The secondary care workstream ran an audit in 2014, composed of two parts: a clinical audit of patients admitted to hospital in England and Wales with COPD exacerbations and a survey of organisation/resourcing of COPD care.
What we did
The secondary care clinical audit 2014 involved the collection of data for consecutive admissions to participating hospitals over a 3-month period, with cases identified prospectively. Data was gathered from patient case notes by members of the clinical team in each participating hospital and entered into a secure, bespoke web-based audit tool. The quality of care delivered against agreed standards, guidelines and frameworks was measured and patient outcome data will be extracted and linked from other existing data sources.
An organisational audit was also run in parallel with the clinical audit, with data collection via the bespoke web-based audit tool. The datasets for each part of the audit were developed and refined during 2013 by the workstream steering group, with input from the NHS and the British Thoracic Society (BTS) COPD leads, and in light of feedback from a short pilot audit run in September 2013. The clinical dataset focused on:
- provision of timely care
- recording of key clinical information
- managing respiratory failure
- oxygen therapy
- inpatient stay
- integration of care at discharge.
Patient information leaflets and posters were also produced describing the purposes of the audit, the information being collected, how the information was to be stored and used, and what action patients should take if they did not want their details to be submitted to the audit. Participating organisations were asked to display the poster in areas where COPD patients are treated and to make the leaflet available to patients who asked for a copy.
The data collection period ran between 1 February and 30 April 2014 with a further month to complete data entry onto a bespoke web-tool. All eligible sites (a total of 208 hospitals from 143 trusts and six Welsh health boards) registered for the secondary care audit, with 99% going on to participate in the data collection for both the clinical and organisational audits. Over 13,800 cases were submitted for the clinical audit.
All relevant secondary care providers in England and Wales were expected to participate. The National COPD Audit Programme is included in the list of national audits for inclusion in trusts’ Quality Accounts, and is also included in the NHS Wales Clinical Audit and Outcomes Review Plan.
The National COPD Audit Programme has been commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) and currently covers England and Wales only. We are very much aware that colleagues in Scotland and Northern Ireland may wish to audit their practice and, while this presents challenges in relation to resourcing and information governance rules that differ from country to country, the National COPD Audit team continues to explore ways in which this could be achieved in the future.