Copyright © Healthcare Quality Quest, 2013. Proposed standards for a national clinical audit —...
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Transcript of Copyright © Healthcare Quality Quest, 2013. Proposed standards for a national clinical audit —...
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