Clinical audit was adopted from the medical profession in the late 1990s and is now widely discussed as a quality improvement tool in veterinary medicine. It is suggested by the Royal College of Veterinary Surgeons as a method to improve the care provided to veterinary patients and many opinion pieces offering advice have been published. However, there is no evidence to support its use in farm animal veterinary practice and no understanding of how it is currently used among farm animal practitioners. This PhD thesis aimed to determine if and how clinical audit can be used efficiently and effectively in farm animal veterinary practice in the United Kingdom (UK). A review of the literature found that the translation of clinical audit from human to veterinary medicine had resulted in confusing and conflicting advice for practitioners working with all species. The definition of clinical audit seemed unclear, advice on how to conduct the process differed between authors and the relationship with evidence and guidelines was ambitious. Very few publications were based on research evidence and most centred on expert opinion. There was also no information on how clinical audit was used or understood by farm animal practitioners. A cross-sectional study to collect experiences and attitudes of farm animal veterinary surgeons in the UK towards clinical audit was conducted using a nationwide survey. Despite the emphasis put on the process, the survey revealed that many veterinary surgeons had never heard of clinical audit, or never been involved in clinical audit in farm animal practice. The participants’ knowledge of clinical audit varied widely, supporting the findings of the literature review that clarification of the process was required. A case-series using qualitative data gathering methods and analysis, including a nominal group technique (Priority Setting Partnership approach) and thematic analysis, was carried out with three farm animal veterinary practices in the UK. Prospective and retrospective clinical audits were implemented in the practices using a clearly defined framework and detailed feedback was collected on the process through a number of routes. Attempting clinical audit in the three practices highlighted many challenges to conducting clinical audit in farm animal veterinary practice. This included the difficulty of differentiating between research and clinical audit, the logistics of data collection on farm, the limitations to conducting retrospective audits in farm practice, and the time taken for the process. A number of benefits of the process were also appreciated. The practitioners found clinical audit to be an interesting exercise that increased communication within the practice and improved knowledge on how procedures were conducted. Protocols and guidelines are a suggested component of clinical audit but little information was found about their veterinary application in the literature review. To investigate the use of protocols and guidelines in farm animal practice a survey-based case study using structured interviews and a questionnaire was completed examining the understanding of, and attitudes towards, a surgical protocol used by veterinary surgeons within a practice. The case study found that guidance can have a place in practice, but highlighted that it should always allow for clinical findings in each case to be considered and acted on appropriately. Suggestions were made that checking all staff follow a guideline may not be the most beneficial way to conduct clinical audit. Following the work of this thesis, the definition of clinical audit and suggestions for its use in the veterinary setting have been simplified and defined. Discussions about the suitability of clinical guidelines and protocols and how each relate to clinical audit have been started and may provide a baseline for future research. Recommendations for farm animal practitioners wishing to conduct clinical audit in practice have been produced with an emphasis on attempting the process for the first time. This thesis has modified the process of clinical audit to ensure that it is accessible and practicable for veterinary surgeons wishing to improve the quality of care delivered in practice.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:728498 |
| Date | January 2017 |
| Creators | Waine, K. V. |
| Publisher | University of Nottingham |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://eprints.nottingham.ac.uk/43805/ |
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