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Clinical Audit as Evidence for Revalidation


Title: The Effective Clinical Director Author: David J Scott Last modified by: David Scott Created Date: 1/27/2013 7:28:46 PM Document presentation format – PowerPoint PPT presentation

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Title: Clinical Audit as Evidence for Revalidation

Clinical Audit as Evidence for Revalidation
  • Dr David Scott, GMC Associate, Consultant
    Paediatrician and Clinical Lead for Childrens
    Services, East Sussex Healthcare NHS Trust
  • and
  • Former Chairman BMA CC Medical Managers

Topics to be Covered
  • assessing the evidence for revalidation how much
    of the information should be provided by the
    Trust and how much by the individual
  • how do you evidence both participation and
    reflection on clinical audit findings?

Topics to be Covered
  • clinical auditing your practice to provide
    evidence for revalidation
  • the role of clinical audit staff in supporting
    clinicians to prepare for revalidation
  • supporting individuals to prepare for revalidation

Purpose of revalidation
  • To confirm that licensed doctors practice in
    accordance with the GMCs generic standards
  • For doctors on specialist/GP register, to confirm
    that they meet the standards appropriate for
    their speciality (recertification)
  • To identify for further investigation, and
    remediation, poor practice where local systems
    are not robust enough or do not exist

Clinical Audit
  • 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, processes, and outcomes
    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.

The Standards (Explicit Criteria)
  • Professional standards that are set for the
    profession that determine a registrants fitness
    to practise.
  • Subjective the patients point of view.
  • Objective those facts that are observable and
    measurable by a nurse or other clinician.

Good Medical Practice
  • Knowledge, skills and performance
  • Safety and quality
  • Communication, partnership and team work
  • Maintaining trust

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Types of Supporting Information for Revalidation
  • Continuing Professional Development
  • Quality improvement activity
  • Significant events
  • Feedback from colleagues
  • Feedback from patients (where applicable)
  • Review of complaints and compliments

History of Audit
  • 1956 - medical audit.
  • 1989 - Kenneth Clarke, then Secretary of State
    for Health systematic, critical analysis of the
    quality of medical care, including the procedures
    used for diagnosis and treatment, the use of
    resources, and the resulting outcome and quality
    of life for the patient.

Clinical Audit Project (1)
  • Registration of project
  • Agreement of criteria for comparison
  • Lead auditor should be named.
  • There should be an entry referring to the size of
    the impact, the trigger, and the desired
    performance, and a credible (named) source.
  • The presentation date and venue will be decided
    at this stage.
  • An audit reference number should be issued.

Clinical Audit Project (2)
  1. Data are made available. The lead auditor should
    describe the methodology of inclusion and
    exclusion criteria and lost data. This technique
    should mirror the rigour of data handling in
    research projects.
  2. Data analysis and interpretation. Statistical
    methodology should be made clear.

Clinical Audit Project (3)
  1. Presentation of the project, with recommendations
    for implementation.
  2. Trust certification of completed audit should be
    provided to all participants.
  3. Incorporation of the findings from the project
    into a protocol should be considered.
  4. Registration for re-auditing, as per (1.) above.

Health Quality Improvement Partnership
Clinical Audit and Revalidation
  • What activities can be considered clinical audit.
  • Principles for the use of clinical audit in
  • Criteria and key indicators for demonstrating
    involvement by a doctor in the process of
    clinical audit
  • Criteria and key indicators for demonstrating
    reflection and action in response to the results
    of clinical audit
  • Agree the criteria and indicators of a good
    clinical audit project.

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Audit Standards - Revalidation
  • Participation in High Quality Clinical Audit
  • Reflection on the results of Clinical Audit
  • Taking action on the results of Clinical Audit
  • Academy of Medical Royal Colleges (2009)

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Trust Audit Programme
  • National
  • Regional
  • Local
  • Departmental
  • Individual

Audit Activity
  • Audit meetings
  • Mortality and morbidity meetings
  • Serious case reviews
  • Root cause analysis (RCA)
  • Professional review meetings
  • Risk management meetings
  • National audits relating to your specialty
  • Medical record audits
  • Peer review

National Audit Projects
Medical Record Audit Tool
Evidence of participation
Activity Standard Evidence
Attendance at meetings Attend 2/3 meetings Meeting Register
Audit presentation Presentation at Audit Meeting Copy of presentation
Medical record review RCP standards Audit report
Serious case reviews Internal/external experts Copies of anonymised minutes
Peer reviews NICE Guidance, Protocols guidelines Extracts from reports
Out-patient clinic review Peer opinion Reflections on case discussions
Feedback from Colleagues
Feedback from Patients
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Appraisal Discussion
  • Standards
  • Evidence
  • Contributory factors
  • Probity
  • Improvement
  • Personal development
  • Remediation

Performance of Doctors
Adapted from Birch K, Scrivens E Field S
  • I shut my
  • eyes in order
  • to see
  • Paul Gaughuin (1848-1903)

The Role of Clinical Audit Staff
  • Support and advice
  • Manage database of clinical audits
  • Arrange and support audit meetings
  • Participate in networks

Support for Revalidation
  • Activity data
  • Outcome data
  • Complication rates
  • Mortality morbidity data
  • Serious incidents
  • Patient satisfaction data

  • Participation in an enhanced appraisal process
    combined with effective audit of your clinical
    practice should satisfy and reassure patients,
    lead to greater job satisfaction and a
    recommendation for revalidation.

Future Reading
  • Academy of Medical Royal Colleges. Clinical
    Audit and Revalidation - Report and
    Recommendations. https//
  • Royal College of Physicians. What is meant by
    clinical audit for the purposes of
    revalidation? http//