Clinical Governance and Audit - Professor Tahir Pillay

Intro
Clinical audit in the laboratory • Audits are part of continuous quality improvement and one of the key elements of clinical governance. • Laboratory-based clinical audits: are a means of providing feedback to the users of the laboratory and its statt involve measuring the performance of laboratory services against established standards established using the principles of evidence-based medicine
Overall process of audit • The audit is conducted, findings are made and changes are implemented and then a re-audit is performed after a certain time period to ensure that the changes have been implemented and maintained. It is a cyclical process • Areas of audit in the laboratory include
Role of the laboratory in medical decisions • Importance of laboratory data medical decision making process
Laboratory audit Five distinct activities can be considered under the broad umbrella of audit: 1. Solving problems associated with process or outcome 2. Monitoring workload in the context of controlling demand 3. Monitoring introduction of new tests and/or changes in practice 4. Monitoring adherence with best practice (eg, with guidelines) S. Monitoring of analytical quality
Relationship between clinical governance and audit . Clinical audit is one of the key elements of clinical governance . Clinical governance is a system whereby healthcare organisations are accountable for continuously improving the quality of services
What is the definition of Clinical Governance? - What are the seven pillars of Clinical Governance? • What is your role in supporting Clinical Governance? What is at the heart of Clinical Governance? What is the RAID model of Clinical Governance and what steps does it involve? How does these steps inter-relate
a system through which medical organisations are accountable for continuously improving the quality of services" OR •"a corporate accountability for clinical performance.
"A framework through which healthcare organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish." Department of Health A first Class Service 1998
a quality improvement process that seeks to improve the patient care and outcomes through systematic review of care against explicit criteria and the implementation of change
All core audits for clinical governance should address: the patient userview . critical incident reporting . the perceived quality of help and advice to other doctors.
Royal College of Pathologists . 2005-the Royal College of Pathologists published a code of practice for clinical biochemists and clinical biochemistry services in which clinical biochemists were required to participate in clinical audits to assess the quality and appropriateness of the services provided.
Benchmarking . Process of measuring products, services and practices against leaders in a field, allowing the identification of best practices that lead to sustained and improved performance.
Role of evidence-based medicine · Evidence-based medicine (EBM) core of continuous quality improvement programmes and audits are very much part of the continuous process to implement and maintain best practice in the laboratory
What is the difference between audit and research? Research Create new knowledge and provides
Approach to conducting an audit . Clinical audits should be conducted within a structured programme, with effective leadership, involving all staff, and with emphasis on team work and support.
How does audit affect laboratory services? • Assessing and modifying laboratory and clinical practice • Ranging from the use of services to the clinical effectiveness of Laboratory tests as well as their impact on clinical outcom . Clinical care . Quality assurance programmes • Test utilisation
Structure programme • Effective leadership involved all staff . Emphasize team work and support • Funding should be available as staff resources will be use • Allocate time for staff • The audit may need registration and approval from the institution
How does audit affect laboratory services . Clinical care • High quality clinical guidelines help clinicians to change the ordering pattern of tests to more rational ones with a better cost/benefit ratio . Quality assurance programmes - Highlight areas where better use can be made of resources • Provide evidence of poorly managed quality assurance schemes - Test utilisation - Unnecessary testing . Demand management
Summary • Systematic improvement of health services requires the objective measurement of people, practices and organisations against valid and explicit standards in order to identify and implement appropriate change - Laboratory-based clinical audits are an essential part of total quality management important for good clinical governance. • Useful in developing guidelines for testing, assessing test utilisation and various aspects of quality assurance programmes
Summary (continued) • Audits are part of continuous quality improvement in the laboratory and one of the key elements of clinical governance. • Audits compare current practice against an accepted standard that has been set and examine whether this practice meets the standard. • Audit is a cyclical process: It compares practice to standards measures performance, makes improvements and importantly, involves a re-audit after a time period to ensure that the improvement is sustained. . There are ample areas for audit in the laboratory, ranging from the preanalytical to the postanalytical phases.