Audit, Service Evaluation and Research Midhun Mohan STARSurg Steering Committee Protocol Launch Meeting and Research Skills Course September 16 th 2015, RCS England Learning Objectives Similarities and differences The audit cycle Audit standards Implementing change How to get involved Protocol Launch Meeting and Research Skills Course September 16 th 2015, RCS England Whos done one before? Protocol Launch Meeting and Research Skills Course September 16 th 2015, RCS England Audit Definition Clinical audit is 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, process and outcome 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 Protocol Launch Meeting and Research Skills Course September 16 th 2015, RCS England Audit Definition Clinical audit is essentially all about: checking whether best practice is being followed making improvements if there are shortfalls in the delivery of care How do we decide what best practice is? AUDIT STANDARDS A standard is an explicit statement describing the quality of care to be achieved, which is definable and measurable Audit standards are derived from: National Guidelines Royal college guidelines NICE guidelines Protocol Launch Meeting and Research Skills Course September 16 th 2015, RCS England Audit Standards Protocol Launch Meeting and Research Skills Course September 16 th 2015, RCS England Service Evaluation Designed and conducted solely to define or judge current care Designed to answer: What standard does this service achieve? Measures current service without reference to a standard. No allocation to intervention: the doctor and patient have chosen intervention before service evaluation No randomisation Does not require REC review Protocol Launch Meeting and Research Skills Course September 16 th 2015, RCS England Audit Designed and conducted to produce information to inform delivery of best care. Designed to answer: Does this service reach a predetermined standard? Measures against a standard. No allocation to intervention: the doctor and patient have chosen intervention before audit. No randomisation. Does not require REC review. Protocol Launch Meeting and Research Skills Course September 16 th 2015, RCS England Research Attempts to create generalisable new knowledge regarding best practice. Tests hypotheses that evaluate or compare interventions. Usually large scale over a long time period. May involve patients receiving a completely new treatment. May involve patients being given different treatments. Uses random representative sampling methods to ensure generalisability of findings. Extensive statistical analysis is usually required. Results need to be generalisable to a wider population. Always requires ethics committee approval. Protocol Launch Meeting and Research Skills Course September 16 th 2015, RCS England Overview Audit - is designed to answer the question "Does this service reach a predetermined standard? Service evaluation - is designed to answer the question "what standard does this service achieve? Research - is designed and conducted to generate new knowledge and should follow the systems for approval of NHS Research Protocol Launch Meeting and Research Skills Course September 16 th 2015, RCS England The Audit Cycle Referred to as a cycle or a spiral systematic process Each cycle aspires to a higher level of quality Protocol Launch Meeting and Research Skills Course September 16 th 2015, RCS England Step 1 Identify problem and the local resources available for audit You are an F1 on the respiratory ward One month into your attachment, you notice that patients with COPD who met the criteria for starting non-invasive ventilation had not been given this treatment. PROBLEM IDENTIFIED You tell your consultant who tell you to do an audit You discover the hospital has an audit lead and clinical audit office. You contact them and them and they say they are happy to help Go to the office rather than calling much easier to get things sorted In agreement with your local audit lead, you choose the British Thoracic Society guidelines on non-invasive ventilation in acute respiratory failure and find these on the societys website. Protocol Launch Meeting and Research Skills Course September 16 th 2015, RCS England Step 2 Audit Standard Determine what you are trying to measure and define gold standards All patients with an acute exacerbation of COPD with respiratory acidosis (pH