Assess
6.7 Acting on the results of clinical audit – sustaining improvements
As we become more proactive in EBVM, we may go further than identifying areas requiring improvement and be able to proactively establish a system to regularly (continuously or periodically) assess outcomes. We can then use that information to review our treatments, protocols and procedures, for the betterment of ourselves and our veterinary patients.
The overarching principle to successful implementation and adoption of both EBVM and clinical audit is to keep things small and simple, especially to start off with. It should be possible for you to set a modest goal of clear benefit, and to achieve it. Communication is also important – be sure you keep records of the process and of your findings so that you can compare the next cycle with the last. Discuss the tasks and progress with colleagues both during and after each audit cycle. Good communication will help to involve the more experienced (and often busiest) members of the practice who may at first be reluctant or unable to engage otherwise.
While the primary goal of clinical audit is improving performance, sustaining that improvement is also essential. The audit cycle is a continuous process, and requires re-auditing to ‘close the loop’. Re-audit is central to both assessing and maintaining the improvements made during clinical audit. The same methods for sample selection, data collection and analysis should be used to ensure that the data are valid and comparable with the results from previous audit(s).
Part of the audit process should be for you and your colleagues to identify thresholds that might trigger you to further action. That action might involve further in-depth investigation, or it may involve an increased frequency of the audit cycle to see if preliminary results are indeed a trend in the wrong direction, or just an anomaly that should be monitored but perhaps not acted on at this time. On the whole, a common sense approach is required. However, an explicit and systematic process can help veterinary practices avoid falling into complacency or inertia.
Where an initial audit demonstrates that desired performance levels are not being reached and an action plan has been put in place, the audit should then be repeated to show whether the changes implemented have improved care or whether further changes are required. This cycle is repeated until the desired standards are being achieved. Where the initial audit showed that no changes or improvements were required, re-auditing allows you to ensure that the high standards of care are being maintained.
Sustainable improvements in quality of care are going to be more readily achieved where everyone in the practice (or profession) is aware, and supportive, of planned audit activity. In addition to fostering a culture of continuous improvement, longer term success may require practice development; for example, there may be a requirement for training or organisational changes, such as modifying format, content or quality of clinical records, updating or changing practice management software or time allocation for team members involved in clinical audit to gather and analyse.