Peer Audit

The CCMDB Peer Audit is a real-time audit to quantify the variability in our data collection.

Preamble

What the Peer Audit is and is not

The Peer Audit is not meant identify "wrong" data or to single out a specific collector who is doing something bad. We are trying to quantify the precision rather than the accuracy of our individual data elements. A lot of us have hunches about where there are problems, this audit is to give us objective indicators.

Following that, please do not compare notes on the patients you are auditing as this would prevent us from getting an accurate idea how consistent our data is.

Goals and follow-ups to the peer audit

Julie will generate accuracy scores from the audit data, and we will provide these back to you in this article.

Once we know which areas have the least accuracy we will look for reasons for the inaccuracies and try to eliminate them. This will largely happen ad-hoc using the wiki. We may also come back to you personally to find out why there are discrepancies, but this is to find the reasons and fix the underlying problem, not to criticize individuals.

We will also use our findings to correct data, but this is for a very small subset of our database and just coincidental.

Start Date

• programming by Tina - Done
• testing by collection office - in progress
• pilot by collectors - START TEST: Nov 17-27.09.TOstryzniuk 13:00, 17 November 2009 (CST)
  • sites to start testing Nov 17.09:
    • HSC SICU & MICU - Joyce and Lois
    • HSC Med all wards: (Gail, Con, Pat, Marie)
    • VIC Med (Tara and Shirley Nov 18. Next week: Tara, Wendy and Shirley)
    • GRA Med all wards (Steph and Sheila)
    • STB CICU - Laura K
  • Start Week of Nov 23.09
    • STB -all ICUs- MICU CICU & CCU - Kym and Darlene & Laura
    • STB Med all wards-(Deb, Elaine, Galye)

Processes and Procedures

What is collected

• All data elements for patients, excluding TISS for ICU.

How it is collected

Every data collector (except community ICU) has an audit ward assigned in Peer Audit Partners.

The first patient admitted to the audit ward on Thursday morning will be an audit patient and will be followed as if he or she were a patient admitted to the regular ward of that collector.

• for pilot testing purpose Nov 17-27.09 -select any day of the week.

The serial numbers to be used for audit patients will be 111 and following. If a patient is not discharged by next Thursday, use the next number, e.g. 112. Re-use earlier numbers once they become available, i.e. once patient 111 is sent and deleted, use the number for the next audit patient.

On the next send day a separate batch is sent for audit patients discharged during the previous week. To do this, make sure you either first delete your regular sent patients, or that you uncheck their "FinalCheck" checkbox. The records are sent as a separate batch with the following parameters

• batch: "a"
• initials: dd-mmm-yy- and use your own initials, e.g. 03-jun-09_TT

This will differentiate this data from our other collection data and facilitate further processing by our statistician.

Data Sending

If the batch is "a" (i.e. for audit patients) then CCMDB.mdb will send and temp information to the following alternative audit locations:

• Tasks: Regional Server\output\tasks_peer_audit.mdb
• Temp: Regional Server\output\TmpV2_peer_audit.mdb
• Don't need to process pending for this.

Data Processing

To do: Find out where Pagasa stores regular files once appended, make a subdirectory for "a" files there...

Discussion

• Waiting for update to Data Appending ProcessTtenbergen 16:05, 10 September 2009 (CDT)

Data Analysis

• retrieve file from <above> location
• match every field one on one, give count of good vs bad and degree of difference
• do a pair-analysis for dxs, Admit 1 specific, and others regardless of diagnosis number

Follow-Up

• Post accuracy scores to this article
• further investigate causes for differences

Discussion

• does the peer audit include doing a TISS which is normally done by bedside nurse?--Laura Kolesar
  • No EXCLUDE TISS.--TOstryzniuk 12:34, 18 November 2009 (CST)

• I regularly cover for both Kym and Darlene for sick, vacation and we help each other out when the others are busy. How do I audit an area if I am covering for vacation in the same area??--LKolesar 11:07, 18 November 2009 (CST)
  • Good question. If you are covering for vacation in the same area, don't do an audit on that week. The main idea for the peer audit is to repeat the data collections totally by 2 different data collectors. -- JMojica 14:14, 18 November 2009 (CST)

• For SBGH med, our start date is the week of Nov.23/09. Do we audit the first patient admitted to the ward for Monday Nov. 23/09, or do we audit the first patient admitted to the ward for Thursday, Nov. 26/09? (under "How it is collected-it says to audit "the first patient admitted to the audit ward on Thursday morning") We will also be doing some vacation relief starting the month of December, and actually continuing on for most of January and February 2010. So, do we do the same as Laura, above, and not audit if you are covering for vacation?DPageNewton 14:36, 18 November 2009 (CST)
  • STB will start "next week" and audit the first patient admitted on Thursday. If no admissions on Thursday then first patient admitted Friday.TOstryzniuk 15:33, 18 November 2009 (CST)
  • Yes don't do audits during week you are covering vacation.TOstryzniuk 15:33, 18 November 2009 (CST)

• For Vic med- We collect the admit date/time pt admitted to medicine service and the actual date/time the patient is moved to the ward. Do you want the first patient on the Thursday to be the first patient to arrive to the ward that day or the first patient admitted to the medicine service that day? What do you wish us to do if there are no patients admitted that day? Do you want at least 1 patient per week for the audit? Also, Shirley works the Mon, Tues, And Wed while Wendy and I work the Tues, Wed, and Thurs. How do you want us to work this so we are consistant? Also, what happens if the patients we are auditing have prolonged lengths of stay (ie 6 mos to a year)? Also, Wendy and I now do S3 as well and all the EMIP/OVER patients and split the workload between our laptops. Do you want us to follow any of the S3 patients as most of these patients have been transferred from other wards and have been medically stable and are usually waiting placement? Do you want us to follow patients that are transferred between wards or just new admits? Sorry lots of question but we would like to be consistent with other locations.TAngell 15:04, 18 November 2009 (CST)