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Julie Henderson (Acting Head of Clinical Services) discusses the Clinical Audit Service: - Clinical Leadership and Engagement - Inclusive Approach - Audit Measurement This presentation includes two case studies: 1) National Diabetes Audit 2) National Lung Cancer Audit
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Clinical Audit ServiceSupporting better care
EHI Live 2013EHI Live 2013
Clinical Audit Development
• Clinical Leadership and Engagement
• Inclusive Approach- Patient and Carer representatives- AHPs and Care Team representatives
• Audit Measurement- Existing standards?- Baseline and variability?- Indicator Development and Assurance
Clinical Audit Design
• NICE Quality Standards
• Professional and Clinical Standards
• Information Standards
• Data Standards
• Statistical Standards
Clinical Audit Considerations
• Mandated or not?
• Considering the burden
• How to present findings and feedback
• Support for improvement activities
• Re-auditing
Clinical Audit and Improving Quality
• Audit Findings, Feedback and Recommendations
• NICE Quality Standards
• Outcomes Frameworks- NHS OF- CCG Outcomes Indicator Set
• Regulation, Professional Validation and Inspection- CQC- Royal Colleges
Clinical Audit and Improving Quality
• Local ownership – CCGs, Boards, Clinical Senates, Strategic Clinical Networks, Action Teams, Patient Groups, Health and Wellbeing Boards, Healthwatch etc
• Transparency- Methodology- Findings- Recommendations- Outliers- Indicator Construction- Data
Case Study: National Diabetes Audit
• Worlds largest clinical audit - over 2.4 million people with diabetes
• 90 per cent of GP practices in England and Wales participate
• Clinically led and patient focused
• Assessment of full integrated diabetes patient care pathway from GP practices to hospitals
• Links patient records from multiple sources
• Measures care against NICE clinical guidelines and quality standards
• Provides benchmarked practice specific and hospital specific reports
• Identifies diabetes patients with multi-morbidities and increased cardio vascular risk
• Provides clinical recommendations for quality improvements
What Aspects of Diabetes Care and Outcomes are Measured?
Patient
GP care
Inpatient Care
Mortality
test results
Outpatient care
CardiovascularComplications
Pregnancy care
Kidney disease
Who is Involved in the NDA?
• The NDA is a fully collaborative clinical audit that brings together:
- Patients- GPs- Diabetologists- Physicians- Nurses- Midwifes- Commissioners- Informaticians- Governance specialists- Analytical methodologists
What Reports are Available?
• NDA publishes national, CCG and Trust reports and provides GPs with practice specific reports
Reports contain• Compliance with NICE clinical guidelines and quality
standards• Clinical recommendations for quality improvement• Benchmarked analysis• Increased risk of adverse outcomes and cardiovascular
complications• Increased risk of mortality• Equity of care measures
Clinical Improvements
NICE updated clinical guidelines in 2008 to recommend that people with diabetes have a urine albumin: creatinine ratio (ACR) test annually. Urine ACR test is used to detect and monitor kidney disease
Early detection and treatment can prevent or delay the progression of chronic kidney disease (CKD), reduce or prevent the development of complications and reduce the risk of cardiovascular disease
In 2010 the NDA reported that 65 per cent of people with diabetes were receiving the NICE recommended Urine ACR test. The NDA initiated a programme of communication and improvement to highlight these issues. In 2 years the percentage of people with diabetes receiving the test rose to 75 per cent
This means that an additional 200,000 people with diabetes are receiving this test that identifies and monitors kidney disease
National Lung Cancer Audit
Audit Finding: not enough patients with small cell lung cancer receive chemotherapy
Recommendation: chemotherapy rates below 65 per cent for this group of patients should be reviewed
West Suffolk NHS TrustThis trust identified that patients were waiting too long for treatment and therefore the cancer was too advanced for chemotherapy
An alert system was established to flag up patients with the very aggressive small cell lung cancer, which allowed fast track booking of oncology appointments
West Suffolk NHS Trust
West Suffolk NHS Trust
The Trust then followed this up by assessing whether this reduction in waiting times meant that more patients were able to receive treatment before they deteriorated and became too ill for chemotherapy
The treatment rates for Small Cell Lung Cancer were between 50 and 60 per cent prior to improvement activities
Following the quality interventions this increased to over 70 per cent
