gloucestershire pccag clinical audit and the audit cycle
TRANSCRIPT
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Gloucestershire PCCAG
Clinical Audit and the Audit Cycle
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Gloucestershire PCCAG
What we are going to cover today
• The audit cycle
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Gloucestershire PCCAG
What we are going to cover today
• The audit cycle
• Criteria and standards
![Page 4: Gloucestershire PCCAG Clinical Audit and the Audit Cycle](https://reader031.vdocuments.net/reader031/viewer/2022012919/56649f1d5503460f94c3429c/html5/thumbnails/4.jpg)
Gloucestershire PCCAG
What we are going to cover today
• The audit cycle
• Criteria and standards
• Structure, process and outcome
![Page 5: Gloucestershire PCCAG Clinical Audit and the Audit Cycle](https://reader031.vdocuments.net/reader031/viewer/2022012919/56649f1d5503460f94c3429c/html5/thumbnails/5.jpg)
Gloucestershire PCCAG
What we are going to cover today
• The audit cycle
• Criteria and standards
• Structure, process and outcome
• An audit example
![Page 6: Gloucestershire PCCAG Clinical Audit and the Audit Cycle](https://reader031.vdocuments.net/reader031/viewer/2022012919/56649f1d5503460f94c3429c/html5/thumbnails/6.jpg)
Gloucestershire PCCAG
What we are going to cover today
• The audit cycle
• Criteria and standards
• Structure, process and outcome
• An audit example
• Problems with audit
![Page 7: Gloucestershire PCCAG Clinical Audit and the Audit Cycle](https://reader031.vdocuments.net/reader031/viewer/2022012919/56649f1d5503460f94c3429c/html5/thumbnails/7.jpg)
Gloucestershire PCCAG
What we are going to cover today
• The audit cycle
• Criteria and standards
• Structure, process and outcome
• An audit example
• Problems with audit
• How audit fits into ‘Clinical Governance’
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Gloucestershire PCCAG
A definition of audit
“The systematic critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources and the resulting outcome and quality of life for the patient”
Working for Patients 1989
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Gloucestershire PCCAG
Reactions to audit
• Enthusiasm
• Cynicism
• Obligation
• Doubt
• Exhaustion
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Gloucestershire PCCAG
Types of audit
• Managerial
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Gloucestershire PCCAG
Types of audit
• Managerial
• Financial
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Gloucestershire PCCAG
Types of audit
• Managerial
• Financial
• Clinical
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Gloucestershire PCCAG
Types of audit
• Managerial
• Financial
• Clinical Multi-disciplinary
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Gloucestershire PCCAG
Types of audit
• Managerial
• Financial
• Clinical Multi-disciplinary
Cross boundary
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Gloucestershire PCCAG
Types of audit
• Managerial
• Financial
• Clinical Multi-disciplinary
Cross boundary
Cohort based
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Gloucestershire PCCAG
Types of audit
• Managerial
• Financial
• Clinical Multi-disciplinary
Cross boundary
Cohort based
Comparative
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Gloucestershire PCCAG
Types of audit
• Managerial
• Financial
• Clinical Multi-disciplinary
Cross boundary
Cohort based
Comparative
Significant event based
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Gloucestershire PCCAG
Effective audit
• An educational activity
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Gloucestershire PCCAG
Effective audit
• An educational activity
• Promotes understanding
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Gloucestershire PCCAG
Effective audit
• An educational activity
• Promotes understanding
• Resource effective
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Gloucestershire PCCAG
Effective audit
• An educational activity
• Promotes understanding
• Resource effective
• Raises standards
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Gloucestershire PCCAG
Effective audit
• An educational activity
• Promotes understanding
• Resource effective
• Raises standards
• Promotes change
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Gloucestershire PCCAG
Effective audit
• An educational activity
• Promotes understanding
• Resource effective
• Raises standards
• Promotes change
• Source of information
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Gloucestershire PCCAG
Effective audit
• An educational activity
• Promotes understanding
• Resource effective
• Raises standards
• Promotes change
• Source of information
• Peer led
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Gloucestershire PCCAG
Effective audit• An educational activity• Promotes understanding• Resource effective• Raises standards• Promotes change• Source of information• Peer led• Involves patients
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Gloucestershire PCCAG
The audit cycleProblem or objective identified
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Gloucestershire PCCAG
The audit cycleProblem or objective identified
Criteria agreed and standards set
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Gloucestershire PCCAG
The audit cycleProblem or objective identified
Criteria agreed and standards set
Audit (Data collected)
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Gloucestershire PCCAG
The audit cycleProblem or objective identified
Criteria agreed and standards set
Audit (Data collected)
Identify areas for improvement
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Gloucestershire PCCAG
The audit cycleProblem or objective identified
Criteria agreed and standards set
Audit (Data collected)
Identify areas for improvement
Make necessary changes
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Gloucestershire PCCAG
The audit cycleProblem or objective identified
Criteria agreed and standards set
Audit (Data collected)
Identify areas for improvement
Make necessary changes
Re-audit
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Gloucestershire PCCAG
The audit cycleProblem or objective identified
Criteria agreed and standards set
Audit (Data collected)
Identify areas for improvement
Make necessary changes
Re-audit
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Gloucestershire PCCAG
Another way of expressing the audit cycle
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Gloucestershire PCCAG
Another way of expressing the audit cycle
• Determine which aspects of current work are to be considered
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Gloucestershire PCCAG
Another way of expressing the audit cycle
• Determine which aspects of current work are to be considered
• Describe and measure present performance
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Gloucestershire PCCAG
Another way of expressing the audit cycle
• Determine which aspects of current work are to be considered
• Describe and measure present performance• Develop explicit standards
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Gloucestershire PCCAG
Another way of expressing the audit cycle
• Determine which aspects of current work are to be considered
• Describe and measure present performance• Develop explicit standards• Decide what needs to be changed
![Page 38: Gloucestershire PCCAG Clinical Audit and the Audit Cycle](https://reader031.vdocuments.net/reader031/viewer/2022012919/56649f1d5503460f94c3429c/html5/thumbnails/38.jpg)
Gloucestershire PCCAG
Another way of expressing the audit cycle
• Determine which aspects of current work are to be considered
• Describe and measure present performance• Develop explicit standards• Decide what needs to be changed• Negotiate change
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Gloucestershire PCCAG
Another way of expressing the audit cycle
• Determine which aspects of current work are to be considered
• Describe and measure present performance• Develop explicit standards• Decide what needs to be changed• Negotiate change• Mobilise resources for change
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Gloucestershire PCCAG
Another way of expressing the audit cycle
• Determine which aspects of current work are to be considered
• Describe and measure present performance• Develop explicit standards• Decide what needs to be changed• Negotiate change• Mobilise resources for change• Review and renew the process
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Gloucestershire PCCAG
Criteria and standards
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Gloucestershire PCCAG
Criteria and standards
• Criteria are those aspects of care that you wish to examine
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Gloucestershire PCCAG
Criteria and standards
• Criteria are those aspects of care that you wish to examine
• Standards are the pre-stated or implicit levels of success that you wish to achieve
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Gloucestershire PCCAG
Structure, process and outcome
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Gloucestershire PCCAG
Structure, process and outcome
• Structure refers to resources you have available (including current knowledge, skills and attitudes)
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Gloucestershire PCCAG
Structure, process and outcome
• Structure refers to resources you have available (including current knowledge, skills and attitudes)
• Process refers to what you actually do, e.g. a protocol
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Gloucestershire PCCAG
Structure, process and outcome
• Structure refers to resources you have available (including current knowledge, skills and attitudes)
• Process refers to what you actually do, e.g. a protocol
• Outcome refers to the health benefits, cost effectiveness or patient satisfaction
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Gloucestershire PCCAG
The great coffee audit
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Gloucestershire PCCAG
The great coffee audit
Problem The doctors feel that their coffee isn’t hot enough after slogging through morning surgery
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Gloucestershire PCCAG
The great coffee audit
Problem
Criteria
The doctors feel that their coffee isn’t hot enough after slogging through morning surgery
The coffee shall be hot and satisfying to the hard pressed docs
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Gloucestershire PCCAG
The great coffee audit
Problem
Criteria
Standards
The doctors feel that their coffee isn’t hot enough after slogging through morning surgery
The coffee shall be hot and satisfying to the hard pressed docs
The coffee shall be served at a temperature of 85-90C on 80% of occasions and there will be 90% satisfaction level expressed by the docs
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Gloucestershire PCCAG
The great coffee audit
Methods The junior receptionist shall check the temperature of the coffee daily for two weeks and circulate a questionnaire to the partners asking them to score a coffee satisfaction level between 1 and 10. The practice manager shall visit Tesco’s and interview the manager about the availability, costs, quality and sell-by dates of the coffee brands available
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Gloucestershire PCCAG
The great coffee audit
Review After a rather tense audit team meeting it was found that the coffee temperature fell below 37C on at least 33% of occasions and reached the standard on only 10% of occasions. The doctors scored the coffee at an average 3/10 and two expressed it undrinkable. The practice manager reported the results of her Tesco’s visit.
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Gloucestershire PCCAG
The great coffee audit
Change It was agreed to replace the aged coffee maker ( after agreeing suitable redundancy terms for the senior receptionist) with a shiny new machine from Argos. As an additional ‘quality initiative’, cream cakes would be served after surgery. The coffee contract would be switched from the corner shop to Tesco PLC Trust
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Gloucestershire PCCAG
The great coffee audit
Re-audit For a further two weeks it was agreed to measure the coffee temperature and re-circulate the questionnaire. It was gratifying to find 100% correlation with agreed standards with the exception of one partner who didn’t like coffee anyway.
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Gloucestershire PCCAG
The great coffee audit
Re-audit
Future audit
For a further two weeks it was agreed to measure the coffee temperature and re-circulate the questionnaire. It was gratifying to find 100% correlation with agreed standards with the exception of one partner who didn’t like coffee anyway.
• Cost implications of standard maintenance• Cholesterol assays for partners
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Gloucestershire PCCAG
Contents of an audit
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Gloucestershire PCCAG
Contents of an audit
• Background
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Gloucestershire PCCAG
Contents of an audit
• Background
• Literature review
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Gloucestershire PCCAG
Contents of an audit
• Background
• Literature review
• Criteria and standards
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Gloucestershire PCCAG
Contents of an audit
• Background
• Literature review
• Criteria and standards
• Methods or protocol
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Gloucestershire PCCAG
Contents of an audit
• Background
• Literature review
• Criteria and standards
• Methods or protocol
• Results
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Gloucestershire PCCAG
Contents of an audit
• Background
• Literature review
• Criteria and standards
• Methods or protocol
• Results
• Recommendations for change
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Gloucestershire PCCAG
Contents of an audit
• Background
• Literature review
• Criteria and standards
• Methods or protocol
• Results
• Recommendations for change
• Recommendations for further audit
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Gloucestershire PCCAG
Why audit
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Gloucestershire PCCAG
Why audit
• Useful clinically
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Gloucestershire PCCAG
Why audit
• Useful clinically
• Encourages teamwork
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Gloucestershire PCCAG
Why audit
• Useful clinically
• Encourages teamwork
• Improves patient care
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Gloucestershire PCCAG
Why audit
• Useful clinically
• Encourages teamwork
• Improves patient care
• Financial benefits (sometimes!)
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Gloucestershire PCCAG
Why audit
• Useful clinically
• Encourages teamwork
• Improves patient care
• Financial benefits (sometimes!)
• Becoming contracturally an obligation with the arrival of PCG’s
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Gloucestershire PCCAG
Problems with audit
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Gloucestershire PCCAG
Problems with audit
• Audit and research
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Gloucestershire PCCAG
Problems with audit
• Audit and research
• Statistical verification
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Gloucestershire PCCAG
Problems with audit
• Audit and research
• Statistical verification
• Outcome measures and proxies
![Page 75: Gloucestershire PCCAG Clinical Audit and the Audit Cycle](https://reader031.vdocuments.net/reader031/viewer/2022012919/56649f1d5503460f94c3429c/html5/thumbnails/75.jpg)
Gloucestershire PCCAG
Problems with audit
• Audit and research
• Statistical verification
• Outcome measures and proxies
• Protocols
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Gloucestershire PCCAG
Problems with audit
• Audit and research
• Statistical verification
• Outcome measures and proxies
• Protocols
• Closing the loop - introducing change and re-audit
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Gloucestershire PCCAG
A word about clinical governance
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Gloucestershire PCCAG
A word about clinical governance
“A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards by creating an environment in which excellence in clinical care will flourish”
A First Class Service 1998
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Gloucestershire PCCAG
‘Clinical Governance’
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Gloucestershire PCCAG
‘Clinical Governance’
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Gloucestershire PCCAG
‘Clinical Governance’
Research
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Gloucestershire PCCAG
‘Clinical Governance’
Research
Audit
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Gloucestershire PCCAG
‘Clinical Governance’
Research
Audit Evidence based
medicine
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Gloucestershire PCCAG
‘Clinical Governance’
Research
Audit Evidence based
medicineDissemination of
guidelines
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Gloucestershire PCCAG
‘Clinical Governance’
Research Practice development plans
Audit Evidence based
medicineDissemination of
guidelines
![Page 86: Gloucestershire PCCAG Clinical Audit and the Audit Cycle](https://reader031.vdocuments.net/reader031/viewer/2022012919/56649f1d5503460f94c3429c/html5/thumbnails/86.jpg)
Gloucestershire PCCAG
‘Clinical Governance’
Research Practice development plans
Audit Evidence based
medicineDissemination of
guidelines
Personal development
plans
![Page 87: Gloucestershire PCCAG Clinical Audit and the Audit Cycle](https://reader031.vdocuments.net/reader031/viewer/2022012919/56649f1d5503460f94c3429c/html5/thumbnails/87.jpg)
Gloucestershire PCCAG
‘Clinical Governance’
Research Practice development plans Postgraduate
medical education
Audit Evidence based
medicineDissemination of
guidelines
Personal development
plans
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Gloucestershire PCCAG
‘Clinical Governance’
Research Practice development plans Postgraduate
medical education
Audit Evidence based
medicineDissemination of
guidelines
Personal development
plans
Practice accreditation
![Page 89: Gloucestershire PCCAG Clinical Audit and the Audit Cycle](https://reader031.vdocuments.net/reader031/viewer/2022012919/56649f1d5503460f94c3429c/html5/thumbnails/89.jpg)
Gloucestershire PCCAG
‘Clinical Governance’
Research Practice development plans Postgraduate
medical education
Audit Evidence based
medicineDissemination of
guidelines
Personal development
plans
Practice accreditation
Special interest groups
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Gloucestershire PCCAG
‘Clinical Governance’
Accountability