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Clinical Audit 2020: The Third Way.

Dear Colleague,

The purpose of this e-postcard is to provide you with initial feedback and findings from the Clinical Audit Support Centre’s (CASC) online clinical audit survey. Please share these draft results with other colleagues and staff that have a remit for clinical audit and wider quality improvement work.


The online survey was devised by CASC and supported by SNAP surveys. CASC sent an e-postcard at the start of December 2011 to a random selection of those with an interest in clinical audit inviting them to participate. The survey was also advertised via the CASC website and on Twitter. The survey remained open for 14 days and closed at midnight on 20th December. Over the course of 14 days a total of 158 returns were received. This figure is slightly down on the 182 respondents attained when the survey was first carried out in December 2010.

It is CASC policy to conduct all healthcare surveys in a confidential fashion and we did not ask respondents to provide any personally identifiable data. Of the 158 respondents, the vast majority (76%) classified themselves as ‘clinical audit professionals’. All sectors of healthcare were represented in the survey but most worked in acute care. Given that the survey was carried out online and took approximately ten minutes to complete, the quality of responses was excellent – with few missed answers reported.

Initial findings

The CASC team are working on the data and will be producing a more detailed report. The key findings are:

  • Of 153 eligible respondents, 33% stated that they felt ‘more positive’ about clinical audit than a year ago, 22% stated they felt ‘more negative’ and 45% reported they were ‘neither more or less positive’
  • Ratings for national clinical audits were markedly down in the recent survey. In 2011, 34% of respondents rated NCA’s as ‘excellent’ or ‘good’. In 2010 the figure was 42%. The proportion of respondents rating NCA’s as ‘poor’ or ‘very poor’ increased from 11% (2010) to 24% (2011)
  • Of 151 eligible respondents, 84% felt that local audits are more effective than national audits (16%) at improving patient care. In the comparable study in 2010, 78% favoured local audits
  • 31% of respondents stated that they did not ‘intend to work in clinical audit or have responsibilities for audit in 5 years time’ (compared to 25% in December 2010)
  • The most used software packages for managing audit data were reported as: Excel (89%), followed by Access (42%) and SNAP (27%)
  • The highest three reported sources for clinical audit information (as in the 2010 survey) were: HQIP website (80%), CASC e-newsletter (79%), HQIP e-bulletin (77%)
  • 14% did not know their re-audit rates (up from 9% in 2010). Of the remainder, 39% reported a re-audit rate of between 21-40%. Next highest was 41-60% with 22% of responses. In total, 2011 figures reported 58% had a re-audit rate of 40% or less (the same result as in the previous year)
  • 53% did not know what proportion of their clinical audits save money (51% in 2010). Of those who did, 64% stated 0-20% of their audits result in a financial cost saving (compared to 76% a year earlier)
  • 49% of respondents stated they had ‘fewer resources’ to support clinical audit in their organisations now compared to 12 months previously (up slightly from 45% in 2010). 41% stated that audit resources have not altered significantly and 10% stated they had more resources.

Brief comments

Although the CASC team have not analysed the data from the recent survey in detail it is encouraging to note that there appears to be considerable consistency in terms of the results from 2011 compared to the results from 2010. This suggests that the sample size is appropriate and providing a representative overview of the state of clinical audit. Results highlight a number of worrying trends that will be examined in more detail via further analysis. These include: increased negative attitudes towards national clinical audits, an increase in the proportion of respondents intending to leave clinical audit in the next 5 years and an increase in the number or respondents stating they have less resources for conducting audit at their disposal. However, it is not all bad news and it is encouraging to note that marginally more respondents felt ‘more positive’ (33%) than ‘more negative’ (22%) when asked ‘do you feel more positive or more negative about clinical audit now than you did a year ago?’

What happens next?

The CASC team will be working hard to analyse the wider data sets that we have. We aim to produce a full draft report by the end of April 2012. This will be published on the CASC website. Results from the survey will also be circulated on the National Clinical Audit Forum and we hope this will lead to valuable online discussions.

As in 2011 we will also circulate results of the survey and ask the following organisations to comment on the draft report: Department of Health, National Clinical Audit Advisory Group, Healthcare Quality Improvement Partnership and the National Audit Governance Group.

And finally…

CASC hope that you find this information useful and we look forward to producing the final report. We would especially like to take this opportunity to thank those of you who took the time to complete the survey. We would also like to thank Snap Surveys, whose Research Services team set up and hosted the questionnaire and collected responses via their secure server. Snap Surveys help healthcare providers in the UK to gather patient data and you can find out more by visiting www.snapsurveys.com/healthcare.

Best wishes to you all.

Tracy Ruthven and Stephen Ashmore, CASC Directors

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