Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Inaugural NOCA Conference

18 May 2015
The National Office of Clinical Audit (NOCA) hosted its inaugural conference at the Royal College of Surgeons in Ireland (RCSI) today, Monday 18th May 2015.  Through collaboration of RCSI and the HSE Quality Improvement Division, NOCA was established in 2012 with the specific purpose to create sustainable structures to develop and support clinical audit nationally. 
Opening the Conference, ‘Managing what we measure’ Dr Philip Crowley, Director of HSE Quality Improvement Division, main sponsor of NOCA and member of the NOCA Governance Board, noted that despite the challenges and road blocks along the way, since its May 2012 launch, NOCA have worked steadily to overcome many obstacles and are now firmly positioned as credible enablers for quality improvement.  
Dr Crowley spoke to the importance of the NOCA Team having established strong alliances with international leaders in quality improvement. In particular, he welcomed Prof Danny Keenan, Medical Director of Healthcare Quality Improvement Partnership, Prof Fiona Lecky, Trauma Audit and Research Network UK and Prof Simon Jones, University of Surrey all who travelled to share their international experience of clinical audit and quality improvement.  NOCA has and will continue to look to international expertise for evidenced based methodologies and systems of clinical audit.
Dr Crowley spoke to the importance of robust clinical audit and review when actual or perceived harm is identified, he stressed the importance of continual review and audit in the proactive, systematic structures that NOCA have established.  He noted hospitals and clinicians wanting to improve outcomes for patients and their own practice was not a new concept, what was new to the Irish health sector was ensuring audit findings are shared locally and nationally with a health service and its decision makers willing to take recommendations and action.  
Mr Ken Mealy, Clinical Director to the NOCA Executive Team opened the first session which outlined the journey NOCA has taken over the last three years.  He noted that despite the progress NOCA have made, challenges requiring national policy still remain.  In particular due to the absence of the Health Information Bill, NOCA’s first audit stream identified and developed in 2012, the Irish Audit of Surgical Mortality remains dormant. 
Professor Sean Tierney, Chair of the NOCA Governance Board, closed the day by acknowledging the effort of all involved nationally and within hospitals to truly participate in full audit.  He noted turning clinical information into quality data took considerable time, patience and if done correctly, the audit cycle is never complete.  He highlighted the service requirement to commit adequate resources to maintain quality data collection.  He hoped from the day, all appreciated that clinical audit should be an iterative process from which over time learning can be achieved and measured.  

Additional information:
NOCA has now fully commissioned and is working with hospitals through established governance structures with the following: 

  • Major Trauma Audit – Led by Dr Conor Deasy / Marina Cronin 

  • Irish Hip Fracture Database  - Led Dr Emer Ahern, Mr Conor Hurson, Louise Brent / Deirdre Burke

In parallel NOCA is working to deployment in the following national streams:

  • National Audit of Hospital Mortality – Dr Barry White / Dr Howard Johnson / Marina Cronin

  • National ICU Audit – Led Dr Rory Dwyer / Mary Baggot is now live in Mater Misericordiae University Hospital and University Hospital Limerick, deployment will continue to all Intensive Care Units over the next year.

Final user testing of a bespoke electronic collection tool for the implementation of the Irish National Orthopaedic Register, is underway with the support of South Infirmary Victoria University Hospital.  Its implementation will deliver a much needed arthroplasty register that will monitor performance and allow agile recall of orthopaedic implants from both public and independent elective hospitals.  

More recently NOCA commenced work with the National Perinatal Epidemiology Centre and are now working to support governance to ensure output of their valuable audits are returned and used at hospital level to improve outcomes for mothers and newborns nationally.  

The Irish Audit of Surgical Mortality – Clinically led Mr Ken Mealy, is currently awaiting the introduction of the Health Information Bill.