Clinical audit is a quality improvement process, aimed at improving patient care and promoting good clinical practice. In the latest issue of Journal of Small Animal Practice, Rose et al report their use of clinical audit to address and improve their hospital’s management of post-operative hypothermia in dogs. They used the Plan-Do-Study-Act (“PDSA”) model in order to do this, and this approach will hopefully give all practitioners the confidence that clinical audit is achievable and worthwhile in each and every practice.
Clinical audit forms a key element of clinical governance – doing the right thing, in the right way, for the right patient, at the right time – and can be a powerful tool for positive change. Further positive outcomes are enhancement of team-work and improvement in communications. Essentially, clinical audit is just asking, ‘Are we adhering to current agreed best practice (evidence-based standards or guidelines) and, if not, can we do anything to improve?’. Research is required to ask and answer the question, ‘What is best practice?’ and therefore has different goals to that of clinical audit.
One stumbling block for veterinarians is the current lack of evidence-based standards although there are an increasing number of guidelines available. Any standards set should be SMART (Specific, Measurable, Achievable, Relevant and Timely); which should make them easy to compare against one’s own performance. Although Rose et al found no consensus for the definition of canine hypothermia, they chose a clinically-acceptable value in their first audit cycle and soon realised that a high proportion of dogs were hypothermic at the start of the recovery period and that it was taking a considerable length of time for dogs to be re-warmed to normothermia. After evaluation of their first audit results and, hugely importantly, consultation amongst staff members, the second audit cycle aimed to (and did) shorten the time to reach normothermia in the post-operative period.
When done properly, as demonstrated by Rose et al, clinical audit can not only improve patient care but also be very rewarding.
Read the full editorial by Alex Dugdale