Dr Lynn McVey, research assistant in applied healthcare at the University of Leeds, explains how research project QualDash is helping to harness the benefits of clinical audit data.
Quality dashboards visually display information about hospitals and clinical services to help healthcare professionals understand how well their service is performing. Researchers at the University of Leeds developed a quality dashboard called QualDash to help NHS staff explore patient data from national clinical audits. The researchers spoke to staff in five English hospitals about how they use data to improve care quality, and what supports and constrains them.
What are national clinical audits?
National clinical audits (NCAs) are one of many sources of data that hospitals can use to monitor their performance. There are over 100 NCAs in the UK, providing reports of patient data for many clinical areas, ranging from maternity care to dementia. Audit reports are publicly available from the Healthcare Quality Improvement Partnership.
Who collects NCA data?
Individual clinical services collect data for NCAs. The work is often done by doctors and nurses, sometimes assisted by non-clinical support staff. Large amounts of information are involved, covering everything from admission through to treatment and outcomes. For example, the Myocardial Ischaemia National Audit Project includes data on heart attacks and associated conditions. It collects 140 separate pieces of information for every patient!
Using the data for monitoring and quality improvement
NCA data are intended to be used by Trusts to monitor the quality of care they provide and to stimulate quality improvement. All the Trusts in the QualDash study used NCAs to assess whether the care they provided was safe and effective and had systems in place to track their own performance in NCAs and resolve any problems.
Here’s an example from paediatric intensive care of how audit data can lead to improvements. Clinicians used data from PICANet (Paediatric Intensive Care Audit Network) to identify a slight increase in the number of infants and children on ventilators whose breathing tubes had been accidentally dislodged (described as self-extubation). A paediatrician describes the actions which were taken:
‘We started to see a small spike in self-extubations of patients, so we introduced a monograph [training manual] where we trained all the nurses in taping and how to check a chest x-ray […] Once we brought that in, then we followed up at the clinical governance meeting, whether or not we had made an impact on the rate of accidental extubations […] because we keep that [data] automatically through the PICANet database, we can monitor all that’.
Helping hospitals use NCA data
We identified three main factors that support hospitals in using NCA data, especially for quality improvement:
The resource that hospitals are able to dedicate to NCA data collection, checking and reporting has a direct bearing on data use. Where staff have enough time and expertise to do the job well, where they can access data easily and where data are embedded in routine quality monitoring and improvement processes, data can be used fully.
Teams use NCAs when they trust data quality. Factors for quality include accuracy, completeness and timeliness. This links with resource levels, because adequately resourced teams tend to produce high-quality data.
Data need to be presented or customised in ways that are meaningful to the staff who use them. Because staff and committee time is precious, simple, colourful presentations such as bar charts are preferred, as they can be understood quickly.
How quality dashboards can help
Unfortunately, these supportive factors were not available to all the clinical services we spoke to during our study. For example, some didn’t have enough staff and IT resources to collect information that was as accurate and timely as they wished, reducing their confidence in the data and resulting in more limited data use.
We believe quality dashboards, like QualDash, can help:
- provide clear, easy-to-understand and customisable presentations of data
- reduce the time staff need to spend constructing queries and reports
- provide timely access to a clinical unit’s own data for monitoring and quality improvement.
Given NCAs’ potential to improve patient care, and how much NHS resource goes into collecting the data, we think quality dashboards to help visualise data better are well worth developing.
Find out more
Acknowledgements: This research is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme (project number 16/04/06). The views and opinions expressed are those of the author and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health and Social Care.