Define Clinical Audit
A quality improvement cycle that involves measurement of the effectiveness of healthcare against agreed and proven standards for high quality, and taking action to bring practice in line with these standards so as to improve the quality of care and health outcomes.
Describe research
- Designed to derive generalisable new knowledge
- Designed to test a hypothesis
- Addresses clearly defined questions, aims and objectives
- Study design may involve allocating patients to intervention groups
- Normally requires Research Ethics Committee review
Describe Clinical audit
- Designed and conducted to produce information to inform delivery of best care
- Designed to answer ‘does this service reach a predetermined standard’?
- Measures against a standard
- No allocation to intervention
- Does not typically require Research Ethics Committee review
Describe service evaluation
- Designed and conducted solely to define or judge current care
- Designed to answer ‘what standard does this service achieve’?
- Measures without reference to a standard
- No allocation to intervention
- Does not require Research Ethics Committee review
Why do Clinical Audit?
- Health and Social Care Act 2008
- CQC - Essential Standards of Quality and Safety Revalidation for Medical Staff
- Professional standards for individual disciplines
- NHS Standard contract (must participate in relevant NCAPOP audits)
- Local Trusts Quality Accounts/Monitor Compliance Framework
- Monitoring of current practice alongside Guidance (local, regional, Royal Colleges and National)
- High volume/High cost procedures
- Response to a Serious Incident, Risk Issue or Complaint
- Trust/Departmental/Specialty/Local Priorities
- Re-Audits
- Quality Improvement
What are the 4 stages the clinical audit cycle
1) Preparation and planning
2) Measuring Performance
3) Implementing Change
4) Sustaining Improvement including Re-audit
The Hawthorne Effect
The Hawthorne Effect is the alteration of behaviour by the subjects of a study due to their awareness of being observed
Name four common random sampling techniques
1) Simple random sampling
2) Systematic sampling
3) Stratified sampling
4) Cluster sampling
What is simple random sampling?
Each item in the population has an equal chance of being selected
What is systematic sampling?
Sample is selected according to fixed intervals between individuals on the population list ie. every 20th item in the population
What is stratified sampling?
Sample is selected by dividing the population into groups called strata. A sample is then selected from each strata.
What is cluster sampling?
Where it is not possible to spread the sample across the population as a whole, the sample is selected by dividing the population into groups or clusters. A number of clusters are then randomly selected.
What does SMART goals stand for?
Specific Measurable Achievable Realistic Timely
Describe some principles of distributive justice
- Strict egalitarianism (everyone should be treated exactly equally)
- First come, first served
- Utilitarianism
- Prioritarianism (those worse off should get more help than those better off)
- Sufficientarianism (there is enough resources for everyone?)
- Desert-based principles (based on deservingness eg. smokers shouldn’t get lung cancer treatment)
Define stigma
The presence of an attribute that discredits its possessor
Define enacted stigma
Real experience of negative attitudes of discrimination
Define felt stigma
Fear that prejudice or discrimination may occur
What is discreditable stigma?
attribute, condition or impairment not immediate obvious or known by many e.g. mastectomy
What is discrediting stigma?
obvious and visible attribute, condition or impairment
What are the ethical problems with the Mental Health Act
- It assumes the presence of a mental illness automatically renders someone incompetent (false)
- It discriminates between the physically and mentally ill
What is artificial intelligence?
A machine which has the ability to mimic human behaviour
What is machine learning?
A subset of artificial intelligence which uses algorithms to learn for itself.
Requires features to be identified and then categorization algorithms.
What is deep learning?
A subset of machine learning. Has the ability to identify its own features and learn for itself.
What are the pros and cons of algorithm-based medicine?
Pros:
- Should be objective.
- Once developed should provide rapid decisions / diagnoses
Cons:
- Can require large amounts of data and computing power.
- Unable to discern the nuances of patient presentations.
- Application specific.
- Only as good as the data provided.
