This blog is going to go through a practical example of audit and the results. Last week we identified a long list of areas of practice that could be audited. There were several areas of practice that I was interested in auditing – patient outcomes, care of ‘maintenance’ patients and letter writing.
Please note I am not an audit expert, just an ordinary clinical osteopath, like most of my readers. If you want expert opinion on audit please seek advice from NCOR I am just sharing a practical example of audit, hopefully to inspire you to carry out your own audit in practice.
For this example I chose the first item – patient outcomes. This is not the simplest or quickest audit to do but it gives a good insight into practice. There are templates available for simple audits on the NCOR website and when you purchase a Mint Folder.
I decided to look at patient outcomes in relation to several aspects – communication with the patient, estimated number of treatments, actual number of treatments, and outcome of treatment. We know several best pathways of care particular with relation to persistent pain, back pain and communication. To make the process clear I will use the model below and work through it:
What do we want to accomplish
The aim is to see whether I am providing patients with good information and treatment processes – are predictions of the number of treatments required accurate. Treatment given, duration of symptoms, region of pain and communication with patient will be considered to reveal any influences on treatment numbers required.
The questions is – are treatment predictions more accurate if particular treatment protocols are used or to put that the opposite way – are treatment outcomes better/worse with certain treatment protocols? Are we using the best treatment protocols and how does that influence treatment outcomes?
What changes might be useful
We know that the biopsychosocial model is important in our approach to patient care but is that being effectively utilised in clinic.
The recent NICE guidelines for chronic low back pain identified that ‘best treatment’ would include manual therapy, exercise and psychological therapies. This is consistent with research evidence for many long-term pain conditions. The question is whether this is what is being done in my practice and how it influences treatment outcomes.
The standards set for this audit are:
- All patients should be receiving three-fold care – manual therapy, exercise and psychological support
- All patients should have identified values/goals that they can achieve through treatment
- Treatment outcomes may be better when all these elements are in place
- Does particular communication with patients improve outcomes – providing videos, information etc.
NICE guidelines and persistent pain literature has identified multifactorial treatment is the best approach for patients. Communication of these treatment approaches is important too.
How will we measure progress?
The audit will be carried out by taking data from adult new patients seen in the last year (2016). 50 entries should provide sufficient data for analysis. If not, more will be entered.
Information will be entered into an excel spreadsheet and then analysis carried out to identifiy patterns and see whether ‘best treatment’ protocols are being followed and when they are does it result in better treatment outcomes. How accurate are we at predicting these outcomes?
I know that all my patient records will not include these elements at this stage as I am changing the way I practice. I want to see how many patients I am using this approach with and what benefit it has as I continue to make further changes in my treatment approach.
I will be sharing the excel audit form in the facebook group but will test out the audit first before sharing.
The next phase is to DO so I will now be carrying out the audit and share the results and actions in another blog before the end of the month.
Carry out the plan
So I am off to carry out the plan, gathering 50 adult new patient case histories from 2016 and entering the data into the form.
I will initially enter 10 lots of patient data and then review my form to make sure it is effectively gathering data that will be effective in achieving the aims of the audit.
The outcomes will be analysed and reported in another blog.
Are you feeling inspired to carry out an audit of your practice? Maybe you already regularly use audit. Share your experience and inspire your colleagues to discover the benefits of audit.