Fulop, Naomi

Moonesinghe, S Ramani

Vindrola, Cecilia

Wagstaff, Duncan

English

UCL Discovery

REVITALISING AUDIT FOR PATIENT CARERevitalising audit and feedback by understanding andresponding to local contextsDuncan Wagstaff anaesthetic registrar 1, Cecilia Vindrola research associate 2, Naomi Fulop professorof healthcare organisation and management 2, S Ramani Moonesinghe head 11Centre for Perioperative Medicine, Division of Surgery and Interventional Science, University College London, Charles Bell House, London W1W7TY, UK; 2Department of Applied Health Research, Institute of Epidemiology and Health Care, UCL, University College London, London, UKFoy and colleagues summarise the challenges and opportunitiesfor using audit and feedback to improve patient care.1 We agreethat research should be embedded to improve the effect ofnational audits. In addition to the study designs described byFoy et al, an understanding of relevant contextual factors usingqualitative methods can help explain how national audits areperceived locally and used for improvement (or not). Recentevaluations of a quality improvement intervention in the UKusing data from the National Emergency Laparotomy Audit,for example, showed the importance of social barriers tochange.2-4With this in mind, we are conducting a concurrent qualitativeprocess evaluation of the national Perioperative QualityImprovement Programme (PQIP) in the UK, a multidisciplinaryinitiative supporting local quality improvement to benefitpatients undergoing major surgery (www.pqip.org.uk).5 6 A keyaspect of this evaluation is its formative nature, providing theopportunity for the programme to evolve rapidly in response tostakeholder feedback. We hope that by understanding the social,organisational, and professional contexts within which PQIPoperates will help us to refine its implementation and optimiseits impact.Competing interests: SRM is lead of PQIP, director of the Health Services ResearchCentre at the Royal College of Anaesthetists, and associate national clinical directorfor elective care at NHS England. DW is a PQIP fellow at the Health ServicesResearch Centre.1 Foy R, Skrypak M, Alderson S, etal . Revitalising audit and feedback to improve patientcare. BMJ 2020;368:m213. 10.1136/bmj.m213 321072492 Stephens TJ, Peden CJ, Pearse RM, etal. EPOCH trial group. Improving care at scale:process evaluation of a multi-component quality improvement intervention to reducemortality after emergency abdominal surgery (EPOCH trial). Implement Sci 2018;13:142.10.1186/s13012-018-0823-9 304248183 Stephens TJ, Peden CJ, Haines R, etal. Enhanced Perioperative Care for High-riskpatients (EPOCH) trial group. Hospital-level evaluation of the effect of a national qualityimprovement programme: time-series analysis of registry data. BMJ Qual Saf2019;bmjqs-2019-009537. 10.1136/bmjqs-2019-009537 315154374 Peden CJ, Stephens T, Martin G, etal. Enhanced Perioperative Care for High-risk patients(EPOCH) trial group. Effectiveness of a national quality improvement programme toimprove survival after emergency abdominal surgery (EPOCH): a stepped-wedgecluster-randomised trial. Lancet 2019;393:2213-21.10.1016/S0140-6736(18)32521-2 310309865 Wagstaff D, Moonesinghe SR, Fulop NJ, Vindrola-Padros C. Qualitative process evaluationof the Perioperative Quality Improvement Programme (PQIP): study protocol. BMJ Open2019;9:e030214. 10.1136/bmjopen-2019-030214 312965156 Gilhooly D, Moonesinghe SR. The Perioperative Quality Improvement Programme:improving outcomes. Br J Hosp Med (Lond) 2018;79:117-117.10.12968/hmed.2018.79.2.117 29431488Published by the BMJ Publishing Group Limited. For permission to use (where not alreadygranted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissionsd.wagstaff@ucl.ac.ukFor personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribeBMJ 2020;369:m1467 doi: 10.1136/bmj.m1467 (Published 16 April 2020) Page 1 of 1LettersLETTERS on 19 May 2020 at UCL Library Services. Protected by copyright.http://www.bmj.com/BMJ: first published as 10.1136/bmj.m1467 on 16 April 2020. Downloaded from 

Revitalising audit and feedback by understanding and responding to local contexts

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Revitalising audit and feedback by understanding and responding to local contexts

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