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Surgical audit to be first stream under NOCA
May 22, 2012
Dara Gantlyanalyses the details of the upcoming clinical audit programmes to be rolled out under the National Office of Clinical Audit.
Mr Ken Mealy, Consultant General Surgeon, Wexford, and Clinical Lead of the IASM, and Minister for Health Dr James Reilly at the launch of the new National Office of Clinical Audit (NOCA) at the RCSI last week
The Irish Audit of Surgical Mortality (IASM) will be the first stream under the new National Office of Clinical Audit (NOCA), launched last week in the RCSI by the Minister for Health.
NOCA — established through the collaboration of the HSE’s Quality and Patient Safety Directorate and Clinical and Strategy Programmes Directorates, together with the RCSI and the College of Anaesthetists — will design, develop and implement a set of national clinical audit programmes aimed at improving patient outcomes and promoting patient safety in hospitals.
The IASM — clinically led byMr Ken MealyandDr David Honan— will be a confidential, independent, peer-review audit that will provide documented, critical analysis of the outcomes of surgical care. It will allow for the detection of system issues and emerging trends and will enable Irish clinicians to benchmark clinical outcomes against international standards.
Three additional audit streams have been identified for 2012, including: an Irish National Orthopaedic Register (INOR) to record and monitor joint replacement, led byMr David Moore,Mr Paddy KennyandMr Connor Green; a National Intensive Care Audit (NICA) to monitor patient care and outcomes in intensive care, clinically led byDr Rory DwyerandDr Michael Power; and a collation of data from the average length of stay element of the elective surgery programme to inform efficient bed usage in hospitals.
The initial 10 ICUs identified for audit in 2012 are: Beaumont; St James’s; Limerick Regional; Waterford; CUH; St Vincent’s; AMNCH, Tallaght; Our Lady’s, Drogheda; Galway University Hospital; and the Mater.
Speaking at the launch, Mr Mealy pointed out that these clinical audits would improve patient safety by promoting constant clinical reappraisal, the identification of under-performance and the right mechanisms to correct areas of weakness. “While some work is still required to finalise the roll-out of the INOR and the NICA, IASM is ready for immediate launch,” added the Wexford surgeon.
MinisterDr James Reilly— who said it was timely to have this launch the day before HIQA’s report on patient safety at TallaghtHospital was published — indicated that clinical audits aimed to assess the extent to which care was consistent with best practice. “It also assesses the extent to which care achieves expected outcomes. The establishment of the National Office of Clinical Audit will provide a sustainable governance structure to advance national clinical audits and will bring Ireland in line with international best practice.
Measurable criteria
“Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against measurable criteria. The establishment of NOCA supports improvements to clinical practice and service delivery in order to benefit the patient. Put simply, this is about making sure that patients are getting the best treatments performed properly,” the Minister stated.
He added that NOCA would allow clinicians to examine their own individual performance, service providers to assure their services, and policy-makers to develop evidence-based policy.
“That has been one of the key planks of our policy in government — that it will be evidence-based; not on a political whim, but on real, measurable outcomes.”
Prof Eilis McGovern, President of the RCSI and Chair of the NOCA Governance Board, said structured clinical audits would provide NOCA with the tools needed to report on the outcomes of the audits in order to ensure shared clinical learning experiences: “Promoting a culture of life-long learning and peer review will help to create an open culture of identifying and reporting incidents in order to provide the best care for patients.”
She added: “I know that while this initiative is starting in surgery and intensive care, the goal would be to ultimately extend it into all areas of medical practice so that we have a culture of continually looking at what we do and benchmarking it against best practice.”
Also at the launch,Dr Philip Crowley, HSE National Director for Quality and Patient Safety, said clinical audit was an essential element of any healthcare system that was serious about measuring quality of care and improving patient safety.
‘Landmark occasion’
Describing the launch of NOCA as a “truly landmark occasion” and a “good news story”, he added: “The establishment of a National Office of Clinical Audit reaffirms the ongoing commitment to assessing openly how health services compare against high-quality standards, so that any changes needed to improve the quality of care can be identified and acted upon. This is part of a continual learning process, which is very much in keeping with the commitment to patient safety first.”
Dr Crowley paid tribute to the clinicians leading the audits for showing this kind of leadership. “That is the only way that we are going to turn around our health services,” he said.
The inaugural NOCA Governance Board — expected to meet in early June — will comprise members from the HSE, RCSI, the College of Anaesthetists of Ireland, the Irish Institute of Trauma and Orthopaedic Surgery, the Joint Faculty of Intensive Care Medicine of Ireland, the Independent Hospitals Association of Ireland, the Office of Nursing and Midwifery Directorate and public representation.
Speaking to journalists after the launch, Minister Reilly added that from a layman’s point of view, clinical audit was about making sure that what doctors did was truly making their patient recover “more quickly and more completely”. “If they are not, then they shouldn’t be doing it,” he stated.