7. Clinical Audit and Service Evaluation Flashcards
define 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”
Differentiate audit from research
- Audit can be the final stage of a research project
- Research findings can identify areas for audit
- Audit can help with dissemination of research findings
- Audit can identify gaps in research evidence
Allocation of treatment/service difference between audit and research?
If by protocol (RESEARCH)
Beware: grey areas exist – seek advice (local NHS ethics committee)
describe how audit questions are formed and how they might differ from research questions
Audit Questions: Does this service reach a predetermined standard?
Research questions:
Qualitative research:What is the patient experience of receiving this service?
Quantitative research: How do patient outcomes compare between this service (or treatment) and an alternative?
“PICO” (Patient Intervention Comparison Outcome)
Sescribe methods used to answer audit questions
Retrospective – notes review (beware missing data)
Prospective – ongoing data collection (beware the “Hawthorne effect”)
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 6) Compare data with the standard 7) Develop and implement change 8) Re-audit
Common elements of audit and research?
Professionally led
Influence on clinical practice
Formal data collection
Methodological rigour
Data analysis / interpretation
Publishable: Potentially
Ethical consideration:
Research – Yes
Audit – No, but may be needed if it is judged to put pts at risk. If uncertain, seek advice from the ethics committeeKey factors to distinguish research from audit?
The intent
The allocation of treatment/service
Key factors to distinguish research from audit?
The intent
The allocation of treatment/service
What is service evaluation
Not audit or research
“a review process undertaken solely to define or judge current service with the intention of benefiting those who use it”
Service evaluation - used to inform local practice
Components:
– structure (what you need - infrastructure, staff)
– process (what you do)
– outcome (what you expect)
What is service evaluation?
Not audit or research
“a review process undertaken solely to define or judge current service with the intention of benefiting those who use it”
Service evaluation - used to inform local practice
Components:
– structure (what you need - infrastructure, staff)
– process (what you do)
– outcome (what you expect)
What questions are asked by service evaluations?
E.g.
Does the service achieve its objectives
Does the service (still) meet pt’s needs? Is the service equitable?
Examples:
• What are the waiting times for pts attending the A&E department in XXX hospital?
Audit: Purpose? Question? Objective? Interventions? Data additional to usual care? Allocation to intervention? Randomisation?
Purpose?
Inform delivery of best care
Question?
Does it reach a pre- determined standard?
Objective?
To measure service against accepted / defined standard
Interventions?
Already in use
Service evaluation: Purpose? Question? Objective? Interventions? Data additional to usual care? Allocation to intervention? Randomisation?
Purpose?
Define or judge current care
Question?
What standard does this service achieve?
Objective?
To measure current service without reference to a standard
Interventions?
Already in use
Data additional to usual care?
Can include questionnaire / interview
Allocation to intervention?
No
Randomisation?
No
Research: Purpose? Question? Objective? Interventions? Data additional to usual care? Allocation to intervention? Randomisation?
Purpose?
Generalisable new knowledge
Question? Test hypothesis (quant), explore themes (qual)
Objective?
Specific research objectives
Interventions?
Novel use or application
Data additional to usual care?
Yes, including invasive tests
Allocation to intervention?
Yes, usually
Randomisation?
Maybe
Main barriers in audit undertaking?
Main audit barriers:
- Lack of resources
- Lack of expertise or advice in project design & analysis
- Problems between groups and group members
- Lack of an overall plan for audit
- Organisational impediments
