The Clinical Audit Department at the Royal Bournemouth and Christchurch Hospitals (RBCH) NHS Foundation Trust assists all Trust staff to carry out clinical audits. It keeps a record of all audit activity in the Trust and provides reports to the Trust Board and other Trust committees on the audits that are taking place.
The Clinical Audit Department is highly regarded by the Trust and its work is a critical part of Clinical Governance. The audits it carries out underpin the Trust’s commitment to deliver continuous improvement to patient safety and quality of care.
THE NEED
Clinical Audits involve assessing evidence-based clinical care against a predetermined standard. Clinical teams decide which standards they are going to audit against, design a data collection form then collect and analyse the data to see whether the required standards are met. If standards are not met, the team identifies changes to practice that should ensure future compliance then a re-audit confirms the practice has improved. Until the early 1990s, processing of completed questionnaires was a manual process that involved keying results into a database. It was tedious, labour-intensive and error-prone. In 1993, faced with mounting pressure on its resources, the Clinical Audit Department went in search of an automated solution.
THE SOLUTION
After careful study, the department chose Formic Fusion for Healthcare. The solution automatically scans, reads and extracts information from any paper form and, with a click of a button, sends it electronically to a project database, Microsoft Access, Excel or other clinical system where it can be analysed – and it can do this about 50 times faster than a human operator. Working with limited resources and time, and up against some resistance, the department felt this would be the right choice for them.
THE RESULT
The Clinical Audit Department dealt with in excess of 300 hundred audits last year, and this is set to increase this year. In a typical month, 5,000 completed questionnaires running to tens of thousands of pages need to be processed and the results fed back to clinical specialists and hospital managers. Since it first began using Fusion, the Clinical Audit Department has used the software to design thousands of different questionnaires. Fusion for Healthcare enables clinical audit staff to deal with this volume of forms which would require at least twice the amount of staff to process manually. Efficiency is also at a premium because the scope and scale of the new projects commissioned each week vary widely, making the department’s workload uneven and unpredictable.
Formic’s solution also includes a design module which is used to produce both draft and final versions of the questionnaire. It also has the capability to help the team ask the right questions – an element which the team finds holds the greatest significance to the whole process, as Diane Paine explains.
“As well as making it easy to create professional-looking forms that are more likely to be filled in, the design module also helps us to ask the right questions. Poorly worded questions mean bad data and we don’t want to wait until half way through a big survey to discover that we’ve got it wrong.”
“For example,” says Diane, “in one survey, we asked out-patients how long they had to wait before being seen by a doctor. Some patients, who turned up early for their appointments, were adding this time to their responses. So an appointment that ran exactly to schedule could have been recorded incorrectly as an hour or so late. While Fusion can’t do our thinking for us, the discipline of creating the questionnaire in the design module results in tighter questions first time and fewer re-drafts.”
The software has also dramatically improved the accuracy of forms processing. “Manual keying resulted in error rates as high as 30 percent,” explained Diane. “Using Fusion these have dropped to less than 1 percent. It also gives us consistency; we can keep to the same format and style of questions Trust-wide and carry out cross-analysis of the results.”
The more projects that the team takes on, the greater the need to deploy Fusion’s Web Forms capability, which the team uses at every possible opportunity.
The role of the department is a vital one, not only to the patients, the Trust and the public, but to the authorities that govern healthcare.
“The feedback we gather, whether on clinical audits or the quality or our services, helps demonstrates to the public and external bodies, such as the Care Quality Commission and NHS Litigation Authority, that the services provided by the Trust are of a high standard. Fusion’s role in RBCH Trust is making sure this data is accurate and current.”
