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Demystifying Clinical Audit
863
Demystifying Clinical Audit Gayle Hartigan Audit Development Officer, CSI’
The concept of auditing clinical practice, as a systematic method of improving the quality of patient care, was introduced in 1989 as part of the NHS reforms. However, the results of a recently-published national evaluation of medical a n d clinical audit by CASPE Research reveal that, while medical audit programmes have been established in virtually all provider units in England, progress towards multi-professional clinical audit has been limited, a n d difficulty has arisen in ensuring coverage and equity in the allocation of audit funds to all the health care professions. The Department of Health recognises t h a t different approaches to auditing have been adopted by different professions and it is acknowledged that these varying approaches a n d individual professional sensitivities should be recognised a n d respected i n t h e move towards multi-professional, clinical audit. An ongoing initiative to fund the establishment of audit leads in the non-medical colleges and professional bodies aims to redress any potential imbalance between professions with regard to obtaining auditing skills a n d experience, and to help in providing equal accessibility to audit training and resources for all health care professionals. In March 1994 the CSP made a successful bid to the D e p a r t m e n t of H e a l t h for funding to support t h e e s t a b l i s h m e n t of a clinical a u d i t lead within t h e Society and, in September, a n audit development officer was appointed on a one-year fixed-term contract, to develop clinical a u d i t focused upon t h e work of chartered physiotherapists. Her r81e will include carryir,g out a mapping exercise, on behalf of the CSP, to determine t h e current levels of involvement a n d progress in clinical audit throughout the profession; production of a CSP Clinical Audit Pack containing practical information on clinical a u d i t planning, methodologies and execution; organisation of training days and workshops in clinical audit; and providing a focus for members to obtain practical advice and guidance on all aspects of clinical audit activity. It is also planned to set up a database at the CSP of chartered physiotherapists with knowledge of, experience or a n interest in clinical audit which could form the basis for a national network of clinical auditors within t h e physiotherapy profession, to promote the exchange of ideas and methodologies and the sharing of clinical audit information. Despite t h e relatively large expenditure on clinical audit since 1989 and the proliferation of a vast number of publications, journals a n d distance learning packages, confusion continues to exist regarding the precise definition of‘ clinical audit, the way in which it differs from research and, in particular, whether it can be applied uni-professionally within the therapy pro-
fessions. In November 1994 the CSP sought clarification from Mr Sean Brennan, clinical audit adviser to the Department of Health, and the following extract is reproduced from Mr Brennan’s reply (CSP italics): ‘When the Department refers to the Clinical Audit programme, it is using the term in its generic form, ie to describe any audit undertaken by any clinician. This might be performed in uniprofessional groups, either because that is a more appropriate approach to a particular topic or during the early developmental stages of audit within a profession within a unit, or in a multi-professional group.’
Clinical audit differs from research in t h a t research seeks new knowledge a n d understanding, whereas clinical a u d i t is a method of examining t h e use of existing practices and associated resources in a specific setting, and determining whether there a r e areas where improvements can be made. Research and clinical a u d i t can serve to s t r e n g t h e n each other on a mutual basis, in t h a t clinical audit may highlight a need or desirability for changes to current practice, either by incorporation of research findings, or by local problem solving which, in turn, may identify pertinent areas for research. The required changes are usually written up in the form of a local protocol and clinical audit becomes the tool by which implementation of the new practice can be monitored. Because improvements are made using existing local resources, the results of clinical audit can be applied only within the specific setting where t h e audit was carried out. However, publication of the aims, methodology a n d results of clinical audit is a n effective way of sharing clinical information throughout a profession; similar audits could be carried out in different settings, and research projects could be initiated on the basis of audit results. Although physiotherapists may have been mostly involved in clinical audit on a multiprofessional basis a s part of a health care team, there are many areas where clinical audit could be applied uni-professionally within the physiotherapy profession. For example, physiotherapists could examine the appropriateness of a range of interventions which may be used to treat patients with a specific diagnosis and, by comparison of the outcome for patients, determine which interventions are most effective. Uni-professional clinical audit is facilitated by establishment of a local audit group within the physiotherapy service/department s o t h a t clinical practice i s audited on a systematic basis with findings discussed by peer review and shared by the physiotherapy service as a whole. The establishment of such a framework for clinical audit a t service/dcpartmental level need not require large investments of either time or
Physiotherapy, December 1994. vol80, no 12
864
other resources; many physiotherapy units hold regular clinical meetings a n d perhaps one meeting per month, for example, could be.designated as a clinical audit meeting. The experience, knowledge and confidence gained by carrying out uni-professional audits at service/departmental level will enable physiotherapists to play a proactive rde in the planning of multiprofessional a u d i t s a n d allow g r e a t e r professional input into the corporate clinical audit programmes of their units of employment.
As part of the mapping exercise mentioned above, a clinical audit activity questionnaire is printed on the following pages and a prepaid envelope is included in this edition of the Journal. All members are requested to complete and return the questionnaire to the CSP. The information will be used to identify future audit
training needs and to highlight areas where additional resources for physiotherapy audit may be required. An additional questionnaire is printed below for members who wish to have their names included on the CSP database of clinical auditors in physiotherapy, a n d may be returned in the same envelope. Gayle Hartigan can be contacted on extension 247 a t t h e CSP or on h e r mobile telephone number: 0378 3 14 185. References CASPE Research (1994). ‘The development of audit. Findings of a national survey of healthcare provider units in England’, CASPE, London. Department of Health (1994). The Evolution of Clinical Audit. HMSO.
The CSP is compiling a database of physiotherapists with experience of and/or an interest in clinical audit. It is hoped that the database will form the basis for a national network of clinical auditors in physiotherapy to promote collaboration in clinical audit both within the physiotherapy profession and with other health care professions, and to facilitate exchange of audit information, ideas and methodologies. If you are involved or interested in clinical audit and wish to make contact with other physiotherapists or other health care professionals who are conducting clinical audit, either in similar fields or for general purposes, please supply the following details:
Name ............................................................................................................................ Employment address ....................................................................................................
Contact telephone number ........................................................................................... Area(s) of clinical audit activity in which you are involved
...................................................................................................................................... ......................................................................................................................................
...................................................................................................................................... I am aware that these details will be included in a list of audit contacts which will receive a wide circulation within the clinical audit field.
Signed .......................................................................................................................................................
Physiotherapy, December 1994, vol80, no 12
Demystifying Clinical Audit Gayle Hartigan Audit Development Officer, CSI’
The concept of auditing clinical practice, as a systematic method of improving the quality of patient care, was introduced in 1989 as part of the NHS reforms. However, the results of a recently-published national evaluation of medical a n d clinical audit by CASPE Research reveal that, while medical audit programmes have been established in virtually all provider units in England, progress towards multi-professional clinical audit has been limited, a n d difficulty has arisen in ensuring coverage and equity in the allocation of audit funds to all the health care professions. The Department of Health recognises t h a t different approaches to auditing have been adopted by different professions and it is acknowledged that these varying approaches a n d individual professional sensitivities should be recognised a n d respected i n t h e move towards multi-professional, clinical audit. An ongoing initiative to fund the establishment of audit leads in the non-medical colleges and professional bodies aims to redress any potential imbalance between professions with regard to obtaining auditing skills a n d experience, and to help in providing equal accessibility to audit training and resources for all health care professionals. In March 1994 the CSP made a successful bid to the D e p a r t m e n t of H e a l t h for funding to support t h e e s t a b l i s h m e n t of a clinical a u d i t lead within t h e Society and, in September, a n audit development officer was appointed on a one-year fixed-term contract, to develop clinical a u d i t focused upon t h e work of chartered physiotherapists. Her r81e will include carryir,g out a mapping exercise, on behalf of the CSP, to determine t h e current levels of involvement a n d progress in clinical audit throughout the profession; production of a CSP Clinical Audit Pack containing practical information on clinical a u d i t planning, methodologies and execution; organisation of training days and workshops in clinical audit; and providing a focus for members to obtain practical advice and guidance on all aspects of clinical audit activity. It is also planned to set up a database at the CSP of chartered physiotherapists with knowledge of, experience or a n interest in clinical audit which could form the basis for a national network of clinical auditors within t h e physiotherapy profession, to promote the exchange of ideas and methodologies and the sharing of clinical audit information. Despite t h e relatively large expenditure on clinical audit since 1989 and the proliferation of a vast number of publications, journals a n d distance learning packages, confusion continues to exist regarding the precise definition of‘ clinical audit, the way in which it differs from research and, in particular, whether it can be applied uni-professionally within the therapy pro-
fessions. In November 1994 the CSP sought clarification from Mr Sean Brennan, clinical audit adviser to the Department of Health, and the following extract is reproduced from Mr Brennan’s reply (CSP italics): ‘When the Department refers to the Clinical Audit programme, it is using the term in its generic form, ie to describe any audit undertaken by any clinician. This might be performed in uniprofessional groups, either because that is a more appropriate approach to a particular topic or during the early developmental stages of audit within a profession within a unit, or in a multi-professional group.’
Clinical audit differs from research in t h a t research seeks new knowledge a n d understanding, whereas clinical a u d i t is a method of examining t h e use of existing practices and associated resources in a specific setting, and determining whether there a r e areas where improvements can be made. Research and clinical a u d i t can serve to s t r e n g t h e n each other on a mutual basis, in t h a t clinical audit may highlight a need or desirability for changes to current practice, either by incorporation of research findings, or by local problem solving which, in turn, may identify pertinent areas for research. The required changes are usually written up in the form of a local protocol and clinical audit becomes the tool by which implementation of the new practice can be monitored. Because improvements are made using existing local resources, the results of clinical audit can be applied only within the specific setting where t h e audit was carried out. However, publication of the aims, methodology a n d results of clinical audit is a n effective way of sharing clinical information throughout a profession; similar audits could be carried out in different settings, and research projects could be initiated on the basis of audit results. Although physiotherapists may have been mostly involved in clinical audit on a multiprofessional basis a s part of a health care team, there are many areas where clinical audit could be applied uni-professionally within the physiotherapy profession. For example, physiotherapists could examine the appropriateness of a range of interventions which may be used to treat patients with a specific diagnosis and, by comparison of the outcome for patients, determine which interventions are most effective. Uni-professional clinical audit is facilitated by establishment of a local audit group within the physiotherapy service/department s o t h a t clinical practice i s audited on a systematic basis with findings discussed by peer review and shared by the physiotherapy service as a whole. The establishment of such a framework for clinical audit a t service/dcpartmental level need not require large investments of either time or
Physiotherapy, December 1994. vol80, no 12
864
other resources; many physiotherapy units hold regular clinical meetings a n d perhaps one meeting per month, for example, could be.designated as a clinical audit meeting. The experience, knowledge and confidence gained by carrying out uni-professional audits at service/departmental level will enable physiotherapists to play a proactive rde in the planning of multiprofessional a u d i t s a n d allow g r e a t e r professional input into the corporate clinical audit programmes of their units of employment.
As part of the mapping exercise mentioned above, a clinical audit activity questionnaire is printed on the following pages and a prepaid envelope is included in this edition of the Journal. All members are requested to complete and return the questionnaire to the CSP. The information will be used to identify future audit
training needs and to highlight areas where additional resources for physiotherapy audit may be required. An additional questionnaire is printed below for members who wish to have their names included on the CSP database of clinical auditors in physiotherapy, a n d may be returned in the same envelope. Gayle Hartigan can be contacted on extension 247 a t t h e CSP or on h e r mobile telephone number: 0378 3 14 185. References CASPE Research (1994). ‘The development of audit. Findings of a national survey of healthcare provider units in England’, CASPE, London. Department of Health (1994). The Evolution of Clinical Audit. HMSO.
The CSP is compiling a database of physiotherapists with experience of and/or an interest in clinical audit. It is hoped that the database will form the basis for a national network of clinical auditors in physiotherapy to promote collaboration in clinical audit both within the physiotherapy profession and with other health care professions, and to facilitate exchange of audit information, ideas and methodologies. If you are involved or interested in clinical audit and wish to make contact with other physiotherapists or other health care professionals who are conducting clinical audit, either in similar fields or for general purposes, please supply the following details:
Name ............................................................................................................................ Employment address ....................................................................................................
Contact telephone number ........................................................................................... Area(s) of clinical audit activity in which you are involved
...................................................................................................................................... ......................................................................................................................................
...................................................................................................................................... I am aware that these details will be included in a list of audit contacts which will receive a wide circulation within the clinical audit field.
Signed .......................................................................................................................................................
Physiotherapy, December 1994, vol80, no 12