An Audit Example – Part 2, STUDY, ACT

This is part 2 of an example of audit, if you missed part 1 read it here.  I have found it a really helpful exercise, it demonstrated what audit is meant to show – what we think we are doing in practice is not necessarily what we are doing.  I have got some good points for action to help me improve over the next year.  My aim is to hopefully demonstrate to you the value of audit and encourage you to audit your own practice and gain the benefits for professional development.

STUDY

It took approximately 2.5 hours to input the date from 50 patients into the audit form.  This was not as arduous as it may seem as I just did it in gaps between patients and it was soon done.

Looking at the data there are a number of observations that can be made, some just about the data and others comparing the data to my criteria.

As a reminder, my audit criteria were:

  • 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.

Population included in audit:

Average age  50.24

Condition presenting with:

Median time of condition: 3 weeks, Range 1 day to 8 years; 11 patients presented with conditions that were within the chronic pain time frame of 3 months or longer.

Achieving of criteria:

How often three-fold care achieved

19 cases received psychosocial, exercise and manual therapy

Identification of values/goals

37 patients identified values, of these 26 have treatment values as an outcome

No. treatments  Average 3.22

Range of techniques

Patterns noted

These are just patterns identified from the data but cannot be used to make any significant conclusions, they are just interesting to note:

Neck and shoulder treatment was successful in this population – all better or improved.

Length of time of problem doesn’t correlate with outcomes

Patients over 60 –  No. = 15 – 6(2), 2(1), 7(0)

On average treatment estimates, although not always recorded, were over-estimated by 1 treatment.

Commentary

The range of conditions were as I would have expected for my patient population with low back pain and neck pain being the most common presentations.  About 20% of the patients present with chronic conditions.  Less than half of the patients received the benchmark of three-fold care.  Values were identified for 70% of patients but only used as an outcome measure for 50%.  The average number of treatments was just over 3 which confirms what I tell my patients.  There did not seem to be any correlation between treatment interventions and identification of values or psychosocial elements to conditions and treatment outcomes.  Within my clinic though I know that I do not place enough emphasis on achieving values or necessarily addressing psychosocial elements.  I was surprised that as many as 20% of patients did not receive exercise advice.  Records were not sufficient to demonstrate different methods of communication used with patients.

Approximately 20% of this patient population did not improve with treatment, 78% felt better or improved after treatment.  Of those that did not improve there was a mix of presentations and duration of symptoms.  There were no patterns in treatment techniques that were used.  Only 3 had psychosocial factors recorded.  Most had identified values but these were only an outcome measure for one of these patients.

 ACT

The audit shows that in terms of my criteria there is significant room for improvement.  In this snapshot of my patients there are several improvements that can be made:

  • Increase the number of patients for whom values are identified and use them as an outcome measure for patients.
  • Use more variety of options for sharing information with patients – making more use of educational videos and articles and record these in patient records
  • Increase the number of patients receiving three-fold care, especially for chronic pain – exercise, psychosocial support and manual therapy.

This can be done by:

  1. Emphasising values in case history taking and identifying them as a goal for treatment.
  2. Improving resource list to easily send information to patients.
  3. Improve documentation of communication methods, and use wider variety – have resources available.
  4. Identify and record psychosocial elements within the case history, have resources available for patient support, make sure exercise is matched to patient’s values.

Action plan

Action Timescale
Review the case history to make sure there is sufficient space for recording values and psychosocial aspects of care End of March 2017
Make a portfolio of resources for patients – articles and videos and leaflets May 1st 2017 and ongoing additions
Work on incorporating values and psychosocial elements into patient care and recording in notes, provide appropriate support and resources to patients Ongoing

 RE-AUDIT

Re-audit in 12 months to assess success of implementation of changes and impact of changes on outcomes.

Reflection

In order to demonstrate how this audit has affected my practice I will use a written reflection.  This may be most beneficial after the re-audit as I have plenty of time in my 3 year CPD cycle.

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