Case Studies

Royal Bournemouth & Christchurch NHS Foundation Trust


PROMOTING CLINICAL PRECISION IN THE AUDIT PROCESS

The work of the Clinical Audit Department at the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust underpins the Trust’s commitment to deliver continuous improvement to patient safety and quality of care. For example, one of the department’s biggest projects was a survey of patients who had undergone hip replacement, which gathered feedback on the quality of care they received, the efficacy of the procedure, levels of pain experienced before and after surgery and management of the recovery period.

THE PROBLEM

Until the early 1990s, processing of completed questionnaires was done manually. This was a tedious, labour-intensive and error-prone process that involved keying results into a database. In 1993, faced with mounting pressure on its resources, the clinical audit department went in search of an automated solution to the problem of processing survey forms.

According to clinical audit analyst Diane Paine, “It’s fair to say that some clinicians use to regard clinical audits with suspicion, as if they were being checked up on, but as the perceived value of audits has increased so too did demand.”

To cope with this growth, the clinical audit department eventually settled on the product that it still uses more than a decade later: Formic Fusion for Healthcare.

THE SOLUTION

The Formic software reads the data from completed forms and exports it at the click of a button to an Excel spreadsheet for analysis. Fusion includes a design module which is used to produce both draft and final versions of the questionnaire.

“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,” Diane says. “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, as part of one survey, out-patients were asked 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,” Diane says. “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 PRESENT

In 2007, the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Clinical Audit Department dealt with over 200 audits. 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 a staggering 1,800 different questionnaires.

Efficiency is 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. For example, a trust-wide patient satisfaction survey has recently been launched, which is expected to generate 2,000 completed forms each month.

“Without Fusion we would be too busy keying forms to worry about the quality of the response,” Diane says.

THE RETURN ON INVESTMENT

Fusion for Healthcare enables clinical audit staff to deal with a volume of forms that would require at least twice the amount of staff to process manually. The software has also dramatically improved the accuracy of forms processing. “Manual keying resulted in error rates as high as 30%. With Fusion these have dropped to less than one per cent,” Diane says.

“Using Fusion for Healthcare also allows for consistency It means we can keep to the same format and style of questions trust-wide and carry out cross-analysis of the results.”

The Clinical Audit Department has been responsible for distributing/collating and presenting the results of annual pharmacy survey for approximately 25 trusts in the South West of England for the past three years. The success of this programme spawned a further regional survey, which is also in its third year.

Diane believes clinical audits will remain heavily dependent on paper for the foreseeable future, but is already deploying Fusion’s Web Forms capability is completed online along with several other forms.

According to Diane, there are some obstacles that technology may never overcome. “I can’t foresee a time when the system will be able to read doctor’s handwriting,” she says.

KEY BENEFITS

Three-fold increase in clinical audit staff productivity enabling the team to handle over 200 audits in a year

Data error rates reduced from 30% to 1%

Ability to create professional-looking forms that are more likely to be filled in

Survey design tool that results in tighter questions first time, fewer survey re-drafts and higher response rates