Monitor changes against standards or select criteria, and don’t forget to keep track of performance!

EBVM includes patient, client, experiential and practice factors as well as the peer-reviewed scientific literature, and all of these will influence the information you gain and want to gain from a clinical audit.

For example, you might want to know if implementation of a protocol or new treatment will improve client satisfaction, decrease costs to the client, increase profit margins, save time, improve veterinary compliance, reduce side effects, increase survival, or increase quality of life. In order to answer this ‘What if?’, you need to ensure you are asking the right questions to the right person (e.g. quality of life is often best evaluated by owners through practical questions involving the animal’s daily life, not by their veterinarian).

Some examples of ways in which we could monitor changes against standards or criteria might be:

  • Making sure that recurrence or complication rates for a specific disorder are equivalent to a recent multicentre case series found in the literature.
  • Setting nosocomial infection rates to reduce by a certain percentage from the current baseline if no history of actual rates is available.
  • Insisting that client-reported quality of life or pain score ratings should be equivalent to published results, should improve from what they currently are in your clinic, or should be greater than a predefined percentage.
  • Necessitating that client satisfaction should improve, or remain static where it has already been at high levels.
  • Requiring veterinary or owner compliance to be above a certain cut-off percentage (e.g. veterinary adherence to safety protocols would be expected to be 100%, while expectations of client compliance to puppy vaccination schedules may be set slightly lower).
  • Stipulating that cost implications of implementing a new protocol should be comparable to those associated with the previous protocol, or that the new protocol will have a demonstrable cost benefit to the client and/or practice.

The overarching principle to successful implementation and adoption of both EBVM and clinical audit is to keep things small and simple, especially to start off with. It should be possible for you to set a modest goal of clear benefit, and to achieve it. Communication is also important – be sure you keep records of the process and of your findings so that you can compare the next cycle with the last. Discuss the tasks and progress with colleagues both during and after each audit cycle. Good communication will help to involve the more experienced (and often busiest) members of the practice who may at first be reluctant or unable to engage otherwise.

Example Scenario 1: Dry cow therapy
Rachel has selected two criteria against which to monitor the performance of her new dry cow therapy protocol, and she will review these after farms have been using the new therapy for at least six months.

  1. The cost implications – are the costs of this therapy to the farmer directly or indirectly comparable to the previous therapy?
  2. Improvements in somatic cell count (SCC) and clinical mastitis rates – has the bulk tank SCC reduced or stayed at the same level, and has the incidence of clinical mastitis in the post-calving period reduced or stayed the same in cows treated with the new dry cow therapy?
Example Scenario 2: Small animal dental imaging
Tom has selected three criteria to monitor the dental radiography unit, and will evaluate these after the technology has been in use for 12 months:

  1. Has the number of teeth removed from dental patients remained the same, increased or decreased?
  2. Have owners completed feedback surveys of the post-dental behaviour in their dog or cat, and are these surveys indicating that owners are happy with the results they are seeing?
  3. Has the average dental invoice amount increased or decreased?