Clinical Audit as Evidence for
Revalidation
Dr David Scott, GMC Associate, Consultant
Paediatrician and Clinical Lead for Children’s Services,
East Sussex Healthcare NHS Trust
and
Former Chairman BMA CC Medical Managers Subcommittee
Topics to be Covered
• assessing the evidence for revalidation:
how much of the information should be
provided by the Trust and how much by
the individual
• how do you evidence both participation
and reflection on clinical audit findings?
Topics to be Covered
• clinical auditing your practice to provide
evidence for revalidation
• the role of clinical audit staff in
supporting clinicians to prepare for
revalidation
• supporting individuals to prepare for
revalidation
Purpose of revalidation
• To confirm that licensed doctors practice in
accordance with the GMC’s generic
standards (relicensing)
• For doctors on specialist/GP register, to
confirm that they meet the standards
appropriate for their speciality (recertification)
• To identify for further investigation, and
remediation, poor practice where local
systems are not robust enough or do not exist
Clinical Audit
• A quality improvement process that seeks to improve
patient care and outcomes through systematic review
of care against explicit criteria and the
implementation of change.
• Aspects of the structure, processes, and outcomes of
care are selected and systematically evaluated
against explicit criteria.
• Where indicated, changes are implemented at an
individual, team, or service level and further
monitoring is used to confirm improvement in
healthcare delivery.
The Standards (Explicit Criteria)
• Professional – standards that are set
for the profession that determine a
registrant’s ‘fitness to practise’.
• Subjective – the patient’s point of view.
• Objective – those facts that are
observable and measurable by a nurse
or other clinician.
Good Medical Practice
– Knowledge, skills
and performance
– Safety and quality
– Communication,
partnership and
team work
– Maintaining trust
Types of Supporting
Information for Revalidation
• Continuing Professional
Development
• Quality improvement
activity
• Significant events
• Feedback from
colleagues
• Feedback from patients
(where applicable)
• Review of complaints
and compliments
History of Audit
• 1956 - medical audit.
• 1989 - Kenneth Clarke, then Secretary
of State for Health: “systematic, critical
analysis of the quality of medical care,
including the procedures used for
diagnosis and treatment, the use of
resources, and the resulting outcome
and quality of life for the patient.”
Clinical Audit Project (1)
1. Registration of project
– Agreement of criteria for comparison
– Lead auditor should be named.
– There should be an entry referring to the size of
the impact, the trigger, and the desired
performance, and a credible (named) source.
– The presentation date and venue will be decided
at this stage.
– An audit reference number should be issued.
Clinical Audit Project (2)
2. Data are made available. The lead auditor
should describe the methodology of
inclusion and exclusion criteria and lost
data. This technique should mirror the
rigour of data handling in research projects.
3. Data analysis and interpretation. Statistical
methodology should be made clear.
Clinical Audit Project (3)
4. Presentation of the project, with
recommendations for implementation.
5. Trust certification of completed audit should
be provided to all participants.
6. Incorporation of the findings from the project
into a protocol should be considered.
7. Registration for re-auditing, as per (1.)
above.
Health Quality Improvement Partnership
http://www.hqip.org.uk
Clinical Audit and Revalidation
•
•
•
•
•
What activities can be
considered clinical audit.
Principles for the use of clinical
audit in revalidation
Criteria and key indicators for
demonstrating involvement by a
doctor in the process of clinical
audit
Criteria and key indicators for
demonstrating reflection and
action in response to the results
of clinical audit
Agree the criteria and indicators
of a good clinical audit project.
Audit Standards - Revalidation
• Participation in High Quality Clinical
Audit
• Reflection on the results of Clinical
Audit
• Taking action on the results of Clinical
Audit
Academy of Medical Royal Colleges (2009)
Trust Audit Programme
•
•
•
•
•
National
Regional
Local
Departmental
Individual
Audit Activity
• Audit meetings
• Mortality and
morbidity meetings
• Serious case
reviews
• Root cause analysis
(RCA)
• Professional review
meetings
• Risk management
meetings
• National audits
relating to your
specialty
• Medical record
audits
• Peer review
National Audit Projects
Medical Record Audit Tool
Evidence of participation
Activity
Standard
Evidence
Attendance at meetings Attend 2/3 meetings
Meeting Register
Audit presentation
Presentation at Audit
Meeting
Copy of presentation
Medical record review
RCP standards
Audit report
Serious case reviews
Internal/external
‘experts’
Copies of anonymised
minutes
Peer reviews
NICE Guidance,
Protocols & guidelines
Extracts from reports
Out-patient clinic
review
Peer opinion
Reflections on case
discussions
Feedback from Colleagues
Feedback from Patients
Appraisal Discussion
•
•
•
•
•
•
Standards
Evidence
Contributory factors
Probity
Improvement
Personal
development
• Remediation
Performance of Doctors
Adapted from : Birch K, Scrivens E & Field S (1999)
Insight
“I shut my
eyes in order
to see”
Paul Gaughuin (18481903)
The Role of Clinical Audit
Staff
• Support and advice
• Manage database of
clinical audits
• Arrange and support
audit meetings
• Participate in
networks
Support for Revalidation
•
•
•
•
Activity data
Outcome data
Complication rates
Mortality & morbidity
data
• Serious incidents
• Patient satisfaction
data
Conclusion
• Participation in an enhanced
appraisal process combined with
effective audit of your clinical
practice should satisfy and
reassure patients, lead to greater
job satisfaction and a
recommendation for revalidation.
Future Reading
• Academy of Medical Royal Colleges. Clinical Audit
and Revalidation - Report and Recommendations.
https://www.p-cat.org.uk/downloads/Clinical-AuditRevalidation.pdf
• Royal College of Physicians. What is meant by
‘clinical audit’ for the purposes of revalidation?
http://www.rcplondon.ac.uk/faqs/what-meant-clinicalaudit-purposes-revalidation