Clinical Audit, Research or Service Evaluation Flashcards
What is a clinical audit?
“a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change”
What is research?
“the attempt to derive generalisable new knowledge by addressing clearly defined questions with systematic and rigorous methods”
What is a service evaluation?
- “a review process undertaken to define or judge a current service with the intention of benefiting those who use it:
- Used to inform local practice
- May result ins service redesign
Give some examples of service evaluation questions
- Does the service achieve its objectives?
- How?
- What are the costs?
- Components: Structure, process, outcome
- Does the service (still) meet the patient’s needs?
- Examples:
- What are the patient experiences of attending a community pulmonary rehabilitation service?
- What are the waiting times for patients attending A&E department in XXX hospital
Give some examples of clinical audit questions
- Does this service reach a predetermined standard?
- What proportion of patients presenting to A&E are seen within 4 hours?
- What proportion of patients presenting with an STI are tested for HIV: compliance with national guidance?
- What proportion of patients with diabetes have a 6-month review by their GP or practice nurse?
Give some examples of research questions
- How do patient outcomes compare between this service (or treatment) and an alternative? Quantitative Research (hypothesis test)
- Example: What is the impact of a nurse-led dermatology clinic in primary care on the quality of life of children with eczema?
- Parts to a (quantitative) research question: PICO
- Patient/Intervention/Comparison/Outcome
- Example: What are the concerns of women being recalled for a repeat cervical smear? … Qualitative Research (no stats)
Describe the overlap between research and audit
- Research findings can identify areas for audit
- Audit can be the final stage of a research project
- Audit can help with dissemination of research findings
- Audit can identify gaps in research evidence………
What are the common elements of research and audit?
- Question-driven:
- Research: what should we be doing
- Audit: are we doing it right?
- Professionally led
- Influence on clinical practice
- Formal data collection – use of a proforma
- Can involve service users
- Methodological rigour
- Data analysis / interpretation
- Publishable??
What are the two main types of audit?
- Retrospective – notes review (beware missing data)
- Prospective – ongoing data collection (beware the “Hawthorne effect”)
What are the main methods used in an audit?
- Identify a topic / problem
- Identify local resources (? local audit dept)
- Choose the standard, create the audit proforma
- Define the sample
- Collect data (? do a pilot)
- Compare data with the standard
- Develop and implement change
- Re-audit
What are the main criteria for choosing a topic?
- Is the topic of high cost, high volume, or risk to staff or users?
- Is there evidence of a serious quality problem, for example patient complaints or high complication rates?
- Is evidence available to inform standards, for example systematic reviews or national clinical guidelines?
- Is the problem amenable to change?
- Is the topic a priority?
- for the organisation?
- for a national policy initiative?
- Is there potential for involvement in a national audit project?
What are the main criteria for chosing a standard?
- Agree the standard (minimal, ideal or optimal)
- Minimal: lowest acceptable level of performance
- Ideal: the care possible under ideal conditions (e.g. 100% survival ???) elusive!
- Optimal: realistic under normal conditions of practice (somewhere between minimal and ideal)
What are major sources of evidence used for choosing a standard?
o National guidelines (e.g. NICE, SIGN)
o Cochrane database of systematic reviews
o MEDLINE, PubMed, EMBASE (check with NHS library)
What are the elements involved in selecting a sample?
- Inclusion criteria
- Exclusion criteria (e.g. comorbidities)
- Size of sample: power calculations
- Estimated percentage (P)
- Standard error (SE) of percentage = √ [P (100 – P) / n] where ‘n’ = sample size
- SE is a measure of the error of your estimate
- Small ‘n’→ large error, Large ‘n’ → smaller error
- SE used to derive a 95% confidence interval (95%CI)
- 95%CI is an interval in which we are 95% confident that the TRUE percentage lies
Give the function of an audit
Assesses activity against an agreed standard of best practice
