Clinical Audit
Clinical audit is a crucial part of the Trusts strategy to improve health care to service users. The evaluation of clinical performance against standards or through comparative analysis, with the aim of informing the management of services, is an essential component of modern healthcare provision. It forms part of the Trusts clinical governance arrangements helping to ensure safe and effective clinical practices.
During 2022/23, EEAST participated in 100% of all required national audits which for ambulances are those defined within the Ambulance Clinical Quality Indicator (ACQI) programme, three of which: stroke; cardiac arrest and STEMI were included earlier in this section. It also fully participated in the National epidemiology and Outcome from out-of-Hospital Cardiac Arrest (OHCA) registry study undertaken by the University of Warwick and is included as an audit within the Healthcare Quality Improvement Partnership (HQIP) annual programme.
The fourth ACQI relates to Sepsis, a description of which is provided below along with EEASTs performance compared against the national average and upper and lower scores.
Although recognition of sepsis by our staff has a high compliance rate, we were seeking to continue to achieve a sustained high level of recognition and appropriate treatment for sepsis patients, recognising that early recognition, timely interventions and transportation to hospital is a key factor for the patients outcome.
The care bundle is made up of four indicators which all have to be met to be compliant:
- Recording of patient observations (breathing rate, level of consciousness and blood pressure)
- Administration of oxygen
- Administration of fluids
- Pre-alert provided to the receiving hospital.
This ACQI was removed from the national programme in July 2022, the table below demonstrates our performance for the care bundle against national data published for the year to this date. EEAST was the third highest performing trust for this ACQI.
| Sepsis Care | National Data (April to November 2022) |
|---|---|
| National Average | Highest Score |
| Sepsis care bundle | 84.6% |
Local Audits 2022/23
Undertaking audit in relation to the nationally mandated Ambulance Clinical Quality Indicators relating to cardiac arrest, stroke, STEMI and sepsis patients is a huge amount of work, however in 2022/23 we also undertook nine further audits as defined within our set plan for the year. The table below shows the audit topic, levels of compliance, identified areas requiring improvement and next steps to improve the quality of care we deliver.
| Topic | Compliance | Areas for improvement | Next steps |
| Management of Abdominal Pain - Pilot Audit | Overall care bundle compliance - 50% | Documentation of pain scoresReferral to another HCP where indicated | Re-audit 2023/24 - increase care bundle by 25%+ |
| Asthma - Re-audit | Overall care bundle compliance - 66.8% | Recording of oxygen saturation levels including where the patient was unable to provide oneDocumentation of Beta-2agonist administered | Re-audit 2023/24 - increase care bundle by 25% |
| Use of Antimicrobials - Pilot Audit | 6/8 indicators achieved 100% compliance | Recording of:- Blood glucose level- News2 score | Re-audit 2023/24 to include additional indicators relating to actual News2 score and whether the patient had any history of diabetes |
| Deliberate Self Harm | Overall care bundle compliance - 71.3% | Documentation of:- Mental capacity assessment- Information relating to social/family support network or Next of Kin | Re-audit 2023/24 - increase care bundle by 20%Inclusion of the completion and quality of documentation within the mental capacity assessment forms |
| Assessment and Management of Maternity including use of Misoprostol and Tranexamic Acid - Pilot Audit | High levels of compliance for:Observations, timeframe for bleeding and total blood loss | Documentation of: Uterine massage Administration of uterotonic drug (misoprostol) ahead of administration of tranexamic acid Separate patient care record for baby | Re-audit 2023/24 - longer audit period to ensure larger data capture |
| Re-audit of PCR Submission | Submission rate - 97.9%Records completed electronically - 93.4%Documentation of clinical impression code - 93.1% overall. Completed in 99.1% of electronic records | Documentation of clinical impression code to be increased, however this achieved higher levels of compliance when an electronic record was completed. Due to the ongoing increase of the use of electronic vs paper records, this should also improve. | Audit will not be repeated in 2023/24, however a new audit of the quality of documentation will be introduced. |
| Trauma - Use of Tranexamic Acid - Re-audit | High levels of compliance for:Observations, timeframe for bleeding and total blood loss, administration of oxygen and hospital pre alerts | Documentation of pain scoresA number of patients were given this drug by another HCP meaning that the true usage administered by EEAST staff is inaccurate.There seems to be some confusion for staff regarding the difference between JRCALC guidelines and Trust Patient Group Directives as to bolus | Results of audit will be discussed with the Trusts Trauma Lead, Medical Director and Pharmacist to identify actions for implementation.Topic to be re-audited in 2023/24 once actions have been implemented. |
| Non-ConveyancePaediatric Patients - Pilot Audit | 9/11 indicators achieved compliance level of above 95%High levels of safety netting | Documentation of:- Blood glucose level- Educational facilityWorsening advice given | Re-audit 2023/24 with the aim of increasing the remaining to indicators to 95%. |
A further three audits were not completed in the year;
- Falls in the elderly. This will be undertaken as part of a new national ACQI in 2023/24. EEAST currently participating in the pilot audit. National commencement date to be set by NHS England.
- Mental health. Awaiting further information from NHS England regarding commencement and requirements.
- Learning difficulties. This has been included as a priority within the clinical audit plan for 2023/24.
As well as an extensive clinical audit plan, the Trust undertakes a number of routine monthly audits for topics such as infection prevention and control and the management of medicines to ensure that patients and staff remain protected and we remain compliant with legislation.
