Article Figures & Data
Figures
- Fig 1.
Mean adjusted glycated haemoglobin values for children and young people with type 1 diabetes cared for by paediatric diabetes units in England and Wales: an example of ‘alarm’ level outliers. Units outside the upper three standard deviation control limit are designated ‘alarm’ level outliers. Adapted with permission from the Healthcare Quality Improvement Partnership. HbA1c = glycated haemoglobin; PDUs = paediatric diabetes units; SDs = standard deviations.
- Fig 2.
Interval from decision to operate to arrival in theatre (expedited): an example of special cause variation. The black line represents the month-by-month national benchmark hospital performance on the time interval from decision to operate to the patient arriving in theatre. The teal line illustrates the data for this particular hospital. The teal dots represent individual patients. There are three outliers (dots) above the upper control limit (red line), indicating patients who waited longer than the upper control limit. Adapted with permission from National Emergency Laparotomy Audit.
Tables
Case study 1: The provider experience: King’s College Hospital NHS Foundation Trust
The national clinical audit programme is a significant component of the quality improvement programme at King’s College Hospital NHS Foundation Trust (KCH). The trust has two large acute hospital sites: 87 national audits and confidential enquiries are relevant to the King’s College Hospital (Denmark Hill) site and 64 to the Princess Royal University Hospital (Bromley) site.
Reviewing the results of national audits is a significant undertaking and happens both within the clinical teams and centrally. There is no standardisation in the reporting of the national audits, so the patient outcomes team analyses each report and summarises, with input from the clinical leads, the key messages in relation to successes, concerns and required improvement. This enables the busy clinical teams, clinical governance structures, executive team and board to understand quickly and easily the implications of the results and use the information to drive improvement.
As with all NHS organisations, excellent patient outcomes and experience are the key aims, so to get most value out of the effort expended, the trust particularly focuses the efforts on national audit indicators relating to patient outcomes and experience. Where the trust does not perform well against these indicators, the trust targets a detailed review of the processes through internal investigations. The trust embeds the improvement actions into existing care group-, division- and trust-level action plans, ensuring that the work is joined up with other organisational priorities and improvement actions.
The trust is currently working with the business intelligence unit to develop an application to enable the capture of these data for use within the trust’s data warehouse. This will support clinical teams to use data from the national audits alongside performance and activity data to provide a holistic picture of their service. In addition, this will enable the trust to analyse themes occurring across the national audits, such as those relating to complications, pain management and provision of services.
Case study 2: The inspector experience: working with Calderdale and Huddersfield NHS Foundation Trust
From an inspector perspective, outcomes from externally validated data are an important part of engagement, monitoring and on-site inspections; as they help the Care Quality Commission (CQC) to objectively measure how an organisation is performing.
The approach to managing outlier alerts from national audits can also be an indicative of an organisation’s responsiveness and culture; for example, Calderdale and Huddersfield NHS Foundation Trust recently experienced an outlier alert in relation to a National Paediatric Diabetes Audit measure. The trust informed the CQC relationship owner (inspector) of this at the point at which they were alerted. This indicated that the trust was open and proactively managing alerts. It also enabled the inspector to have timely oversight of potential areas of concern, greater awareness of trust investigations to determine why the alert occurred (for example, from audit peer review) and knowledge of any immediate actions taken. Ongoing work includes reviewing the completion of action plans and discussing performance during regular engagement meetings. The proactive approach taken by the trust helped to provide assurance to CQC that the organisation was not merely collecting data but was actively using it to drive quality improvements, a marker of being well led.9
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Outliers from national audits: their analysis and use by the Care Quality Commission in quality assurance and regulation of healthcare services in England
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- Article
- ABSTRACT
- Introduction
- The use of data from national audits
- How audits identify outliers
- The CQC actions following notification of an audit outlier and the response expected from providers
- How hospitals can use audit data to inform quality improvement initiatives
- Does the use of data from national audits and assessment of outliers improve patient care?
- Ongoing challenges with the use of audit data in the regulatory process
- Conclusion
- Supplementary material
- Acknowledgements
- References
- Figures & Data
- Info & Metrics
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