A national audit of compliance with specialist skin cancer quality improvement guidelines

2015 ◽  
Vol 68 (11) ◽  
pp. 1631-1632
Author(s):  
E. Kissin ◽  
J.A. Dunne ◽  
B.W.E.M. Powell
Keyword(s):  
Quality Improvement ◽  
Skin Cancer ◽  
National Audit

scholarly journals Specialist pneumonia intervention nurse service improves pneumonia care and outcome

2021 ◽  
Vol 8 (1) ◽  
pp. e000863
Author(s):  
Robert C Free ◽  
Matthew Richardson ◽  
Camilla Pillay ◽  
Kayleigh Hawkes ◽  
Julie Skeemer ◽  
...  
Keyword(s):  
Quality Improvement ◽  
National Health Service ◽  
Low Cost ◽  
Community Acquired Pneumonia ◽  
National Audit ◽  
Mortality Benefit ◽  
Model Of Care ◽  
Spin Period ◽  
National Health Service Trust ◽  
Set Up

BackgroundA specialist pneumonia intervention nursing (SPIN) service was set up across a single National Health Service Trust in an effort to improve clinical outcomes. A quality improvement evaluation was performed to assess the outcomes associated with implementing the service before (2011–2013) and after (2014–2016) service implementation.ResultsThe SPIN service reviewed 38% of community-acquired pneumonia (CAP) admissions in 2014–2016. 82% of these admissions received antibiotic treatment in <4 hours (68.5% in the national audit). Compared with the pre-SPIN period, there was a significant reduction in both 30-day (OR=0.77 (0.70–0.85), p<0.0001) and in-hospital (OR=0.66 (0.60–0.73), p<0.0001) mortality after service implementation, with a review by the service showing the largest independent 30-day mortality benefit (HR=0.60 (0.53–0.67), p<0.0001). There was no change in length of stay (median 6 days).ConclusionImplementation of a SPIN service improved adherence to BTS guidelines and achieved significant reductions in CAP-associated mortality. This enhanced model of care is low cost, highly effective and readily adoptable in secondary care.

scholarly journals The National Pain Audit for specialist pain services in England and Wales 2010–2014

2018 ◽  
Vol 13 (3) ◽  
pp. 185-193 ◽  
Author(s):  
Cathy Price ◽  
Amanda C de C Williams ◽  
Blair H Smith ◽  
Alex Bottle
Keyword(s):  
Quality Improvement ◽  
Waiting Times ◽  
Pain Clinic ◽  
Standards Of Care ◽  
National Audit ◽  
England And Wales ◽  
Safety Standards ◽  
Diagnostic Coding ◽  
Pain Clinics ◽  
Pain Services

Introduction: Numerous reports highlight variations in pain clinic provision between services, particularly in the provision of multidisciplinary services and length of waiting times. A National Audit aims to identify and quantify these variations, to facilitate raising standards of care in identified areas of need. This article describes a Quality Improvement Programme cycle covering England and Wales that used such an approach to remedy the paucity of data on the current state of UK pain clinics. Methods: Clinics were audited over a 4-year period using standards developed by the Faculty of Pain Medicine of The Royal College of Anaesthetists. Reporting was according to guidance from a recent systematic review of national surveys of pain clinics. A range of quality improvement measures was introduced via a series of roadshows led by the British Pain Society. Results: 94% of clinics responded to the first audit and 83% responded to the second. Per annum, 0.4% of the total national population was estimated to attend a specialist pain service. A significant improvement in multidisciplinary staffing was found (35–56%, p < 0.001) over the 4-year audit programme, although this still requires improvement. Very few clinics achieved recommended evidence-based waiting times, although only 2.5% fell outside government targets; this did not improve. Safety standards were generally met. Clinicians often failed to code diagnoses. Conclusion: A National Audit found that while generally safe many specialist pain services in England and Wales fell below recommended standards of care. Waiting times and staffing require improvement if patients are to get effective and timely care. Diagnostic coding also requires improvement.

scholarly journals National clinical audit for hospitalised exacerbations of COPD

2020 ◽  
Vol 6 (3) ◽  
pp. 00208-2020
Author(s):  
John R. Hurst ◽  
Jennifer K. Quint ◽  
Robert A. Stone ◽  
Yvonne Silove ◽  
Jane Youde ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Financial Incentives ◽  
National Standards ◽  
Care Process ◽  
National Audit ◽  
Cross Sectional ◽  
Delivery Of Care ◽  
Copd Exacerbations ◽  
Process Indicators ◽  
Benchmarking Performance

IntroductionExacerbations of COPD requiring hospital admission are burdensome to patients and health services. Audit enables benchmarking performance between units and against national standards, and supports quality improvement. We summarise 23 years of UK audit for hospitalised COPD exacerbations to better understand which features of audit design have had most impact.MethodPilot audits were performed in 1997 and 2001, with national cross-sectional audits in 2003, 2008 and 2014. Continuous audit commenced in 2017. Overall, 96% of eligible units took part in cross-sectional audit, 86% in the most recent round of continuous audit. We synthesised data from eight rounds of national COPD audit.ResultsClinical outcomes were observed to change at the same time as changes in delivery of care: length of stay halved from 8 to 4 days between 1997 and 2014, alongside wider availability of integrated care. Process indicators did not generally improve with sequential cross-sectional audit. Under continuous audit with quality improvement support, process indicators linked to financial incentives (early specialist review (55–66%) and provision of a discharge bundle (53–74%)) improved more rapidly than those not linked (availability of spirometry (40–46%) and timely noninvasive ventilation (21–24%)).ConclusionCareful piloting and engagement can result in successful roll-out of cross-sectional national audit in a high-burden disease. Audit outcome measures and process indicators may be affected by changes in care pathways. Sequential cross-sectional national audit alone was not generally accompanied by improvements in care. However, improvements in process indicators were seen when continuous audit was combined with quality improvement support and, in particular, financial incentives.

scholarly journals Role of the Prescribing Observatory for Mental Health

2012 ◽  
Vol 201 (6) ◽  
pp. 428-429 ◽  
Author(s):  
Thomas R. E. Barnes ◽  
Carol Paton
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
Positive Change ◽  
Psychiatric Services ◽  
National Audit ◽  
Prescribing Practice ◽  
Qualitative Work ◽  
The Uk

SummaryPositive change in prescribing practice in psychiatric services can be achieved with participation in the UK Prescribing Observatory for Mental Health (POMH-UK) quality improvement programmes. Key elements are feedback of benchmarked performance for local clinical reflection and customised change interventions informed by the national audit findings and parallel qualitative work. However, progress is gradual and gains generally modest.

scholarly journals A multicenter prospective audit to investigate the current management of patients undergoing anti-reflux surgery in the UK: Audit & Review of Anti-Reflux Operations & Workup

2021 ◽  
Author(s):  
◽  
Rob Walker ◽  
Tom Wiggins ◽  
Natalie S Blencowe ◽  
John M Findlay ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Future Research ◽  
National Audit ◽  
Prospective Audit ◽  
Audit Review ◽  
Full Dataset ◽  
Operative Care ◽  
National Quality ◽  
Local Quality ◽  
The Uk

Abstract Background There are a variety of surgical and endoscopic interventions available to treat gastroesophageal reflux disease. There is, however, no consensus on which approach is best. The aim of this national audit is to describe the current variation in the UK clinical practice in relation to anti-reflux surgery (ARS) and to report adherence to available clinical guidelines. Methods This national audit will be conducted at centers across the UK using the secure online web platform ALEA. The study will comprise two parts: a registration questionnaire and a prospective multicenter audit of ARS. All participating centers will be required to complete the registration questionnaire comprising details regarding pre-, peri-, and post-operative care pathways and whether or not these are standardized within each center. Following this, a 12-month multicenter prospective audit will be undertaken to capture data including patient demographics, predominant symptoms, preoperative investigations, surgery indication, intraoperative details, and postoperative outcomes within the first 90 days. Local teams will retain access to their own data to facilitate local quality improvement. The full dataset will be reported at national and international scientific congresses and will contribute to peer-reviewed publications and national quality improvement initiatives. Conclusions This study will identify and explore variation in the processes and outcomes following ARS within the UK using a collaborative cohort methodology. The results generated by this audit will facilitate local and national quality improvement initiatives and generate new possibilities for future research in anti-reflux interventions.

How, why and in what contexts do web-based dashboards support the use of national audit data in quality improvement: Findings from a realist evaluation of a novel, quality dashboard in England. (Preprint)

2021 ◽  
Author(s):  
Natasha Alvarado ◽  
Lynn McVey ◽  
Mai Elshehaly ◽  
Joanne Greenhalgh ◽  
Dawn Dowding ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Realist Evaluation ◽  
Support Staff ◽  
Ease Of Use ◽  
Perceived Usefulness ◽  
National Audit ◽  
Local Data ◽  
Care Needs ◽  
Web Based ◽  
Audit Data

UNSTRUCTURED Objective: Dashboards can support data-driven quality improvement in healthcare. They visualise data in ways intended to ease cognitive load and support data comprehension, but how they are best integrated into working practices to impact patient care needs further investigation. This paper reports the findings of a realist evaluation of a web-based, interactive quality dashboard (QualDash) developed to support use of national audit data in quality improvement. Methods: QualDash was co-designed with data users and installed in eight clinical services across five healthcare organisations in England between July and December 2019. Local ‘champions’ were identified to support uptake and adoption. Data to evaluate QualDash were collected between August 2019 and August 2021 and consisted of (1) 148.5 hours of observations including hospital wards and clinical governance meetings, (2) logfiles that captured the extent of use of QualDash and (3) a questionnaire, based on the Technological Acceptance Model, to assess the dashboard’s perceived usefulness and ease of use. Guided by the principles of realist evaluation, data were analysed to understand how, why and in what circumstances QualDash best supported use of national audit data in quality improvement. Results: The services into which QualDash was introduced varied in the amount and type of resources available to support data use. These variations, alongside early staff interactions with QualDash, shaped its use and impact during the evaluation period. Well-resourced sites with skilled audit support staff and local data management systems, continued to use established processes to access and use data. Factors constraining use of QualDash in these contexts included the use of local systems to report metrics not configured in QualDash; staff not being fully aware how QualDash could facilitate their work; and champions’ initial reluctance to lead use of QualDash until some metrics were reconfigured to reflect user expectations. In services less well-resourced to use data, QualDash automated parts of their routine reporting process, streamlining the work of audit support staff, and, in some cases, it highlighted issues with data completeness that they worked to address. Furthermore, questionnaire responses indicated that QualDash was perceived as useful and easy to use despite its variable use in practice. Conclusions: Interactive, web-based dashboards, such as QualDash, have potential to support use of national audit data in quality improvement by facilitating access to and interactions with data. To optimise use and impact, findings suggest that codesign would benefit from greater scrutiny of dashboard visualisations pre-installation, by site staff knowledgeable about metric configurations. Additionally, further consideration should be given to the processes surrounding dashboard use, including data collection, that underpin user confidence in dashboard functions. INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2019-033208

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