Clinical audit: application in small animal practice

Abstract

In an article in the March issue of In Practice, James Dunn outlined a stepwise process for conducting clinical audits in first-opinion small animal practice. In this article, he and Frances Dunn describe how this process might be applied to a specific aspect of small animal practice, using the prescription of fluoroquinolones as an example.

A systematic review of clinical audit in companion animal veterinary medicine

“…These six articles described 10 separate clinical audits, the majority of which were focused on outcomes (“outcome audit”, n = 8) [ 2 , 14 , 20 , 24 , 25 ]. There were two clinical audits assessing the process(es) which might contribute to change (“process audit”) [ 20 , 26 ]. Two articles simply described audits, without documented completion of the clinical audit cycle, such as implementation of change or re-audit [ 27 , 28 ].…”

“…Log books available to record audit data. As above a Viner, 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, 2 nd 6 months: 22 measurements, 3 rd 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.…”

“…The most prevalent form of data analysis was descriptive, in the form of summary data (e.g. total number of affected cases) or percentages [ 2 , 14 , 20 , 24 , 26 ]. Where percentages were reported, none of the identified studies applied suitable statistical analyses to evaluate the reported percentage changes, such as Chi squared test or Fisher’s exact test.…”

“…In contrast, analysis of reports by Mosedale [ 2 ], Dunn and Dunn [ 26 ] and Viner [ 14 ] did not support the claimed improvements (under the following assumptions: two-tailed test with alpha and beta levels of 0.05 and 0.8, respectively) [ 2 , 14 , 26 ].…”

Clinical audit in equine practice, and the International Colic Surgery Audit

“…Indeed, the authors are aware of many clinics performing effective clinical audits that lead to quality improvement. However, we believe the publication of such examples, as has occurred in small animal practice (Dunn and Dunn ; Rose et al . ), will inspire and educate colleagues wishing to undertake their own clinical audits.…”