PTU-078 Comprehensive mapping of quality standards (QSS) in gastroenterology (GI)

Abstract

Introduction Audit is a vital part of quality assurance and enables individuals and services to monitor and improve standards. We describe the experience of mapping and implementing a comprehensive GI audit programme. Methods Different GI QSs are published by the British Society of Gastroenterology, Joint Advisory Group on GI endoscopy (JAG), National Institute for Clinical Excellence and National Confidential Enquiry into Patient Outcome and Death. These were reviewed, where necessary rationalised (overlap/repetition), and grouped by subspecialty. An audit lead was appointed for each subspecialty. Existing QS audit activity was mapped and compared to the new QS template. Audit-leads then designed a comprehensive GI audit programme incorporating all QSs, which was integrated into a rolling calendar of audit activity. Results We identified 226 QSs related to GI. 101 were removed (clinical, surgical or community domains), leaving 125 GI relevant QSs (table1). 97/125 (77.6%) QSs were being actively audited (within 12 months), increasing to 109/125 (87.2%) over the past 5 years. Currently 55/125 can be audited electronically, 24/125 require notes review and 46/125 involve a combined approach. Compliance was poor for QSs needing notes review (49/70), but increased significantly with electronic audit data (51/55; p=0.001) (figure 1). QSs within pre-existing structured audit plans with allocated audit staff had greater compliance (83/93, 89.2%) in comparison to those without (14/32, 43.8%, p Conclusions The currently mandated audit of QSs is a significant burden, with overlap of published gastroenterology QSs and ambiguity in certain areas. The majority require some manual case-note review. Electronically audited QSs are more likely to be monitored. Audit activity is improved when clear audit plans exist. Audit wanes when compliance is not mandatory. Consensus between professional bodies is recommended to devise a practical and comprehensive list of GI standards without duplication. Designing an integrated planned rolling audit programme should improve compliance with national QSs. Ideally all data should be collected electronically and prospectively to validate and simplify the process. Increased mandatory submission of data to professional bodies may promote improved continuous audit activity.