National benchmarking as a support system for clinical governance

Audit of the management of acute asthma in hospital has developed in tandem with guidelines produced and updated by the British Thoracic Society (BTS) , on the principle that agreed guidelines combined with systematic review o f practice by periodic audit are more likely to result in improvements in p ractice than guidelines alone. A short audit data set was distilled from previous experience with more ela borate tools and made available nationally to audit departments and through letters to consultant members of the BTS. Hospitals have been able to cont ribute since 1990. The data set reflects key items of the process of care: peak flow measured on admission and twice daily during the hospital stay; blood gases on admis sion; systemic corticosteroids as an inpatient; discharged with inhaled and oral corticosteroids; written self management plans; follow-up arrangement s. Data from 4,741 admissions over a seven year period are presented. The prop ortion of patients nationally receiving these items of asthma care is given . The median values for hospital performance improved significantly over th e seven years, although there is potential for further improvement. If thes e data represent the national picture, they could form the basis upon which to set national standards for the care of patients with acute asthma in ho spital. A further result of the developing audit has been the recognition o f the value of external benchmarking in providing a context for the interpr etation of local audit results. This audit system provides hospitals with a quick and easy method of obtain ing an overview of local performance, with comparative national data for th e same year. This has potential as a tool for clinical governance with much wider applicability, providing the data are handled carefully, particularl y as the variability between hospitals diminishes over time.