The Effective Clinical Director - HQIP

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The Effective Clinical Director - HQIP Powered By Docstoc
					Clinical Audit as Evidence for

        Dr David Scott, GMC Associate, Consultant
   Paediatrician and Clinical Lead for Children’s Services,
             East Sussex Healthcare NHS Trust
    Former Chairman BMA CC Medical Managers Sub-
     Topics to be Covered
• assessing the evidence for revalidation:
  how much of the information should be
  provided by the Trust and how much by
  the individual
• how do you evidence both participation
  and reflection on clinical audit findings?
     Topics to be Covered
• clinical auditing your practice to provide
  evidence for revalidation
• the role of clinical audit staff in
  supporting clinicians to prepare for
• supporting individuals to prepare for
 Purpose of revalidation

• To confirm that licensed doctors practice in
  accordance with the GMC’s generic
  standards (relicensing)
• For doctors on specialist/GP register, to
  confirm that they meet the standards
  appropriate for their speciality (recertification)
• To identify for further investigation, and
  remediation, poor practice where local
  systems are not robust enough or do not exist
              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.
• Aspects of the structure, processes, and outcomes of
  care are selected and systematically evaluated
  against explicit criteria.
• Where indicated, changes are implemented at an
  individual, team, or service level and further
  monitoring is used to confirm improvement in
  healthcare delivery.
The Standards (Explicit Criteria)
 • Professional – standards that are set
   for the profession that determine a
   registrant’s ‘fitness to practise’.
 • Subjective – the patient’s point of view.
 • Objective – those facts that are
   observable and measurable by a nurse
   or other clinician.
Good Medical Practice

– Knowledge, skills
  and performance
– Safety and quality
– Communication,
  partnership and
  team work
– Maintaining trust
    Types of Supporting
Information for Revalidation
• Continuing Professional
• Quality improvement
• Significant events
• Feedback from
• Feedback from patients
  (where applicable)
• Review of complaints
  and compliments
          History of Audit
• 1956 - medical audit.
• 1989 - Kenneth Clarke, then Secretary
  of State for Health: “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.”
   Clinical Audit Project (1)
1. Registration of project
  – Agreement of criteria for comparison
  – Lead auditor should be named.
  – There should be an entry referring to the size of
    the impact, the trigger, and the desired
    performance, and a credible (named) source.
  – The presentation date and venue will be decided
    at this stage.
  – An audit reference number should be issued.
   Clinical Audit Project (2)
2. Data are made available. The lead auditor
   should describe the methodology of
   inclusion and exclusion criteria and lost
   data. This technique should mirror the
   rigour of data handling in research projects.
3. Data analysis and interpretation. Statistical
   methodology should be made clear.
   Clinical Audit Project (3)
4. Presentation of the project, with
   recommendations for implementation.
5. Trust certification of completed audit should
   be provided to all participants.
6. Incorporation of the findings from the project
   into a protocol should be considered.
7. Registration for re-auditing, as per (1.)
Health Quality Improvement Partnership
Clinical Audit and Revalidation
•   What activities can be
    considered clinical audit.
•   Principles for the use of clinical
    audit in revalidation
•   Criteria and key indicators for
    demonstrating involvement by a
    doctor in the process of clinical
•   Criteria and key indicators for
    demonstrating reflection and
    action in response to the results
    of clinical audit
•   Agree the criteria and indicators
    of a good clinical audit project.
Audit Standards - Revalidation
 • Participation in High Quality Clinical
 • Reflection on the results of Clinical
 • Taking action on the results of Clinical
           Academy of Medical Royal Colleges (2009)
     Trust Audit Programme
•   National
•   Regional
•   Local
•   Departmental
•   Individual
           Audit Activity
• Audit meetings        • Risk management
• Mortality and           meetings
  morbidity meetings    • National audits
• Serious case            relating to your
  reviews                 specialty
• Root cause analysis   • Medical record
  (RCA)                   audits
• Professional review   • Peer review
National Audit Projects
Medical Record Audit Tool
    Evidence of participation
Activity                Standard                 Evidence

Attendance at meetings Attend 2/3 meetings       Meeting Register

Audit presentation      Presentation at Audit    Copy of presentation
Medical record review   RCP standards            Audit report

Serious case reviews    Internal/external        Copies of anonymised
                        ‘experts’                minutes
Peer reviews            NICE Guidance,           Extracts from reports
                        Protocols & guidelines
Out-patient clinic      Peer opinion             Reflections on case
review                                           discussions
Feedback from Colleagues
Feedback from Patients
      Appraisal Discussion
• Standards
• Evidence
• Contributory factors
• Probity
• Improvement
• Personal
• Remediation
Performance of Doctors

    Adapted from : Birch K, Scrivens E & Field S (1999)

      “I shut my
     eyes in order
         to see”

    Paul Gaughuin (1848-
  The Role of Clinical Audit
• Support and advice
• Manage database of
  clinical audits
• Arrange and support
  audit meetings
• Participate in
    Support for Revalidation
• Activity data
• Outcome data
• Complication rates
• Mortality & morbidity
• Serious incidents
• Patient satisfaction
• Participation in an enhanced
  appraisal process combined with
  effective audit of your clinical
  practice should satisfy and
  reassure patients, lead to greater
  job satisfaction and a
  recommendation for revalidation.
            Future Reading
• Academy of Medical Royal Colleges. Clinical Audit
  and Revalidation - Report and Recommendations.
• Royal College of Physicians. What is meant by
  ‘clinical audit’ for the purposes of revalidation?

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