What is a NOCA Clinical Audit?

The purpose of a NOCA clinical audit is to improve the quality of care provided to patients and to improve their outcomes.

NOCA defines clinical audit as

a clinically led, quality improvement process that seeks to improve patient care and outcomes through the systematic review of care against explicit criteria. When the standards are not met, a process of improvement can be undertaken, re-audited to enhance the quality of care provided to patients.

The information provided by a NOCA clinical audit provides information at a national level and at a hospital level. This information informs policy makers (e.g the Dept. of Health), healthcare managers ( e.g. in the HSE) and healthcare professionals (e.g. in hospitals) and the general public about where their healthcare service is doing well and where it could be improved.

An Example: One of the best practice standards for patients who are admitted to hospital with a hip fracture should have surgery within 48 hours. The NOCA Irish Hip Fracture Database (IHFD) measures this. Hospitals can compare how they are achieving this standard and if not, how they can improve.

What is the process of a NOCA Clinical Audit?

How is your data used in a NOCA Audit?

When you are a patient in a hospital your clinical care is documented by your healthcare professional and recorded in a chart and/or an electronic health record. As part of the essential continuous improvement of healthcare your data may then be used to carry out a clinical audit.

For most NOCA Clinical Audits, your personal data will not be used. e.g. name and full address, but other details will be used, such as your age, gender, county in addition to the clinical details around your illness and treatment.

The data used is crucial for reviewing clinical practice and is used to set out new quality improvements in the clinical area being audited.

* An example; clinical data on patient care could include

• Type of Injury / illness

• Type of treatment or operation provided

• Length of stay in a hospital

** INOR audit: please see the INOR patient information leaflet for further detail on consent and implant recalls as part of patient safety objective of the register.

What happens to the data once collected?

• Data is collected by Audit Coordinators. In hospitals, an Audit Coordinator is a nurse or administrator and they make sure the data is suitable for reporting to NOCA

• Data is provided to NOCA via a secure electronic database

• Data is limited to the agreed dateset which is sure to meet the clinical standard

• The NOCA Audit Team analyse this data and produce a clinical audit report

• NOCA Clinical Audit reports are shared with hospitals, healthcare managers, healthcare professionals, policymakers, and the general public. For the general public a summary report is prepared so that the key points are provided in plain English.

Does a patient need to consent to personal data being used for Clinical Audit?

GDPR requires that processing of personal data is fair, lawful and transparent. For most Clinical Audits, consent is not relied on but other conditions under GDPR such as

• Article 6(1)(c) GDPR “processing necessary for performance of contract” with the data subject, or Article 6(1)(e) – ‘processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller, or Article 6(1)(f) – processing is necessary for the purposes of legitimate interests.

• Article 9(2)(h) GDPR– ‘processing is necessary for the purpose of preventative…medicine…the provision of health or social care or treatment or the management of health or social care systems and services…’ or Article 9(2)(i) – ‘processing is necessary for reasons of public interest in the area of public health, such as…ensuring high standards of quality and safety of health care…’

The exception to this for NOCA is the Irish National Orthopaedic Register where consent is used as the lawful basis as full names and addresses are collected to identify patients in the event of an implant recall. Patients decide what information is shared with the register. They do this by consenting yes or no. Where a patient decides not to consent, the hospital will be informed of the dates of surgery where implant was used that is subject to the recall and the hospital will use local procedures to identify and contact the patient. Where a patient consents then the hospital will be provided the full list of patients with contact details and the surgeons will follow up with each patient. Please see the INOR Patient Information leaflet for more information.

All data collected by NOCA is stored in accordance with relevant GDPR practices.

NOCA’s recommendations for improvements

Each NOCA Audit produces an annual report that shows where there is excellent quality in care and where improvements in the quality of care may be required. The report also includes a set of recommendations to improve care. These recommendations are developed by each of the Audit Governance Committees. These committees includes former patients, members of the public and healthcare professional.

Where to find NOCA Audit reports?

Each audit produces a detailed annual report and an associated summary report. These are available to download on our National Audit Report web page

Clinical audit and how it differs from clinical research

Clinical audit measures against agreed standards for all patients meeting the audit criteria (no randomization). The audit findings can create new insights which can then be used to gain new knowledge by conducting research. NOCA does not provide any identifiable data for research purposes. Data is anonymised before it can be used for research. Clinical audit should not be confused with clinical research as their purposes differ greatly.

Further information on clinical audit and research is available here

If you have a concern or query about an aspect of healthcare provision that falls outside NOCA audits, please note that NOCA do not have an investigative remit. If we receive any such enquiries we will forward these to the accountable person. If you have a complaint or comment about your care https://www.healthcomplaints.ie/ will help you find the right place to give your feedback