethics issues are recognized and handled

Training and support for data collectors

Data collectors are trained and supported to provide complete, accurate, reliable and timely data

Proposed standards for a national clinical audit — Process

Pilot testing The entire design, process and tools are pilot tested

Reliability testing

Reliability of data collected or acquired is tested

Data linkages Links to any electronic record systems are secure

Data quality management and assurance

Data are quality assured and analysed appropriately

Preliminary data and peer review

Data are available on a timely basis for local peer review

Proposed standards for a national clinical audit — Process

Identification of good practice and shortcomings

Good practice and shortcomings in quality of patient care are explicitly identified

Analysis of causes of shortcomings

There is support for the analysis of causes of shortcomings in quality

Facilitation of improvements

There is proactive facilitation of improvements in the quality of patient care

Reports Reports are complete, timely and useful

Communication There is communication with all stakeholders throughout all stages

Proposed Standards for a national clinical audit — Outcomes

Level of participation

A target for participation is set and met

Timeliness of preliminary reports

Preliminary data are available for local validation and peer review within weeks

Timeliness of complete reports

Final reports are available within weeks from the validation stage deadline

Evidence of improvements

Improvements in patient care are sufficient to justify continuation

Reliability of data

Data are >90% reliable

• • • • Method and problems encountered

Background• • • •

Proposed standards• • • •

• • • • Applying the standards — lessons learned

The way forward• • • •

Applying the standards — lessons learned

A national clinical audit is like a super tanker —it takes a long time to change direction

With good operational definitions — assessment was straightforward

Room for improvement in the national audit we evaluated — agreement on our judgements and warm reception from all concerned

• • • • Method and problems encountered

Background• • • •

Proposed standards• • • •

• • • • Applying the standards — lessons learned

The way forward• • • •

The way forward

Publication — as a result of strong encouragement to share the work we did

Application — The Standards are being pilot tested for a new national clinical audit project in Australia

Interest from other countries — Representatives of Ministries of Health in 3 countries have indicated interest in national clinical audits and using the proposed standards as a basis for planning

Copyright © Healthcare Quality Quest, 2013

www.hqq.co.uk