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Audit, Dashboards and Benchmarking.
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Electronic Audit & Benchmarking by Monthly Topic.
Electronic Patient Records already contain far more data for regular audit than is worth printing out in full every month. In response to the combined requests of all the users the Protos Maternity system eventually printed out 14 pages every month!
This volume will suggested patterns of Regular Annual Audit with a different main topic/focus each month of the year.
Such audits should, in time, involve comparisons; both with previous years in the same hospital (on-going Intra-Hospital Audit); and also comparisons with other hospitals with a similar workload (Inter-Hospital Benchmarking)
More recently the concept of highlighting trends by the using what is known as a dashboard has become increasingly recognised
(Updated 22 Aug 2010)
When I first started to work with Protos we thought that the electronic creation of monthly maternity unit statistics would be relatively straightforward, and indeed one of the great advantages of maternity computers. How wrong we were. As each new hospital adopted the Protos system each one in turn insisted on adding some extra monthly details which they regarded as essential for their local audit returns. And in the end the statistical report created by the standard Protos maternity system eventually ran to some 14 pages every month!! - which of course no-one ever had time to analyse. What then tended to happen was that one poor local midwife continued to have to produce what was locally required; sometimes using the Protos system, but more often by going through the local paper delivery record book!
At a later date I was asked to be an expert advisor to the Benchmarking Company Ltd.
This was a commercial initiative based on the delusion that standard maternity data was easily available in electronic format and that all that was needed was to convene a small group of obstetric experts who, at one or two afternoon meetings, would advise what data should be used to compare the performance of similar hospitals. The result of that initiative can be seen on www.fawdry.info/eepd/a_ini/??? ???
Being based on these two erroneous assumption the initiative naturally failed.
My conclusion has been that the need both for local statistical reports and for inter hospital benchmarking remained, but that this would only be efficiently and creatively achieved if the following principles were to be generally accepted.
A Logical Priority electronic dataset (as set out in draft form in Volume 5 of the EEPD. See www.fawdry.info/05_LOGICAL.php√) - following a national web-based debate on all definitions involved, needs to be accepted as a national (international?) standard.
Data items not included in the Logical Prioritisation Dataset, but which it was still considered to be important for audit e.g. breast feeding intention at booking, should be collected as a 1 in n sample or for a limited duration (using standard question and answer option after a web based debate, using, as a unique resource, the EEPD Volume 4. The Resource document is intended to facilitate the essential debate about the best wording of each selected data option www.fawdry.info/04_RESOURCE.php√
There should be a Focus each month on a particular subset of the mass of data then available. Such a focus on a particular topic each months would facilitate a review of both annual trends and benchmark comparisons with other U.K. maternity units of similar size and catchment areas. (A draft set of monthly topics are set out below)
Hopefully, in time, it should be possible for all such annual outcome statistical returns to be based not just on the results of individual maternity units; but rather on the process and the outcome for all women seeking maternity care based on the geographical / post code at “booking”
Rupert Fawdry. (Updated 10 Mar 2010)
Lack of an Index so far
Unfortunately, although an Index will in time be useful for this volume, there has not yet been time to create one. For the present therefore can I suggest that you make use of the “Find” facility on your computer to see if what you need is part of this Volume. As soon as possible, in order of usefulness, indexes will gradually be created.
Thank you for your interest.
EEPD Volume Audit and Benchmarking. Contents
It is intended that, once a set of monthly topics have been identified, this section could be used to identify, for each topic, what data should be selected and how the audit results should be displayed for maximum impact.
A. First attempt at Draft Proposals for a Monthly Audit Focus
To reduce statistical variations, it is suggested that all perinatal audits should use Annual Totals for the full year up to 3 months (?) before the date of each perinatal meeting.
A final suggested succession of topics needs to be established following local and national debate. The following is roughly based on the chronology of childbirth.
Month Proposed Audit Topic
A. Jan Presenting Population Characteristics Audit
B. Feb Social Factors and Outcome Audit
C. March Screening Audit
D. April Ultrasound Audit
E. May Outcomes from Inductions Audit
F. June Pain Control in Labour Audit
G. July Method of Birth Audit
H. Sep Outcomes for Standard Primip Audit
I. Oct Perinatal Outcomes Audit
J. Nov Staff Workload Comparisons Audit
Once there was a national agreement on the monthly topic, there would need to be a further web-based debate on the data to be presented under each general topic and how best to present it (bar charts / pie charts etc)
See BJOG Sept 2010. Although in the article the word used is CUMIN (Cumulative index) is used the approach is what is in the UK known as the use of a "Dahboard"
Z. Web Links
Naturally there will often be other websites which may be relevant to this topic. When this is so, it is intended that hyper-links should be created to supplement, or in some cases to replace, material available on the EEPD. Such web-links are not always stable. It therefore seemed best keep a copy of such hyper-links at the end of each volume of the EEPD so that they can be more easily checked on a regular basis.
Links so far
None yet documented for this Volume.
The creation of the EEPD is such a massive enterprise that links to other websites, both to commercial and non-profits making, are essential to it’s long term usefulness. If you know of any potentially worthwhile links please let the editors know so that others may benefit. Also if anyone worldwide has time to use search engines such as google to identify any such links do get in touch urgently. See also www.fawdry.info/eepd/HelpEdit.pdf√