Clinical audits must improve to benefit patients, providers, and doctors

Non-invasive vagus nerve stimulation for treatment of cluster headache: a retrospective review of prescribing in England

British Journal of Healthcare Management ◽

10.12968/bjhc.2021.0126 ◽

2021 ◽

pp. 1-11

Author(s):

Nicholas Silver ◽

Carl Bradley ◽

Rebecca Stuckey ◽

Madeleine Murphy ◽

Fiona Greenwood ◽

...

Keyword(s):

Cluster Headache ◽

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Non Invasive ◽

Innovation And Technology ◽

Prescription Refill ◽

Collection Period ◽

Continued Use ◽

Clinical Audits

Background/Aims Beginning in April 2019, non-invasive vagus nerve stimulation was included in the NHS Innovation and Technology Payment programme. The programme guaranteed reimbursement of at least a 3-month course of treatment using gammaCore, through a prescription refill card, authorised by a headache specialist for patients with cluster headache who reported a clinically meaningful benefit. This study evaluated prescribing and refill trends to assess the use of gammaCore in England since the beginning of this programme. Methods Data regarding gammaCore prescriptions and refills from 1 April 2019 to 31 December 2020 were collected and tabulated. Patients were categorised into three groups: those who initiated gammaCore therapy under the programme (new starters), those who were prescribed ≥1 refill, and those who were prescribed ≥2 refills. One refill corresponds to 3 months of gammaCore therapy. Results In total, 52 NHS sites submitted 2092 prescriptions for gammaCore devices, including 655 for new starters. Among new starters, 46.3% received ≥1 refill and 30.9% received ≥2 refills. Those who started using gammaCore after its inclusion in the Innovation and Technology Payment programme received up to seven refills during the data collection period, representing 21 months of therapy. Conclusions This is one of the largest clinical audits of patients with cluster headache. Patients' continued use of gammaCore treatment through multiple 3-month refills in this audit suggests that non-invasive vagus nerve stimulation is efficacious, tolerable and practical for patients with cluster headache.

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Closing the loop between evidence-based medicine and care delivery: a possible role for clinical audits in spinal surgery

The Spine Journal ◽

10.1016/j.spinee.2013.03.055 ◽

2013 ◽

Vol 13 (12) ◽

pp. 1951-1957 ◽

Cited By ~ 2

Author(s):

Justin M. Dazley ◽

Thomas D. Cha ◽

Mitchel B. Harris ◽

Christopher M. Bono

Keyword(s):

Evidence Based Medicine ◽

Spinal Surgery ◽

Care Delivery ◽

Evidence Based ◽

Closing The Loop ◽

Based Medicine ◽

Clinical Audits

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Surgical audit: are we not closing the loop?

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-06-2017-0109 ◽

2018 ◽

Vol 31 (8) ◽

pp. 966-972 ◽

Cited By ~ 1

Author(s):

Declan Dunne ◽

Nikhil Lal ◽

Nagarajan Pranesh ◽

Michael Spry ◽

Christopher Mcfaul ◽

...

Keyword(s):

No Value ◽

General Surgery ◽

Clinical Medicine ◽

Multi Centre Study ◽

Content Type ◽

Closing The Loop ◽

Audit Cycle ◽

Surgical Audit ◽

Audit Activity ◽

Clinical Audits

PurposeA clinical audit is a key component of the clinical governance framework. The rate of audit completion in general surgery has not been investigated. The purpose of this paper is to assess the rates of audit activity and completion and explore the barriers to successful audit completion.Design/methodology/approachThis was a multi-centre study evaluating current surgical audit practice. A standardised audit proforma was designed. All clinical audits in general surgery during a two-year period were identified and retrospectively reviewed. Data held by the audit departments were collated, and individual audit teams were contacted to verify the data accuracy. Audit teams failing to complete the full audit cycle with a re-audit were asked to explain the underlying reasons behind this.FindingsOf the six trusts approached, two refused to participate, and one failed to initiate the project. A total of 39 audits were registered across three surgical directorates. Only 15 out of 39 audits completed at least one audit cycle, with 4 deemed of no value to re-audit. Only seven audits were completed to re-audit. Achieving a publication or a presentation was the most cited reason for not completing the audit loop.Originality/valueThis study demonstrates that the poor rates of audit completion rate found in other areas of clinical medicine pervade general surgery. Improved completion of an audit is essential and strategies to achieve this are urgently needed.

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Using a community of practice to evaluate falls prevention activity in a residential aged care organisation: a clinical audit

Australian Health Review ◽

10.1071/ah15189 ◽

2017 ◽

Vol 41 (1) ◽

pp. 13 ◽

Cited By ~ 7

Author(s):

Jacqueline Francis-Coad ◽

Christopher Etherton-Beer ◽

Caroline Bulsara ◽

Debbie Nobre ◽

Anne-Marie Hill

Keyword(s):

Vitamin D ◽

Community Of Practice ◽

Clinical Audit ◽

Aged Care ◽

Falls Prevention ◽

Residential Aged Care ◽

Prevention Policy ◽

Shared Interest ◽

Prevention Activity ◽

Clinical Audits

Objective This study evaluates whether a community of practice (CoP) could conduct a falls prevention clinical audit and identify gaps in falls prevention practice requiring action. Methods Cross-sectional falls prevention clinical audits were conducted in 13 residential aged care (RAC) sites of a not-for-profit organisation providing care to a total of 779 residents. The audits were led by an operationalised CoP assisted by site clinical staff. A CoP is a group of people with a shared interest who get together to innovate for change. The CoP was made up of self-nominated staff representing all RAC sites and comprised of staff from various disciplines with a shared interest in falls prevention. Results All 13 (100%) sites completed the audit. CoP conduct of the audit met identified criteria for an effective clinical audit. The priorities for improvement were identified as increasing the proportion of residents receiving vitamin D supplementation (mean 41.5%, s.d. 23.7) and development of mandatory falls prevention education for staff and a falls prevention policy, as neither was in place at any site. CoP actions undertaken included a letter to visiting GPs requesting support for vitamin D prescription, surveys of care staff and residents to inform falls education development, defining falls and writing a falls prevention policy. Conclusion A CoP was able to effectively conduct an evidence-based falls prevention activity audit and identify gaps in practice. CoP members were well positioned, as site staff, to overcome barriers and facilitate action in falls prevention practice. What is known about the topic? Audit and feedback is an effective way of measuring clinical quality and safety. CoPs have been established in healthcare using workplace staff to address clinical problems but little is known about their ability to audit and influence practice change. What does this paper add? This study contributes to the body of knowledge on CoPs in healthcare by evaluating the performance of one in the domain of falls prevention audit action. What are the implications for practitioners? A CoP is an effective model to engage staff in the clinical audit process. Clinical audits can raise staff awareness of gaps in practice and motivate staff to plan and action change as recommended in best practice guidelines.

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