Clinical Audit, Research or Service Evaluation? Flashcards
What is the definition of a Clinical Audit ?
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 off change
- Self examination
“Are we doing it right according to clinical standards? If not, how can we improve?”
What is the definition of Research ?
Research - The attempt to derive generalisable new knowledge by addressing clearly defined questions with systematic and rigorous methods
- Dabble in other areas with other researchers
“What should we be doing?”
What is Service Evaluation ?
Service Evaluation - A review process undertaken solely to define or judge current service with the intention of benefiting those who use it
- Used to inform local practice
- May result in service redesign
“How well does a service achieve its intended aims (patient experience and outcomes)?
What are the differences between the Purpose of a Research, Audit and Service Evaluation ?
Purpose:
- Research: Generalise new knowledge
- Audit: Inform delivery of best care
- Service Evaluation: Define or judge current care
What are the differences between the Question of a Research, Audit and Service Evaluation ?
Question:
- Research: Test hypothesis (quant), explore themes (qual)
- Audit: Does it reach a pre-determined standard ?
- Service Evaluation: What standard does this service achieve
What are the differences between the Objective of a Research, Audit and Service Evaluation ?
Objective:
- Research: Specific research objectives
- Audit: To measure service against accepted/defined standard
- Service Evaluation: To measure current service without reference or a standard
What are the differences between the Interventions of a Research, Audit and Service Evaluation ?
Interventions
- Research: Novel use or application
- Audit: Already in use
- Service Evaluation: Already in use
What are the differences between the Data additional to usual care of a Research, Audit and Service Evaluation ?
Data additional to usual care:
- Research: Yes, including invasive tests
- Audit: Can include questionnaire/interview
- Service Evaluation: Can include questionnaire/interview
What are the differences between the Allocation to intervention of a Research, Audit and Service Evaluation ?
Purpose;
- Research: Yes, usually
- Audit: No
- Service Evaluation: No
What are the differences between the Randomisation of a Research, Audit and Service Evaluation ?
Purpose;
- Research: Maybe
- Audit: No
- Service Evaluation: No
What are the general differences between Research, Audit and Service Evaluation ?
See image
What kind of questions would you ask in Service Evaluation Questions ?
- Does the service achieve its objectives?; How?; What are the costs ?
- Does the service (still) meet patients needs?
- Is the service equitable ?
Components: Structure, process, outcome
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 the hospital ?
What kind of questions would you ask in Audit Questions?
Does this service reach a predetermined standard ?
- What proportion of patients presenting to A&E are seen within 4 hours ? Standard is >95%
- What proportion of patients referred for urgent investigation of colorectal cancer are seen within 2 weeks? Standard = 100%
- What proportion of patients with diabetes have an annual review by their GP or practice nurse? Standard = 100%
What kind of questions would you ask in Research Questions?
How do patient outcomes compare between this service (or treatment) and an alternative ?
- Quantitive 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 or Population, Intervention, Comparison, Outcome)
Example: What are the concerns of women being recalled for a repeat cervical smear ?
- Qualitative research (no stats)
What was the significant of the RECOVERY trial?
NHS Research - University of Oxford
Research during COVID that looked at multiple overlapping trials of potential treatments in 187 Hospitals, 44,500 hospitalised pts.
It showed;
- Dexamethasone 6mq/day reduced mortality by 1/3 in
pts needing respiratory support & by 1/5 in pts
needing O2
- Hydroxychloroquine and convalescent plasma - no clear
clinical benefit
Use of it estimated to have saved >22,000 lives in Uk & > 1 million worldwide !!!
Managed to get treatments published in only 9 days, incredible!
Ingredients to this quick and informative research;
- A national health service,
- Proficient research group, efficient organisation (Oxford best researchers)
- Dedicated medical teams,
- Many volunteers
Affected patient outcomes during covid tremendously
What are the main methods/processes involved in Audits?
Prospective - ongoing data collection (beware the
“Hawthorne effect” - E.g when someone watching you, you do bloods more carefully)
Steps:
1). Identify a topic / problem
2). Identify local resources (? local audit dept)
3). Choose the standard, create the audit proforma
4). Define the sample
5). Collect data (? do a pilot)
6). Compare data with the standard
7). Develop and implement change
8). Re-audit
