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Liverpool Heart and Chest Hospital, Thomas Drive, L14 3PE
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Clinical Audit

Clinical audit is about measuring the quality of care and services against agreed standards and making improvements where necessary.

Clinical effectiveness is the degree to which the organisation is ensuring that best practice, based on evidence of effectiveness where such evidence exists, is used.  

What we do

The Trust recognises the value of clinical audit and sees it as a mechanism for improving quality to provide assurance and achieve high levels of excellence, compassion and safety in care delivery and. It is part of the trust wide Clinical Quality Strategy.

We support the trust in measuring the quality of care against agreed standards and making improvements where necessary. (AUDIT)

The Clinical Audit & Effectiveness Group distribute published NICE guidance and quality standards, National Confidential Enquiries and other High Level Enquiries relevant to the services provided by the Trust, to clinicians for review and implementation as deemed appropriate.

The Clinical Audit & Effectiveness Group is responsible for reviewing the implications of the introduction of all new technology (excluding medicines) to have assurance that governance arrangements are in place in terms of appropriate training, informed consent and clinical audit of the new procedure.

As an organisation, LHCH needs to deliver an audit and effectiveness function that can meet future demands. These include the following:

Care Quality Commission (Registration April 2010)

From 1 April 2015, new essential standards of care have been introduced and are known as ‘fundamental standards’. These are the standards everybody has a right expect when they receive care. They form part of changes to the law recommended by Sir Robert Francis following his inquiry into care at Mid Staffordshire NHS Foundation Trust.

Providers must show they are meeting these fundamental standards of quality and safety across all of the regulated activities they provide.

Department of Health: Quality Accounts

The Quality Account is primarily a public statement of commitment by Trusts to improve quality in priority areas identified in collaboration with stakeholders.  Trusts will be regulated and performance managed against their participation in clinical audit, nationally and locally.

NHS England: NHS Standard Contract

Providers must participate in the National Clinical Audit and Patient Outcomes Programme (NCAPOP) which are relevant to the services they provide and make national clinical audit data available to support the publication of consultant level outcomes.

Commissioning for Quality and Innovation (CQUIN)

A National framework of quality improvement schemes, with locally agreed quality targets to measure against, for care delivery with financial penalties if not achieving. Audit support is required to deliver assurances.

NICE Quality Standards

A set of specific, concise statements that act as markers of high-quality, cost-effective patient care, covering the treatment and prevention of different diseases and conditions they “should support benchmarking of current performance against evidence-based measures of best practice to identify priorities for improvement”  They play a role in Clinical audit, Quality Accounts and Commissioning.

General Medical Council: Consultant appraisal and revalidation

A process by which doctors will have to demonstrate that they are up to date, are fit to practice and are complying with their professional standards. Revalidation draws heavily upon participation in clinical audit, and requires doctors to reflect and act on the results of audit.

Nursing and Midwifery Council - Revalidation, professionalism and the Code

Under revalidation nurses and midwives need to “reflect on their practice based on the requirements of the Code, using feedback from service users, patients, relatives, colleagues and others.

Local Audit Activity

Registration forms, local process and policy are all available for staff at LHCH to conduct a clinical audit and effectiveness projects. Examples where clinical audit can be used for quality improvement:

  • To provide assurance - are we meeting external monitoring requirements and contractual obligations?  Has a recent change in practice improved compliance with the evidence base? 
    Re-audit can provide assurances that improvements are being sustained
  • For safety improvement - Is a particular practice safe when measured against clinical standards?
  • For Clinical and /or cost effective - Is a particular practice compliant with the evidence base e.g. NICE guidance?
  • For Patient experience improvement - Is a service meeting the expectations of its users?

Close working with the Divisions

• To monitor action plans for implementation of best practice based on guideline recommendations and audit findings.

Close working with the Audit Committee and Board 

• Clinical audit should be used to confirm that trust strategies are working and delivering improvements to support the Board Assurance Framework