Table 2 Characteristics of articles reporting clinical audits
From: A systematic review of clinical audit in companion animal veterinary medicine
Reference | Audit subject | Aim | Explicit criteria | Population | Data | Data presentation & analysis | Full audit 2cycle (Y/N) | Outcome(s)/Intervention(s) | Article type |
|---|---|---|---|---|---|---|---|---|---|
aMosedale, 1998 [2] | 1. Client waiting times | 75 % of clients seen within 10 min of appointment time | Standard agreed within clinic | Not reported | Waiting times | Descriptive | N | 1. 77.2 % on time, 83.1 % within 5 min, 93.1 % within 10 min, 13.8 % arrived late | Clinical audit – prospective design |
2. Anesthetic death | 100 % survival | Published anesthetic mortality (0.14 %) rates | 2282 anesthetics (species not reported) | Patient & staff id, procedure, drugs | Descriptive | N | 2. 0.13 % mortality | ||
3. Surgical infection | Minimal infection | Published surgical infection rates (2.5 % for clean procedures) | 389 surgeries (species not reported); 241 audit 1, 148 audit 2 | Dog and cat neuters, incl culture of suspected infections | Descriptive & identification of infections by surgery type/surgeon | Y | 9 suspected infections (241 surgeries), with 5 (2.1 %) positive culture. Following re-training in aseptic technique, re-audit showed 0.67 % (148 surgeries) infection rate (positive culture) | ||
aViner, 2005 [14] | Rabbit anesthesia | Reduction in anesthetic mortality rate | Not specified | 158 rabbits over 3 years (year 1, 41 cases; year 2, 59 cases; year 3, 58 cases) | Anaesthetic mortality rate | Descriptive | Y | Update of anesthetic protocol – details not provided 4 % (100 cases) mortality before update, 0 % (58 cases) after, over 1 year | Clinical audit – combination of retrospective and prospective |
aViner, 2006 [20] | 1. Diagnosis of congestive heart failure | Increased thoracic radiograph use to aid diagnosis of congestive heart failure | Expert opinion and published criteria | 25 dogs | Computer records were used in all audits for an initial retrospective evaluation followed by prospective follow-up | Descriptive | Y | Radiography use increased from 84 % (n = 19) - 100 % (n = 6), through increased client communication & education | Clinical audit - Thesis (Doctorate in professional studies) Mix of retrospective and prospective study design |
2. Pruritis management | Standardised diagnosis of pruritis | Consensus discussion within clinic as well as expert opinion and published criteria. Structured approach to achieve definitive diagnosis | 174 dogs | As above | Descriptive | Y | Definitive diagnosis rate increased from 56 % (n = 24) to 82 % (n = 75). Practice guidelines for establishing diagnoses established. | As above | |
3. Feline hypertension screening | Improve detection of hypertension in at-risk patients | Mean arterial blood pressure (ABP) > 220 mmHg with clinical signs or mean ABP > 180 mmHg with signs (blindness, retinal haemorrhage, seizure, tachycardia) | 99 cats | As above | Descriptive | Y | Use of blood pressure measurement increased from 5-83 cats over 6 months. Implemented changes unclear. | As above | |
4. Renal disease management | Improve management of feline chronic renal disease | Expert opinion and published criteria. Specific diet, ACE inhibitor, regular blood work | 4 cats | As above | Descriptive | N | Failed due to insufficient cases (n = 4) | As above | |
5. Performance of obesity clinic | Improve owner compliance in attending weight loss clinic for pets and meeting targets | 75 % of referred animals attend weight loss clinic and 90 % of animals achieving weight loss target | Unclear | As above | Descriptive | Y | Failed to achieve criteria (52 % attendance). Workflow to refer patients to obesity clinic described. | As above | |
6. Complications following neutering | Reduce post-operative complications | Consensus discussion within clinic. Complication defined as deviation from uneventful recovery | 90 dogs, 149 cats | As above | Descriptive | Y | Reduction in post-operative complications from 47-36 % (bitch spay), 8.3-1.8 % (cat spay). Increase in complications from 26-29 % (dog castration). 0 % complications (cat castration. Log books available to record audit data. | As above | |
aViner, 2010 [24] | Use of blood pressure measurement in cats | Improve identification of hypertension in cats | Not specified – targeted at “high risk” cases (chronic nephritis, hyperthyroidism, cardiomyopathy) | 79 cats over 3 x 2 month periods (month 1, 6 cases; month 2, 22 cases; month 3, 51 cases) | Number of blood pressure measurements billed | Descriptive | Y | First 2 months: 6 blood pressure measurements, 2nd 6 months: 22 measurements, 3rd 2 months: 51 measurements | Clinical audit – retrospective and prospective |
Dunn and Dunn, 2012 [26] | Antibiotic use in small animal clinic | Appropriate prescribing of fluoroquinolone antibiotics | Published guidelines for antibiotic use: clinical evidence of infection, culture and sensitivity testing with tailored therapy | 89 cases (cats and dogs; 72 cases over 12 months [audit 1], 17 cases over 3 months [audit 2]) | Computer records search for antibiotic prescription | Descriptive | Y | Clinic meeting – discuss rationale for antibiotic use guidelines and adherence to policy. Re-audit showed improvement amongst permanent staff and poor performance from a locum veterinarian unaware of practice policy | Clinical audit – retrospective and prospective |
Elliston et al., 2012 [27] | Post-operative wound healing in small animal clinic | Identify suspected wound infections associated with different suture materials | None described | 115 dogs, 170 cats undergoing ovariohyste-rectomy | Case records | Risk ratio, Chi square and Fisher’s exact tests | N | Identified increased risk of wound infection when catgut used for subcutaneous or muscle closure (RR 3.8 and 7.6, respectively) | Audit – retrospective cohort study |
Akinrinmade and Adekunle, 2012 [28] | Perioperative antibiotic use in veterinary teaching hospital. | Evaluate compliance of prophylactic use of antibiotics for surgery | General recommendations for perioperative antibiotic use | 108 small animals (species not specified) | Case records – minimum data set required described | Descriptive | N | Justification of antibiotic use in only 35 % of cases. Antibiotics administered for clean procedures without justification. Rationale for antibiotic type and duration of use unclear. Many records did not meet requirement for minimum data set | Audit - restrospective |
Proot and Corr, 2013 [25] | Surgical complication rate associated with learning a stifle surgical procedure | To apply quality control analysis (cumulative summation) to assess surgeon performance | Published criteria for surgical complication rates used to set limits for analysis. Criteria redefined (more stringent) as training progressed | 122 dogs (167 stifle surgeries) | Consecutive records, 6 months follow up, defined of retrospective complications | Control chart (cumulative summation curve) | Y | Performance improved after 22 procedures (failure rate was acceptable during these procedures) and remained acceptable (more stringent criteria) for the remaining 145 procedures | Clinical audit - retrospective |