Why use the RCGP Out of Hours Clinical Audit Toolkit

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Why use the RCGP Out of Hours Clinical Audit
Toolkit ?

• Dr. Agnelo Fernandes MBE FRCGP
• 6th March 2008

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Out of Hours Clinical Audit Toolkit

• Background
• QR 4 OOHs Providers PCTs - inconsistencies
• DH commissioned RCGP to develop a
• Clinical Audit Toolkit (2006)
• Information gathering during 2006
• Development team - gt60years OOHs experience
• Audit Tool tested autumn 2006
• Toolkit approved by RCGP and DH early 2007
• OOHs Clinical Audit Toolkit Published March 2007

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Out of Hours Clinical Audit Toolkit

• BACKGROUND QR4 (2004 / 2006) For OOHs Providers
• Experienced OOHs clinician to lead audit
  programme
• Regular audit of a random patient contacts - any
  staff group
• Sufficient sample to review clinical performance
  of individuals
• Appropriate action taken on the results of these
  audits.
• Regular reports of audits to the contracting PCT.
  
• Where appropriate results shared with
  multidisciplinary team
• Providers must cooperate fully with PCTs to
  ensure audits include clinical consultations
  whose episode of care involved more than one
  provider organisation - along Patient journey

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Out of Hours Clinical Audit Toolkit

• AIMS
• To support OOH providers for effective clinical
  audit.
• To maximise the opportunities of audit
• To be Practical Deliverable Achievable
• To be a Best Practice Framework - locally
  tailored
• For Continuous Quality Improvement (CQI)

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Out of Hours Clinical Audit Toolkit

• Step 1 Role of clinical audit within the
  Organisation
• Step 2 Define the Patient Pathway
• Step 3 Define the Audit Criteria
• Step 4 Define an Audit Tool
• Step 5 Conduct the Audit
• Step 6 Incorporate Wider Learning
• Step 7 Repeat the Audit cycle

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Out of Hours Clinical Audit Toolkit

• Step 1- Organisation
• Resources
• Accountability
• Roles Responsibilities
• Individual Organisational Learning
• Assessment, Feedback, Learning, Implementing
  change

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Out of Hours Clinical Audit Toolkit

• Step 2
• Define the Patient Pathway
• Local Variability
• Generic Decision Making Processes

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Out of Hours Clinical Audit Toolkit

• Step 3 - Define the Audit criteria
• Criteria against which performance can be audited
• Established Principles GMC, NMC, SBH, OOHs QR,
  RCGP- MRCGP Video consultation assessments
  examples of current good practice
• No evidence based Standards for Criteria in OOHs
• The Standard set for each criterion is the mean
  for the individual organisation
• Scoring system to benchmark mean score for each
  criterion as part of a formative approach

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Out of Hours Clinical Audit Toolkit

• Audit CRITERIA

• Audit CRITERIA

• REASON (elicited)
• EMERGENCY identified
• HISTORY (or Algorithm)
• ASSESSMENT
• CONCLUSIONS
• EMPOWERING behaviour

• MANAGEMENT decisions
• PRESCRIBING
• SAFETY- NETTING
• RAPPORT developed
• IT / Protocols / Algorithms
• ACCESS criteria satisfied

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Out of Hours Clinical Audit Toolkit

• Step 4 Practical Audit Tool
• A generic audit tool
• review of individual call handlers and clinicians
  (doctors, nurses, etc.)
• face to face settings or on the telephone
• Scoring only as a benchmark to monitor progress
  within the individual organisation

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Out of Hours Clinical Audit Toolkit

• Step 5 Conducting the Audit Information
  gathering
• Information IT systems, telephone calls,
  records
• Telephone system records
• Access times Voice recordings
• Computer ( paper) system records
• Productivity Data Outcome Data Clinical Records
• Feedback from patients colleagues
• Significant Events Serious Untoward Incidents
  (SUIs)

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Out of Hours Clinical Audit Toolkit

• Step 5 Conducting the Audit - Sampling
• SAMPLING random sample of patient contacts
  systematically reviewed for every working
  individual
• Baseline minimum standard at least 1 or 4
  examples (whichever is the larger) (cf. part-time
  staff)
• If concerns - a further 4 calls/consultations
  reviewed
• cf. Calls to reflect upon (CtR)
• Early review new staff 2 or 8 calls
  /consultations)
• If complaint or concerns a greater number of
  reviews

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Out of Hours Clinical Audit Toolkit

• Step 5 Conducting the Audit Feedback Reports
• Individual Audit Reports - (e.g. quarterly).
• Individual Feedback to facilitate reflection
• Organisational Reports monthly / quarterly
• Organisational Feedback and Learning
• Via Clinical Governance Group to the Board
• facilitate learning and benchmark progress
• targeted educational activity
• Feedback and Learning involving multiple
  providers
• segmented audits of patient pathway

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Out of Hours Clinical Audit Toolkit

• Step 5 Conducting the Audit - Acting on audit
  findings at individual and organisational levels
• Individual action
• Selected input and Learning Plan
• Organisational actions
• Resources for support educational input
• Persistent poor performer
• Despite support educational input
• Reporting to PCT Performance unit

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Out of Hours Clinical Audit Toolkit

• Step 6 Incorporate learning from other aspects
  of the service
• A multi-disciplinary and multi-agency Clinical
  Governance Group (includes patients and
  commissioners)
• Organisational Reflection Learning

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Out of Hours Clinical Audit Toolkit

• Step 7 Repeat the Audit Cycle
• Routine clinical audit driving CPD
• Performance Review triggered by Audit or
  Complaint /SUI
• Audit to inform Appraisal Performance Review

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Why use the RCGPOut of Hours Clinical Audit
Toolkit?

• Support delivery of QR 4 - effective Clinical
  Audit
• Practical generic audit tool (locally
  adaptable)
• all Staff (clinicians call handlers)
• in different Settings ( telephone, F2F home or
  Base )
• in different Providers along the patient pathway
• Promote Cultural Change individual /
  organisational
• service / contract
• patient centredness - shared decision making
• Audit integral part Continuous Quality
  Improvement