Clinical Audit Project Research Articles

Improving quality is not simple: Results of a clinical audit project about patients with Community-Acquired Pneumonia (CAP)

Improving quality is not simple: Results of a clinical audit project about patients with Community-Acquired Pneumonia (CAP)

Clinical Audits in a Postgraduate General Practice Training Program: An Evaluation of 8 Years' Experience

BackgroundClinical audit can be of valuable assistance to any program which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at evaluating audits' effectiveness, valuable opportunities will be overlooked. Clinical audit projects are required as a part of the formative assessment of trainees in the Family Medicine Residency Program (FMRP) in Kuwait. This study was undertaken to draw a picture of trainees' understanding of the audit project with attention to the knowledge of audit theory and its educational significance and scrutinize the difficulties confronted during the experience.Methodology/Principal FindingsThe materials included the records of 133 audits carried out by trainees and 165 post course questionnaires carried out between 2004 and 2011. They were reviewed and analyzed. The majority of audit projects were performed on diabetic (44.4%) and hypertensive (38.3%) care. Regarding audits done on diabetic care, they were carried out to assess doctors' awareness about screening for smoking status (8.6%), microalbuminuria (19.3%), hemoglobin A1c (15.5%), retinopathy (10.3%), dyslipidemia (15.8%), peripheral neuropathy (8.8%), and other problems (21.7%). As for audits concerning hypertensive care, they were carried out to assess doctors' awareness about screening for smoking status (38.0%), obesity (26.0%), dyslipidemia (12.0%), microalbuminuria (10.0%) and other problems (14.0%). More than half the participants (68.48%) who attended the audit course stated that they ‘definitely agreed’ about understanding the meaning of clinical audit. Most of them (75.8%) ‘definitely agreed’ about realizing the importance of clinical audit in improving patients' care. About half (49.7%) of them ‘agreed’ that they can distinguish between ‘criteria’ and ‘standards’.ConclusionThe eight years of experience were beneficial. Trainees showed a good understanding of the idea behind auditing the services provided. They demonstrated their ability to improve the care given in health centers in which these projects were undertaken.

Audit of audit: review of a clinical audit programme in a teaching hospital intensive care unit

A comprehensive review of the clinical audit programme in a teaching hospital intensive care unit. A retrospective analysis of the clinical audit projects undertaken within the intensive care unit over the preceding 2 years and compared with published national guidelines for clinical audit. A 27-bedded teaching hospital intensive care unit in the UK. Each audit project was reviewed independently by two assessors. The following questions were assessed. 1. Were the projects true audits? 2. Were they prospective of retrospective? 3. Did the projects have input from appropriate members of the multidisciplinary team. 4. How many of the audit projects were re-audits? 5. Of the re-audits how many showed evidence of service improvement? each audit project was also scored against the Audit Project Assessment Tool produced by the UK Clinical Governance Support Team. Of the twenty five audit projects reviewed twenty two were considered to be true audits. All of the projects used only retrospective data. Audit projects were contributed from all sections of the multidisciplinary critical care team but there were few truly multidisciplinary projects. Four of the audit projects were re-audits, of these three showed service improvement and one showed deterioration. Of the twenty two true audit projects reviewed, eleven were classified as good quality projects using the Audit Project Assessment Tool. Despite the clinical audit programme being active and well supported, objective evidence of clinical governance benefit was lacking. The overall clinical audit programme has been revitalised by a series of improvements since undertaking this review and this approach is recommended to other organizations who are interested in improving their clinical audit performance.

Evaluation of the end user (dentist) experience of undertaking clinical audit in the post April 2001 general dental services (GDS) scheme

A mandatory scheme for clinical audit in the general dental services (GDS) was launched in April 2001. No evaluation of this mandatory scheme exists in the literature. This study provides an evaluation of this scheme. More recently a new dental contract was introduced in the general dental services (GDS) in April 2006. Responsibility for clinical audit activities was devolved to primary care trusts (PCTs) as part of their clinical governance remit. All GDPs within Essex were contacted by letter and invited to participate in the research. A qualitative research method was selected for this evaluation, utilising audio-taped semi-structured research interviews with eight general dental practitioners (GDPs) who had taken part in the GDS clinical audit scheme and who fitted the sampling criteria and strategy. The evaluation focused on dentists' experiences of the scheme. The main findings from the analysis of the GDS scheme data suggest that there is clear evidence of change following audit activities occurring within practices and for the benefit of patients. However, often it is the dentist only that undertakes a clinical audit project rather than the dental team, there is a lack of dissemination of project findings beyond the individual participating practices, very little useful feedback provided to participants who have completed a project and very limited use of formal re-auditing of a particular topic. This study provides evaluation of the GDS clinical audit scheme. Organisations who propose to undertake clinical audit activities in conjunction with dentistry in the future may benefit from incorporating and/or developing some findings from this evaluation into their project design and avoiding others.

New Principles of Best Practice in Clinical Audit

This book is a revision and reinterpretation of the classic text on clinical audit, Principles of Best Practice in Clinical Audit, which was first published in 2002. It is a truly practical guide to audit methodology. The book’s editor, Robin Burgess, is chief executive of the Healthcare Quality Improvement Partnership (HQIP), the organization responsible for supporting clinical audit in Great Britain. Robin is an enthusiastic advocate and this comes through in the accessible chapters that he has authored. The book is aimed at anyone who uses clinical audit or who is interested in it as a quality improvement methodology. While its main focus is clinical audit within the National Health Service, the text is equally applicable to occupational health practice both within and outside a health care setting. Do not be daunted by the length of the book. There are only 86 pages covering the four stages of clinical audit: preparation, measuring performance, implementing change and sustaining improvement. These chapters are very clear with short paragraphs and bullet pointed lists. The remaining pages are divided into eight appendices. The first of these provides particularly helpful guidance on the ethics of clinical audit and answers that age old question, what is the difference between research and audit and when do I need ethical approval? The introduction addresses important questions such as: what is clinical audit designed to do?, does clinical audit change practice? (it can) and should we audit process or outcome? And for me, two of the most important take home messages are: ‘clinical audit is a change process’ and ‘poorly conceived clinical audits . . . are a waste of everyone’s time and are not likely to result in any improvement in care’. This book touches on the philosophy, science and ethics of clinical audit as well as providing practical instructions for executing a clinical audit project. I think all occupational health clinicians, at whatever stage in their career, will find it a very useful text.

Estimation of economic consequences of GOLD guidelines adoption in the Italian clinical practice

Background: Chronic Obstructive Pulmonary Disease (COPD) affects about 4.5% of the Italian population, representing one of most burdensome public health problems. Literature data report an annual health care expenditure ranging between € 1,300 and € 4,500 per patient, of which drug costs are a limited share. In 1998 the WHO started GOLD program in order to ameliorate COPD patient management. As a part of his program, periodically updated guidelines are produced with the aim of defining an efficient diagnostic-therapeutic pathway managed by a multidisciplinary team and based on the optimization of the use of drugs and diagnostic tests and the reduction of exposure to risk factors.Objective: to estimate the economic consequences of GOLD guidelines adoption in the Italian clinical practice.Methods: a decision analytic model capable of calculating the impact on the National Health Service budget of an ameliorated adherence to GOLD guidelines (GOLD GL strategy), basing on the needed variations in health care strategies on a defined patient cohort treated with the current approach (CURRENT strategy). The simulation runs on a cohort representing Italian COPD patients over 45 years who transit through 5 Markov health states (4 GOLD stages and death), according to patient characteristics (age, gender, FEV1), with a time horizon of 3 years. Stage-specific drug consumption of the CURRENT strategy is based on data of 3,113 patients collected by three Health Local Units involved in a larger clinical audit project. The consumption of other health resources, i.e. medical visits and inpatient care, is estimated based on a multicentre observational Italian study. The GOLD GL strategy includes spirometry-based staging on the totality of the simulated patients, the development of a therapeutic strategy including the redefinition of pharmacological therapy based on guideline recommendations and experts opinion, and variation of other health resources consumption based on observational data. Costs of health care resources are calculated based on published micro-costing analysis and current prices and tariffs.Results: the model estimates an adjunctive cost of about 19 million of Euros with the GOLD GL strategy, just for the the spirometry-based restaging of about 40% of the over 1 million and 250 thousand prevalent Italian COPD patients. Furthermore, in the first year of the analysis, the redefinition of the best clinical management strategy for all patients would cost about 100 million Euros, which are to be added to the more than 320 million Euros associated with adaptation of the GOLD stage specific pharmacological therapy, consisting mainly in a higher usage of long-acting beta agonist/corticosteroid combinations, only partially offset by the lower prescription of corticosteroid alone. Based on Italian observational data, the consumption of other health care resources with the GOLD GL strategy is reduced by about 44%, reflected in an estimated cost saving of more than 850 millions of Euros. For the first analysis year, the net cost saving associated with full GOLD guideline adoption is estimated equal to 410 millions of Euros; this value decreases by 11% and 21% respectively in the second and third years.Conclusion: our model estimates that the adoption of GOLD guidelines in the Italian clinical practice is associated to an average cost saving of about 300 Euros per patient/year.

Evaluation of the End User (Dentist) Experience of Undertaking Clinical Audit in a PCT-Led NHS Modernisation Agency Pilot Scheme

A new dental contract was introduced in the National Health Service (NHS) General Dental Services (GDS) in April 2006. Responsibility for clinical audit activities was devolved to Primary Care Trusts (PCTs) as part of their clinical governance remit. In July 2003, an NHS Modernisation Agency pilot scheme for clinical audit was launched by Southend PCT. The aim of this study was to evaluate this scheme. A qualitative research method was used. It used audiotape recorded semi-structured research interviews with eight general dental practitioners (GDPs) who had taken part in the scheme. The evaluation focused on dentists' experiences of the scheme. Dentists appreciated the central PCT-based coordinator for the scheme and found that the streamlining of design, analysis and report writing within the audit projects enabled efficient use of time. The design by an outside agency appeared to add credibility to the scheme. Participants felt that comparability of data derived from clinical audit was enhanced by the scheme and could lead to comparison across PCT patch, regional or even national levels. The use of feedback mechanisms within the scheme was appreciated and thought to help produce maximum value from a clinical audit project. There was evidence of beneficial change occurring within practices and for patients. This study provided an evaluation of a particular clinical audit scheme, several aspects of which differed from the traditional GDS scheme. Organisations proposing to undertake clinical audit activities in conjunction with dentistry in the future may benefit from incorporating elements of this scheme into their project design.

Routine Use of Positive Oral Contrast Material Is Not Required for Oncology Patients Undergoing Follow-up Multidetector CT

The purpose of this retrospective medical audit was to evaluate the effect of discontinuing routine administration of oral contrast material to oncology patients undergoing follow-up multidetector computed tomography (CT) on reader evaluation of study adequacy. Analysis of 100 patients' experience of CT shows that positive oral contrast material was their least pleasant experience (P < .0001). Abandoning the routine use of positive oral contrast material for follow-up scans in general oncology patients undergoing multidetector CT, with section reconstruction thickness of 2.5 mm, was audited for 447 patents and included 5-13-month follow-up. The patient satisfaction study and clinical audit were performed according to local institutional audit guidelines. Since this was a clinical audit project, ethical approval was not required under UK National Health Service research governance arrangements. No patient needed to be recalled, no related diagnostic error has been reported, and follow-up CT, available in 285 of 447 cases (64%), revealed no error on the audited scan. We conclude that the routine use of positive oral contrast material is unnecessary for follow-up multidetector CT for general oncology indications.

Patient involvement in clinical audit at a primary care trust

This impact evaluation has been conducted to establish the effectiveness of involving patients in clinical audit and service improvement. Due to the national reconfiguration of primary care trusts (PCTs) where PCTs have been dramatically reduced, some trusts need to secure current structures and processes within the new PCT. Therefore a review of patient involvement in clinical audit and service improvement was carried out in order to continue this partnership work in the new PCT arrangements. In June 2003 a Commission for Health Improvement clinical governance review in Sheffield South West Primary Care Trust was conducted, highlighting patients' lack of involvement in developing and improving services within primary care. Based on these findings, the PCT proposed to create and train a panel of patients and carers to be actively involved in clinical audit and service improvement projects. In April 2004, a clinical audit patient panel (CAPP) was introduced, and an impact evaluation was carried out to establish the level of CAPP individual members' influence on a healthcare organisation, identifying patient involvement and partnership working.It would appear that the CAPP is managed in a structured process that ensures that it is supported, recognised and provided with robust training and information. The CAPP has demonstrated compliance with key national directives including the NHS Plan (2000), Section 11 of the Health and Social Care Act (2001) and the Kennedy Report (2001). Through effective communication and board recognition, the CAPP is a panel of patients who are encouraged and supported to be 'on the inside' of an organisation, able to assist the trust in developing and improving services within primary care. CAPP members have demonstrated this by implementing their knowledge and skills of quality improvement, clinical audit and most importantly by being a patient, carer or member of the public. The panel does not currently include a PCT member of staff. Challenges faced by the panel were around the change in culture towards actively involving patients and carers. Healthcare professionals and the public working together sharing information that is confidential and liable to cause concern at some time, for many, will result in a shift of culture. The CAPP has demonstrated that if recognised and managed effectively, patients and healthcare staff can succeed in effective partnership working.

Clinical effectiveness: a structured teaching approach for junior doctors

PurposeTo formulate an effective teaching prog ramme in the principles of clinical effectiveness for junior doctors, with simultaneous participation in a clinical audit project during their six‐month period of employment.Design/methodology/approachAccident and Emergency (A&amp;E) Senior House Officers (SHOs) were educated in the principles of clinical effectiveness through a structured five‐session approach whilst they concurrently performed their clinical audit project. Throughout the process the A&amp;E SHOs were supported by the Clinical Effectiveness Unit and the A&amp;E Consultant overseeing departmental audit.FindingsThe structured teaching programme resulted in a good understanding of the clinical effectiveness process amongst the A&amp;E SHOs, as demonstrated by their ability to perform a clinical audit project which ultimately improved practice.Research limitations/implicationsThis study has involved the construction and assessment of a teaching framework for junior doctors. The conclusions have been drawn on the basis of objective measures such as the completion of a clinical audit project which successfully improved practice. Thus, the publications of the findings may be considered in the category of a research paper. However, the authors accept that the assessment of a teaching programme's success and its portability to other departments or institutions can be highly subjective.Practical implicationsWith appropriate guidance and support, junior doctors are able to perform meaningful clinical effectiveness exercises at an early stage in their careers and within the constraints of short periods of employment. The structured teaching approach could be considered as a template which other institutions may wish to adopt to educate their own juniors.Originality/valueDespite the increasing importance of clinical audit in modern practice, the authors are not aware of any published teaching programmes which provide junior doctors with the necessary understanding of and skills required to take part in the clinical effectiveness process.

General dental practitioners' experiences of a collaborative clinical audit on antibiotic prescribing: a qualitative study

Objective To evaluate general dental practitioners' experiences of a multi-collaborative antibiotic prescribing audit. Design Qualitative analysis of compulsory post-audit group report data collection forms and individual practitioners' post-audit evaluation forms. Subjects Information was collected from 175 general dental practitioners in the North West of England who participated in the audit. Method The general dental practitioners were divided into groups of 8–10 to undertake the audit. Information from compulsory post-audit group reports was transcribed and analysed. The information was categorised into a number of areas including changes in practice, patients' expectations, training and quality of service. On completion of the audit individual practitioners were asked to complete an evaluation form on the audit process. Results 141 (80.5%) individual evaluation forms were returned. Over 90% of GDPs felt that the audit process was easily understood and the majority of the practitioners thought the audit was worthwhile. Approximately 69% of participants felt that the audit had helped to change their antibiotic prescribing practices. Analysis of the post-audit group report data collection forms revealed more than 100 statements. The most common areas were changes required in practice, patients' expectations, increased training and quality of service. Conclusion The collaborative clinical audit project was seen to be a worthwhile learning experience by the participating general dental practitioners. The audit encouraged GDPs to change their antibiotic prescribing practices and thereby improve patient care. GDPs also highlighted the need for continuing education in the prescribing of antibiotics.

Clinical audit on prescribing antibiotics

Objective To evaluate general dental practitioners' experiences of a multi-collaborative antibiotic prescribing audit. Design Qualitative analysis of compulsory post-audit group report data collection forms and individual practitioners' post-audit evaluation forms. Subjects Information was collected from 175 general dental practitioners in the North West of England who participated in the audit. Method The general dental practitioners were divided into groups of 8–10 to undertake the audit. Information from compulsory post-audit group reports was transcribed and analysed. The information was categorised into a number of areas including changes in practice, patients' expectations, training and quality of service. On completion of the audit individual practitioners were asked to complete an evaluation form on the audit process. Results 141 (80.5%) individual evaluation forms were returned. Over 90% of GDPs felt that the audit process was easily understood and the majority of the practitioners thought the audit was worthwhile. Approximately 69% of participants felt that the audit had helped to change their antibiotic prescribing practices. Analysis of the post-audit group report data collection forms revealed more than 100 statements. The most common areas were changes required in practice, patients' expectations, increased training and quality of service. Conclusion The collaborative clinical audit project was seen to be a worthwhile learning experience by the participating general dental practitioners. The audit encouraged GDPs to change their antibiotic prescribing practices and thereby improve patient care. GDPs also highlighted the need for continuing education in the prescribing of antibiotics.

General dental practitioners' experiences of a collaborative clinical audit on antibiotic prescribing: a qualitative study.

To evaluate general dental practitioners' experiences of a multi-collaborative antibiotic prescribing audit. Qualitative analysis of compulsory post-audit group report data collection forms and individual practitioners' post-audit evaluation forms. Information was collected from 175 general dental practitioners in the North West of England who participated in the audit. The general dental practitioners were divided into groups of 8-10 to undertake the audit. Information from compulsory post-audit group reports was transcribed and analysed. The information was categorised into a number of areas including changes in practice, patients' expectations, training and quality of service. On completion of the audit individual practitioners were asked to complete an evaluation form on the audit process. 141 (80.5%) individual evaluation forms were returned. Over 90% of GDPs felt that the audit process was easily understood and the majority of the practitioners thought the audit was worthwhile. Approximately 69% of participants felt that the audit had helped to change their antibiotic prescribing practices. Analysis of the post-audit group report data collection forms revealed more than 100 statements. The most common areas were changes required in practice, patients' expectations, increased training and quality of service. The collaborative clinical audit project was seen to be a worthwhile learning experience by the participating general dental practitioners. The audit encouraged GDPs to change their antibiotic prescribing practices and thereby improve patient care. GDPs also highlighted the need for continuing education in the prescribing of antibiotics.

Improving the Care of People with Learning Disabilities. Clinical Audit Project Examples Kirsty MacLean Steel, Claire Palmer, Gaskell: London. 2001. 45 pp. £12.00 (pb). ISBN: 1-901242-40-4

Improving the Care of People with Learning Disabilities. Clinical Audit Project Examples Kirsty MacLean Steel, Claire Palmer, Gaskell: London. 2001. 45 pp. £12.00 (pb). ISBN: 1-901242-40-4 - Volume 26 Issue 6

Completing the audit cycle: the outcomes of audits in mental health services.

To assess how far those UK National Health Service mental health settings that tested, and prior to publication, used the Newcastle Clinical Audit Toolkit for Mental Health (NCAT) completed the audit cycle. Twelve clinical audit project reports, each focused on one of the five modules in the NCAT, from four rounds of activity over a 2-year period; clinical and managerial staff in the settings where audit projects had taken place. Interviews with audit project team members about the recommendations of the 12 audit project reports and about contextual issues; all projects had reported at least 2 years previously. In analysing the audit project outcomes, five categories of inaction were discernible and five further categories were needed to describe varying states of progress. It was necessary to discriminate between actions attributed to the NCAT audit projects and actions attributed mainly to other initiatives. In total, 26.4% of audit recommendations were still under discussion or in progress. A relatively low proportion of recommendations from audit report findings (34.7%) had been implemented, and these were divided almost equally between recommendations attributed to the NCAT projects (38) and those attributed to other initiatives in the organization (37). Investigation of the medium-term outcomes of clinical audit projects has provided an insight into what might usefully be termed the process of completing the audit cycle. The time-scales required to reach the point at which action is deemed to have been implemented or not may be as long as 3 years. Conceptualizing the action stage of the cycle as a single discrete event fails to do justice to the complexity of the process, and attributing the implementation of change in clinical settings to single causes such as individual audit projects is problematic.

An audit into homeless families in temporary accommodation.

This article describes a clinical audit project undertaken in a number of hostels providing temporary housing for homeless families and individuals in Hinckley, Leicestershire. The audit, carried out over a 6-week period, aimed to collect information about the health and social needs of the residents in the hostels to determine whether an on-site dedicated health visiting service would be of any benefit to them. Family members housed in three council-run hostels were interviewed and a detailed questionnaire was completed. This was used to gather information about the facilities in the hostels, the nutritional and mental status and health and social needs of the residents, the uptake of childhood immunizations and child health surveillance. It also provided information about the resident families' contact with their family health visitor. Families were living in cramped conditions with shared facilities and no safe play areas for their children. The audit clearly demonstrated that the residents living in the hostels had a range of health problems similar to those described in the literature about the homeless. As a result of the audit, a number of recommendations were made which are discussed in this article.

Improving the Healthcare of People with Learning Disabilities: Clinical Audit Project Examples

Journal of Intellectual Disability ResearchVolume 44, Issue 6 p. 700-701 Improving the Healthcare of People with Learning Disabilities: Clinical Audit Project Examples Kirsty MacLean Steel & Claire PalmerGaskell Publications Department, Royal College of Psychiatrists, London. 1999 45 pp., £12.50 (pbk). ISBN 19012242 40 4. David Brooks, David BrooksSearch for more papers by this author David Brooks, David BrooksSearch for more papers by this author First published: 18 July 2008 https://doi.org/10.1111/j.1365-2788.2000.0309b.xRead the full textAbout ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume44, Issue62000Pages 700-701 RelatedInformation

Measuring the quality of clinical audit projects.

The aim of the study was to develop and pilot a scale measuring the quality of audit projects through audit project reports. Statements about clinical audit projects were selected from existing instruments assessing the quality of clinical audit projects to form a Likert scale. Audit facilitators based in Scottish health boards and trusts piloted the scale. The participants were known to have over 2 years of experience of supporting clinical audit. The response at first test was 11 of 14 and at the second test 27 of 46. Audit facilitators tested the draft scale by expressing their strength of agreement or disagreement with each statement for three reports. Validity and reliability were assessed by test - re-test, item - total, and total - global indicator correlation. Of the 20 statements, 15 had satisfactory correlation with scale totals. Scale totals had good correlation with global indicators. Test re-test correlation was modest. The wide range of responses means further research is needed to measure the consistency of audit facilitators' interpretations, perhaps comparing a trained group with an untrained group. There may be a need for a separate scale for reaudits. Educational impact is distinct from project impact generally. It may be more meaningful to treat the selection of projects and aims, methodology and impact separately as subscales and take a project profiling approach rather than attempting to produce a global quality index.

It ain't what you say.... legibility and clarity of treatment records.

The content of treatment records is irrelevant if it cannot be understood. This is a report of a clinical audit project that aimed to assess the readability of records, and set standards to be maintained throughout the practice for handwriting and use of abbreviations.

Improving the care of elderly people with mental health problems: clinical audit project examples

Kirsty MacLean Steel and Claire Palmer London: Gaskell, 1999 ISBN 1 901242 38 2 pp. 65 $52.95Clinical audit provides a tool for evaluating the outcomes of services by measuring adherence to simple ...