Assess
6.6 Drawing conclusions and making changes
Once you have the results, it is time to act on them! If you started off by establishing criteria by which you will assess your current practice, then it is a simple matter of comparing your results with those criteria, and reporting your results to the practice team.
In many cases, the audit process may well indicate that no change is required. For example, an audit of peri-operative fatalities, or post-surgical wound breakdowns/infections, may indicate that rates have not changed recently and that they remain at levels that are similar to those in other clinics. The point of clinical audit is that it provides baseline data or reference points for comparison. Clinical audit also ensures that a process is in place that will likely result in early identification if things start to go wrong.
Alternatively, your data analysis and interpretation might identify some clinical areas that should be addressed (e.g. areas for improvements in care/performance/service provision etc.). You should use your findings to inform ways of improving, which should be the basis of the recommendations of your audit. These recommendations can be used to develop a realistic and achievable action plan, specifying what needs to be done, how it will be done, who is going to do it and by when. Implementing changes that will improve areas of poorer performance is often the hardest part of any audit.
Example Scenario:
Small animal dental imaging
The implementation of dental radiography was considered beneficial from both an animal welfare and financial aspect, and client feedback was good, despite the increased cost. As the proportion of cats with an owner-reported improvement was lower than desired, Tom’s practice decided to utilise the dental guidelines to implement a new practice protocol for discharge appointments for feline patients after dental treatment, where the vet or head nurse would show owners their cat’s dental chart and radiographs, and a follow-up appointment in 10–14 days would be booked. The practice also decided to continue to monitor client feedback, dental invoices and the numbers of extractions they perform, with a view to reviewing the data again in 12 months’ time.
Key point:
A realistic time frame was set for re-audit in order to ensure the changes implemented to improve outcomes in feline patients could be appropriately evaluated.
Example Scenario:
Completion of financial consent forms
Matthew collected audit data for the previous 100 consecutive hospital admissions, and found that while treatment/procedure consent forms were completed for 99% of cases, completion rates for financial consent forms were considerably lower. Only 57% of financial consent forms included a written estimate and 56% were signed by the owner or representative.
Further analysis shows that financial consent forms were completed for 95% of cases admitted out-of-hours, but for only 46% of cases admitted during normal working hours. He identified that completion of consent forms for out-patient cases was lower than for in-patient cases. Matthew used process mapping as part of his root cause analysis to develop an understanding of the reasons why the performance level for completion of financial consent forms was not being reached. This involves mapping out each step of a process in sequence so that areas for improvement can be identified. As a result of this, the audit team determined that the time of admission would be the easiest point to obtain financial consent, and that vets were best suited to discuss financial estimates and consent with clients. Matthew recognised that a better understanding of the consent process from an owner’s perspective could help to inform future improvements (Whiting et al., 2017).
Matthew presented his audit findings at a hospital team meeting, including his recommendation that a change of policy should be implemented, where the vet admitting the patient would be responsible for discussing financial costs and obtaining financial consent from the client. Matthew plans to re-audit in six months, including collecting data regarding owners’ opinions of the consent process.