Clinical audit was adopted in general practice as a quality improvement process in the 1990s, aiming to improve patient outcomes through a systematic review of care based on standards of best practice and explicit criteria.
Then, where indicated, changes should be implemented at individual team level. There should be further monitoring by re-auditing and more revisions as appropriate to delivering patient care.
But recently clinical audit has become more of a routine tick-box activity in general practice to fulfil QOF requirements.
As the forthcoming requirements for revalidation (as far as we know) include evidence of clinical audits of care that GPs individually provide - and the prospect of earning extra CPD credits by showing how each hour of education leads to improvements of care or practice - this is a good time to review your own approach. By doing this you can make sure clinical audit has resulted in improving the care you provide.
Clinical audit method
Select clinical audits because of high-risk, inconsistent or high-cost clinical activity. The essential steps of the audit cycle are shown in the diagram.
The clinical audit method should be as simple as possible, and set up so you can re-audit later. Data extraction and analysis can be done as far as possible by non-clinical practice staff.
GPs and nurses need to participate only where their clinical input is vital: agreeing the topic, standards and criteria; reviewing findings and deciding on, and implementing, agreed changes.
Individual team members are more likely to alter their professional behaviour in a consistent way if everyone is involved and they realise the need to alter the way they work.
|PATIENT PATHWAY 'HOT SPOTS'|
Prevalence Compare your practice prevalence for the condition with the PCT average, or expected prevalence.
Initial assessment/treatment Check diagnostics, treatment and interventions are all completed against practice protocol (and check your practice protocol is in date and matches best practice or local guidelines - for example, NICE guidance).
Clinical management of continuing care of long-term condition Check diagnostics, treatment and interventions are all completed against practice protocol; consider any aspects of co-morbidity.
Medicines management For example, focus on patient sub-groups where compliance may be more difficult, such as young people.
Self-care See if lifestyle habits are tracked consistently or that self care is positively promoted by GP/nurse.
Review clinical outcomes Compare clinical outcomes between clinicians in the practice or between your practice and others.
Track trends with re-audits.
Team discussion of clinical audit findings Agree an action plan.
Re-audit Review achievements of action plan and plan further service improvement(s) as appropriate.
Thinking more widely
Clinical audit is often focused at one point rather than throughout the patient pathway. So you could study 'hot spots' along the pathway (see box above) where it is more difficult to deliver consistently good care or where patients may not comply with treatment.
Clinical audit is a reflective process, so show that you take responsibility for your part in providing the care reviewed and improvements identified in your appraisal portfolio.
Each clinician in the practice might take responsibility for one of those 'hot spots' or stages. Alternatively, the audit may be designed so that each clinician's practice is distinguishable from that of the others', including any regular locum.
|Audit example: chronic kidney disease (CKD)|
CKD stages 3A and 3B as patients are under GP care.
Aim to improve management of patients on practice CKD stages 3A and 3B in disease register. Use as standards best practice in minimising deterioration of CKD: NICE or SIGN guidelines.
|CPD IMPACT: DOUBLE YOUR credits|
Double your credits
These further action points allow you to double the credits claimed.
Record all your learning with your free online CPD Organiser
Professor Chambers is a Stoke on Trent GP and honorary professor at University of Stafford