Scottish Society for Rheumatology

Streamlining audit data collection on a national scale, to reduce variation and improve care


Summary

The Scottish Society for Rheumatology (SSR) has developed a web-based audit tool as an alternative to traditional audits which can be expensive, time-consuming and resource intensive. The web-based tool allows rapid collection and dissemination of outcomes vital to understand and drive improvements in patient care and achieves significant cost-savings compared to traditional audits.
  • Web-based audits have established an ethos of continuous and repeat audit cycles across Scotland 
  • An 8% increase in uptake of  pneumococcal vaccinations was achieved as a result of guidelines developed using a web-based audit 
  • Each web-based module typically costs £5,000–£6,000 to develop compared to around £300,000 for traditional audits 
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The Challenge

  • Audits are incredibly useful tools to understand the developments and progression of clinical practice and outcomes over time; however, these are often prohibitively expensive, require significant staff resource to run, and take a long time to disseminate results.
  • In the absence of adequate funding, alternative methodologies for data collection have to be developed to ensure that clinical care can be sufficiently assessed in order to identify and drive improvements.

The Solution

  • In 2009, Healthcare Improvement Scotland’s (HIS) predecessor organisation, NHS Quality Improvement Scotland, funded the Scottish Society for Rheumatology (SSR) to develop and test a web-based system of audit.
  • Underlying principles of the tool were that it should be:
    • Sustainable and encourage a culture of continuous short cycle audits
    • Robust and free from bias
    • Able to allow data to be fed back to contributing centres rapidly and accurately
  • Furthermore, annual forums for the reporting of results at SSR meetings were to be established as a means of highlighting agreed standards of care to the clinical community.

Service Pathway

  • The initial project commenced in May 2009 and comprised six modules that were selected by the SSR membership and based on published guidelines.
  • Audits are assigned a clinical lead who is responsible for developing the audit data set (in collaboration with the software designer) and contacting units to encourage participation.
  • The audit tool is hosted on the SSR’s website and does not run on the NHS’s N3 connection, enabling access from anywhere.
  • The user interface was designed to keep screens clear and easy to access, utilising drop-down lists, check-boxes, and tabulated screens for different outcomes. Data field functionality reduces the need for data cleaning.
  • The web-based tool can be used to provide real-time results and can provide a comparison between each participating centre in Scotland through automatically generated reports. 

Service Performance and Outcomes

  • The ease of conducting audits has established an ethos of continuous and repeat cycles of audit, which are reported regularly to ensure that improvements are maintained.
  • An audit investigating work-related issues in rheumatoid arthritis (RA), conducted due to concerns with working disability in Scotland, identified discrepancies between referrals to occupational therapists (OTs) and the results of screenings by OTs – 6% of referrals reported work-related issues compared to 63% identified by OTs. Results of this audit have been presented at a national conference (BSR 2013) and disseminated amongst clinicians in Scotland in order to improve patient care in in this area.
  • In addition, an audit investigating the uptake of the pneumococcal vaccination resulted in the publication of a consensus statement outlining best practice for vaccinations in patients with rheumatic diseases. A subsequent audit cycle identified an 8% increase in vaccination uptake in this vulnerable population as a result.

Financial Performance and Outcomes

  • Web-based audits are significantly cheaper to run with each module typically costing £5,000–£6,000 to develop; this cost covers the hiring of a software developer and ongoing storage of audit data to meet NHS security requirements. Established audit modules can be re-run without a development cost.
  • By comparison, the estimated cost of the CARA clinical audit in 2003–2005 (investigating clinical outcomes of RA patients in Scotland) was approximately £300,000.

Patient Focus and Satisfaction

  • The web-based tool has been designed to drive improvements in patient care and has already been used as the basis for quality improvement initiatives in several areas.
  • The tool is a valuable benchmarking exercise and can provide clinicians with evidence for appraisal and revalidation.
  • Patient group representatives are now an integral part of the network and actively contribute to the design of the audits, ensuring that the audits reflect the issues that are important to patients and also help to raise awareness of the audits.

Commissioning Implications


The SSRs web-based audit tool is an example of commissioning best practice in rheumatology and meets a number of priorities for commissioners, clinicians and patients:

 

  • Guideline compliant – recurrent audit cycles allow for continuous assessment and ensure that clinical care can be aligned with national guidance
  • Standardised care – the SSR’s web-based audit helps to achieve standardised, high-quality care by identifying discrepancies and areas of improvement throughout Scotland, and disseminating the results widely
  • Supporting quality strategies - the SSR’s web-based audit tool can help ensure that national and local audit programmes support the development of appropriate quality indicators, rigorous peer review and local action to address variations in care

This service is a best practice model for auditing clinical practice and outcomes which can be used to drive improvements in patient care. The SSR web-based audit tool is accessible, easy-to-use and allows rapid data collection over a wide geography whilst achieving significant cost-savings compared to traditional audits.


Service diagram