Few optometrists undertake clinical audits, mainly due to a lack of tools and exposure, and practitioners are not routinely trained in the process.
Australia’s first clinical audit tool for optometrists has been developed in Melbourne and is freely available to help practitioners audit the care provided to their diabetic patients.
Keying patient information into spreadsheets enables optometrists to assess their practice’s management of diabetic patients and identifies areas for improvement, enabling practitioners to improve their care and patient outcomes.
University of Melbourne optometrists Dr Laura Downie and Associate Professor Peter Keller, who developed the tool after receiving a Victorian Optometrists Training and Education (VOTE) grant, said that while clinical audit was routinely adopted in many areas of health care, there was a need to improve uptake of this important process within the optometry profession.
‘Clinical audit seeks to improve the quality and outcome of patient care through structured review and involves clinicians examining their practices against agreed explicit standards and where indicated, modifying practices to improve patient care,’ Downie said.
‘It involves finding out whether current care practices are appropriate and identifying any potential shortfalls in patient care. It allows clinicians to assess whether they are adopting best practices, as informed by high-quality clinical research. The ultimate aim is to improve provision of patient care.’
The idea to develop the optometric clinical care audit tool (CCAT) was inspired by comment received from attendees of the VOTE-funded evidence-based-practice workshop series that Downie and Keller delivered to Victorian optometrists in 2014.
‘When we surveyed 80 attendees about their auditing practices, less than five per cent had undertaken any form of audit. A major barrier was lack of available tools,’ Downie said.
‘We were inspired to develop a tool for management of patients with diabetes, as diabetic retinopathy is a major public health issue and there are well-established NHMRC Guidelines (for the Management of Diabetic Retinopathy 2008) to use as a basis for auditing clinical practices.’
The tool audits diagnostic accuracy, appropriateness of therapy, rate/timeliness of referrals, referral accuracy and quality of record-keeping.
Details of up to 100 patients, in this case with diabetes, are entered into an Excel spreadsheet. If more than 100 are included in a retrospective audit, a second spreadsheet is used.
The authors suggest practitioners consider a three-, six- or 12-month audit. Longer duration enables information to be captured about longer-term patient behaviour including whether patients are attending for biennial reviews.
A summary statistics worksheet automatically populates key information comparing the practitioner’s current practices with NHMRC guidelines for managing patients with diabetes. This allows easy implementation of the analysis component by the practitioner without having to invest significant time to analyse patient data.
As data are added, the page highlights areas of relative strengths and potential areas of under-performance in clinical practice. The practitioner can then identify reasons and develop strategies for improving care.
For example, if only a few patients were returning for review within the practitioner’s recommended period, the optometrist may consider implementing a new patient recall system to assist with improving patient review.
To assess the effectiveness of this strategy, the practitioner would audit their practices again after a period of time to see if there had been improvement in this area.
‘Practice support staff may be able to assist with audit by identifying relevant patient records but we consider it is essential for the practitioner to directly input data into the tool,’ Dr Downie said.
‘We have constructed the CCAT to have drop-down menus and self-populating fields. Diagnosis and management worksheets should be used in association with the NHMRC Guidelines as they may require clinical interpretation of relevant retinal findings.’
More than 100 optometrists and students attended its launch and an educational seminar on its use. A pilot study of independent practitioners is evaluating its usefulness.
Other practitioners from Victoria and interstate who are interested in becoming involved with the project can contact Dr Downie at firstname.lastname@example.org.
‘We foresee an opportunity for further development to directly interface with existing optometric practice management software systems,’ she said.
* The CCAT uses a Microsoft Excel template. There are Mac and PC versions and a document with step-by-step instructions freely available for download on the Department of Optometry and Vision Sciences University of Melbourne website.
The optometric clinical care audit tool (CCAT) enables practitioners to improve their care and patient outcomes