One of the greatest opportunities for increasing efficiency and effectiveness in the NHS is the reduction of unwarranted variation in care.
And clinical audit is an essential tool to help realise those opportunities.
Now, Lancashire Teaching Hospitals NHS Foundation Trust is delivering a step change in how it is embedding the use of clinical audit as part of its service and quality improvement commitments through the use of AMaT.
AMaT has reduced the time taken to carry out an audit, and increased visibility of the process
The Audit Management and Tracking tool from Meantime IT is designed to streamline auditing requirements in one simple, easy-to-use system.
“AMaT has reduced the time taken to carry out an audit, and increased visibility of the process,” said Alison Leather, clinical audit and effectiveness manager at the trust.
“This is helping to make sure that quality improvement actions are more embedded in the culture and activity of the trust.”
Frontline care
By providing an interactive and intuitive online tool for trust staff to register, manage and report on clinical audit; AMaT is giving doctors, nurses and healthcare professionals more time to care and creating action plans that deliver meaningful improvements on the NHS frontline.
AMaT allows clinical teams to register audits; associate guidance such as NICE quality standards; complete audits online; and manage action plans and scheduling.
This timely and efficient solution means healthcare professionals have more time to spend at patient bedsides.
Junior doctors, for example, are expected to carry out clinical audit and quality improvement projects as part of their training.
Previously, they might not have known what audits have already been undertaken, leading to duplicate projects that did not address the needs of the trust.
Now junior doctors can see what audits have been done and can focus on areas with real impact, for example by carrying out re-audits of previous quality recommendations, or working with colleagues to focus on areas that have the most benefit.
“We now know what we are doing, so if we wanted to focus on a pathway such as COPD, you can use an audit to get real insight into what is happening in that area,” said Leather.
AMaT is also providing greater visibility of the progress of quality improvements.
“We can say instantly, because they are updating their audits, how many have led to an improvement or achieved their criteria. We just wouldn’t have known this before,” said Suzanne Henderson, project manager and AMaT system manager.
Enabling efficiency
And clinical audit staff also save time through a more-efficient process.
Previously, they would have to undertake a paper-based process and transfer information into multiple systems, leaving little time to progress actions that had come out of previous audits.
The department has saved over £40,000 by not replacing retiring staff after taking on AMAT. The department has also increased the number of projects that they facilitate and support due to the time released by using AMaT.
“Now we don’t have any pieces of paper coming into the office,” said Leather.
“|After about 12 months of use, the process now is entirely online.”
With AMaT, a series of online forms make the creation and validation of clinical audits simple and quick. More time can be spent examining the actions that have been recommended, supported by automated reminders to those responsible for implementing improvement actions. This is helping to increase the number of audits being carried out at the trust.
We can say instantly, because they are updating their audits, how many have led to an improvement or achieved their criteria
“We had around 250 audits every year using our old system,” said Leather.
“There were 467 audit and quality improvement projects registered last year.”
Governance teams are also seeing the benefits. They have increased visibility of audit progress, resulting in a greater focus on implementing change in NHS priority areas such as hand hygiene compliance.
They can now actively consider where an audit is required, such as in support of seven-day services, rather than reacting to the audits suggested across the trust.
Taking action
AMaT features Ward and Area Audit support, which enables wards to actively complete and action their audits. And, by increasing the visibility of ward-based audits from other teams such as pharmacy and outreach, AMAT has extended the number of people who can give feedback on activity. This has provided a holistic view of safe care being delivered to the patients and enabled more-immediate and responsive service improvements. Previously, such feedback and results would have taken sometime to filter back to the wards and their matrons.
The visibility of the regular clinical audits taking place on each ward or area also enables the clinical teams to work closely together and has encouraged nursing staff to embark on their own audit-related projects.
And AMaT is helping staff with the many national clinical audits they have to carry out. Such audits can be seen as time-consuming and struggle to effect positive change, especially if such changes are not clinical in nature. Now, with more visible action plans, and clear status indicators, everyone can see what needs to happen to act on the recommendations.
In addition, it is helping with the Care Quality Commission (CQC) inspection process.
This data-hungry exercise looks to ensure that high standards of care are being maintained.
The ready availability of clinical audit progress saves staff the many hours it can take to provide an accurate picture of audit activity and equipment. The trust is even using AMaT to run its own CQC-style exercises to ensure that it meets national quality standards.
AMaT went live in the autumn of 2016, following a trust review of the clinical audit tools available on the market.
Trust quality leads wanted to work with an IT supplier to develop a solution that supported its desire to use clinical audit to drive organisation-wide quality improvement.
We now know what we are doing, so if we wanted to focus on a pathway such as COPD, you can use an audit to get real insight into what is happening in that area
The result was AMaT, which has been developed to meet the trust’s clinical audit needs and which can be used by others who recognise that proper use of this process through an easy-to-use tool can drive a culture of quality improvement.
“We looked at different systems on the market,” said Leather.
“There was nothing that did everything that we wanted it to do, for example ward audits and NICE compliance statements. We thought, there must be something better out there and we worked with Meantime and they developed a solution that best meets our needs.”
Now over 2,700 staff at the trust have access to AMaT out of the 7,000 employed.
User-driven technology
Such global access is leading to many fresh ideas for development. These include the use of AMaT to review the trust’s mortality and morbidity performance, and further work around developing it around specific clinical specialities.
AMaT is also being explored to support cross-trust audits so that standards of care can be monitored across the multiple care settings central to the NHS’s drive for more-integrated care.