The Countess of Chester Hospital NHS Foundation Trust has pioneered an approach to clinical audit that’s captured the imagination of trusts across the country. Here the trust’s clinical audit leads share how their approach is fostering a learning culture and helping to keep patients safe.
If you were to choose a word or a killer phrase to draw your reader in, chances are it wouldn’t be ‘audit’. With the exception of ‘taxation’ and ‘fiscal probity’, it may be difficult to think of words more likely to make a reader glaze over. Tricky, then, when you want to talk about clinical audits.
So what is a clinical audit and what does it do for NHS patients? Simply put, it looks to see whether the guidelines and pathways for care that doctors and nurses have set have been followed. If they haven’t, or it appears the care given to patients is not as good as it could be, the audit looks into what actions can be taken to improve the situation.
For example, all patients going to theatre for a procedure should give their consent beforehand. How do we know this is happening? By reviewing a sample of patients who have had surgery and checking their notes, we can see whether they have had their consent taken. It gives us a snapshot of how we perform.
So audits provide a picture of the care being delivered. When things go wrong, it becomes even more important to be able to identify where there are gaps.
Dean and I work closely with our Risk and Patient Safety Team, who investigate when incidents take place. They look to establish what happened and why, drawing up an action plan – including a clinical audit – to check that improvements are providing the best possible care to patients.
What we have done in our organisation, the Countess of Chester Hospital NHS Foundation Trust, is take Datix – the integrated governance database system on which we report and manage our incidents – and adapt it so that we can also register our audits.
If, for example, an incident has been reported regarding the taking of observations, we can look into what audits have been done, both centrally and at department-level, on that topic. This provides us with evidence at the click of a button of what assurance we have, and enables us to show the learning we have from that incident.
One of the factors that fell out of Lord Francis’s inquiry into care at Mid Staffs was that the trust did not fully engage with clinical audit. This meant that the problems they had were not being flagged up from the results of their audits. Undertaking audits provides an organisation with knowledge on their performance – a ‘health check’ of systems and procedures to keep patients safe.
Our work on Datix and our ability to link our patient incidents and harms with this health check mechanism has sparked a great deal of interest from other NHS trusts. It has also seen us shortlisted for a Health Service Journal ‘Value in Healthcare’ award.
We have hosted numerous visits and had many conversations with teams about what we have done. A common preconception is that somehow we have now got safety ‘sorted’ – that incidents will drop, and that every doctor will get their audit done on time. In that sense, we are no different from any other NHS trust – incidents will still happen, and audits will still run over time. This is because we are working with human beings and we remain as fallible as anyone. What we are able to do is identify more quickly where these harms are being addressed – a kind of ‘instant intelligence’.
What we must accept in the NHS is that we are human; that we make mistakes. But it’s how we manage the outcomes of these mistakes that provide us with the knowledge that we are doing all we are can to learn from them and to keep our patients safe. How do you manage that process in your organisation?
Michael Spry is the clinical improvement and assurance manager at Countess of Chester Hospital NHS Foundation Trust. Dean Bennett is the trust’s compliance manager. Follow them on Twitter: @mspry78 @deanbennett85
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