The relationship between audit, research and policy: lessons from a community paediatric audiology service

Abstract

The pace of medical change is in danger of paralysing the process of decision making, particularly in services where clinical improvements occur more slowly than the introduction of new interventions. Audit within an individual district enables staff to monitor progress towards desired goals and standards but rarely generates sufficient data to inform decision making about major policy changes. The paper describes how the findings from nine audits of a community paediatric audiology service over a 13-year period were combined with reviews of the literature, resulting in a series of changes to a children's audiological service. The interest and commitment of all the staff involved were maintained by involving them in the process and using them as a valuable source of qualitative data. Audit must be thorough and should be based on precise case definition and comprehensive casefinding if the results are to be meaningful. It is a more powerful means of achieving improvements in systems if it is combined with research evidence, and a readiness to change the system if the agreed goals are not being attained.

Qualitative analysis of parents' experience with early detection of hearing loss

“…12 Studies examining parents' perceptions of the screening and diagnostic processes are, however, few in number, and tend to concentrate on one or two aspects of the experience. One recent study involving a structured questionnaire identified four important features related to parent satisfaction with early detection of hearing loss: parent contact, allowing time to process complex information, provision of unbiased information, and counselling from a skilled empathetic audiologist.…”

The implementation of a new parallel child health record

“…The JPR has also formed the basis of clinical supervision of child protection by the designated child protection nurse for the district. The use of audit to improve clinical practice is well‐established ( NHS Executive 1996) and its value in improving community services has also been recently demonstrated ( Fonseca et al . 1997 ).…”