Is audit research? The relationships between clinical audit and social-research

Reducing the rate of unregistered studies

The aim of this audit cycle is to measure the extent to which unregistered or wrongly classified studies (research, clinical audit, satisfaction surveys/service evaluations) are conducted within a National Health Service (NHS) Trust, and to ascertain whether promotion of the correct processes can improve the results. An anonymous questionnaire was sent to staff in a single NHS Trust via internal post and email concerning unregistered or wrongly classified studies being conducted. An information sheet was attached to the questionnaire, which gave a brief description and information relating to conducting different types of study. The audit was conducted before and after the introduction of a variety of promotional activities within the Research and Development (R&D) department. The percentage of unregistered research was shown to be 45.8% in audit 1, with audit 2 showing a reduction in unregistered studies to 5.2% ( P = 0.005). For clinical audits the results were similar between audits (with no additional promotion) (2.3–2.4%). Satisfaction surveys which were included in the promotion of the research department reduced its level of unregistered studies from 46% to 5% ( P = 0.0084). With the targeted and persistent promotion of the relevant departments a dramatic reduction in unregistered studies can be achieved ( P = 0.01).

Screening for psychological distress in patients with lung cancer: results of a clinical audit evaluating the use of the patient Distress Thermometer

PURPOSE

Patients with lung cancer frequently suffer psychological distress and guidelines in the United Kingdom recommend screening of all cancer patients for this problem. The audit investigated use of the Distress Thermometer in terms of staff adherence to locally developed guidelines, patient willingness to use the tool, its impact on referral rates to clinical psychology services and concordance between the tool and the clinical assessment.

METHOD

Use of the Distress Thermometer was audited over a 3-month period in one lung cancer outpatient clinic. Referrals to clinical psychology services in response to clearly delineated referral indicators were assessed. Patient-reported outcomes were compared with practitioner assessment of need during clinical consultations to see whether the tool was measuring distress effectively.

RESULTS

Thirty three of 34 patients used the Distress Thermometer during the audit period. Ten reported distress levels above 4 in the emotional or family problems domains. On ten occasions, the clinical interview identified problems not elicited by the Distress Thermometer. Guidelines were adhered to by staff, and patients were offered information about local support services and referral to clinical psychology services where indicated. Whilst all patients were happy to receive written information about further sources of support, none wanted to be referred to psychological services at that time.

CONCLUSIONS

The Distress Thermometer is acceptable to patients with lung cancer in outpatient settings but it did not increase referrals for psychological support. Staff found it to be a useful tool in opening up communication about patient issues although it should not replace a comprehensive clinical interview.

Transobturator tape procedure in stress urinary incontinence: UK experience of a district general hospital

We aimed to assess the effectiveness and complications of transobturator tape (TOT) in the treatment of female stress urinary incontinence (SUI). This was a retrospective study of case notes of women who had a TOT procedure between December 2003 and July 2005 at a district general hospital. We reviewed 135 case notes on the TOT procedures performed during the study period. Mean age was 55.9 years (range 28-93 years). The mean follow-up period was 3 months (range 6 weeks-12 months). There were no major complications and 18 minor complications were noted. Six patients were lost to follow-up. In the short term, the subjective level of complete cure and improvement reported by patients was 89.6% and 8.8%, respectively. The cure rates were not related to the patient's body mass index (BMI), preoperative urodynamics (UDS), previous pelvic surgery, type of anaesthesia, concomitant pelvic surgery or occurrence of complications. TOT seems to be a safe and effective procedure for treating female SUI, avoiding the major risks of the retropubic approach. A robustly designed randomised controlled trial with long-term follow-up is necessary to assess long-term success rate and complications when compared with other procedures.

Ethics of collecting and using healthcare data

Primary responsibility lies with the organisations involved, not ethical review committees