Evidence Based Medicine

Clinical Audit / Significant Event Analysis

Clinical Audit

What actually IS audit?

Audit

IS

asking some questions
getting some answers
making some changes

Asking the questions again.

1. What are we doing?

Here we measure our actual performance e.g. what percentage of our asthmatic children have had a peak flow recorded in the past six months?

2. What should we be doing?

Here we decide what standard of care we should be aiming at. This step usually involves consensus among colleagues and reading recent publications.

3. Comparing 1 and 2.

Here we face up to how far short of our own standards we actually fall. Sometimes we are pleasantly surprised to find that we have reached them.

4. Negotiating change.

At this stage we examine, with other relevant health professionals, the facets of our practice that need to be changed to allow us to get nearer to the standard that we have set.

5. Closing the loop.

This is a vital step. It entails reauditing the results to see whether our changes have been instituted and whether they are working.

WHY AUDIT?

An old Chinese proverb says:

" It is one thing to know what to do, but another to be sure that we are doing it."

1. Audit allows one to see how near one gets to the standards.

2. It shows how our systems and every day PRACTICE let us down.

3. It gives us opportunity to change to allow our efforts to be optimised.

4. Audit puts the control of the quality of our work into our own hands.

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Significant Event Analysis

Aims

Develop an effective and comprehensive means of reviewing critical events.
System in place to detect recurrent problems and develop cycles of change
Should be an educational tool, not penalising.
Demonstrate the value of all types of experience, positive and negative.

Three major components:

Events that cause positive or negative feelings in the Doctor
Death audits
Complaints

Perceived benefits

Learn lessons
Improve self reflection
Demonstrate need for change
Recognise that it may be systems and not individuals that are the cause of the breakdown of care
Fulfills the essential tenets of Clinical governance, Good medical practice, Health and Safety.
Encourages data collection.

Method

You must use a standard proforma for all significant events, an example is shown below.

Example standardised proforma:
Name of patient
Age
Patient ID Number
Summary of Significant Event.
Were there patient-related factors that contributed to this significant event?
Were there secondary care related factors that contributed to this significant event?
Were there Primary Care related factors that contributed to this significant event?
What are your recommendations for change? (Individual and team)
Is this significant event a recurrent problem?