Quality improvement topics
Clinical audit
Clinical audit is an 'organised review of current clinical procedures compared with pre-determined standards. Action is then taken to rectify any identified deficiencies in current practices. The review is repeated to see if the standards are being met' (National Audit Office 2005, p.80).
Clinical audit is an important strand of clinical governance activity. Organisations running programmes of clinical audit projects report that they are key to improving standards and disseminating learning.
While clinical audit is an effective way to evaluate whether quality improvements are being implemented it remains underutilised as a learning tool (National Audit Office 2005, National Audit Office 2003).
Clinical effectiveness
Clinical guidelines are ‘systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions’ (Institute of Medicine 1992). “Gold standard” guidelines are prepared via a thorough systematic review of the research literature followed by robust critical appraisal of the evidence. Because clinical guidelines provide opportunities to review care, they are fundamental to clinical effectiveness programmes.
Patient safety
In general, patient safety refers to the concept that patients in health care settings are achieving intended outcomes. Ensuring patient safety involves the establishment of systems and processes that reduce the likelihood of errors and increase the likelihood of intercepting them before any harm occurs.
We have a keen insight into the extent of patient safety incidents (PSIs) in hospital settings thanks to a series of landmark studies since the early 90s. The overall picture is that a large number of patients are injured due to medical treatment and not their underlying disease.
If the results from the British study (Vincent et al 2001) were applied to the NHS, the risk of exposure to harm for someone admitted to hospital in this country is about 1 in 10. Around half these adverse events are preventable. We simply do not know the frequency and type of problems arising in primary care.
Fortunately we are building on the experience of other industries with enviable safety records such as aviation. These industries have used methods that might be of benefit to health care such as the use of reporting systems, computers and design in reducing risk.
Patients and carers have a key role in preventing harm as do leaders who can build a culture that actively learns from error.
References
Some of the items referred to below are in PDF format - see how to access PDF files.
Institute of Medicine (1992). Guidelines for Clinical Practice: From Development to Use. Washington DC: National Academic Press
National Audit Office (2005). A Safer Place for Patients: learning to improve patient safety. London: The Stationery Office
National Audit Office (2003) Achieving Improvement through Clinical Governance: a report on implementation by NHS Trusts (PDF 544.13KB). London: The Stationery Office
Vincent C, Neale G, Woloshynowych M (2001) Adverse events in British hospitals: preliminary retrospective record review. British Medical Journal 322 (7285) 9 June pp. 517-519