A deep dive into Euc’s clinical auditing processes

How do we identify, prevent and manage potential safety and quality issues at Eucalyptus?
Written by
Sarah Fuller
Daisy Lu
Tiffany Cheng

It’s our mission at Eucalyptus to deliver high-quality, high-touch healthcare. Of course, this also means safe healthcare. We’re proud to say that Euc is industry-leading in both clinical safety and governance. Our multidisciplinary teams work to consistently provide safe and high-quality healthcare by leveraging data-driven insights, ensuring compliance with both internal and external healthcare standards.

We know that traditional primary healthcare settings such as GP clinics are limited by often slow-moving and outdated systems. By sharing these insights into the clinical operations at Euc, it’s our aim to shed more light on the potential that digital telehealth platforms like ours have to transform the safety and quality of healthcare at a global scale. This deep dive will show our clinical safety framework, including how we identify, prevent and manage potential safety and quality issues.

What clinical audits do we carry out?

Our clinical audit team, comprised of both pharmacists and a doctor, audit over 5000 consults every month, at a global scale. We currently have six different categories of audits:

  1. High risk – these audits target consultations with significant potential risk to patient safety and are monitored every 24-72 hours.
  2. New prescriber – we manually audit the first 100 consultations of all incoming practitioners at Euc against our safety and quality benchmarks.
  3. Ad-hoc – these are targeted audits prompted by anomalies such as practitioners with unusually high approval rates, in comparison to their peers.
  4. Random – these audits make sure we maintain a high-level view of the entire span of what exactly is going on within our clinical services. We conduct monthly audits to a 95% confidence interval of the total consult volume, across four global markets.
  5. Quality – these audits solely assess consultations against our quality benchmarks to ensure our practitioners are providing a positive patient experience.
  6. Multidisciplinary – Medical Support and Health Coaching teams peer review their patient interactions against our established frameworks, promoting growth, trust, consistency and introspection amongst team members.

The Process

Our four-action approach for high-risk consultations

  1. Risk identification

Based on our clinical protocols, we’ve identified the 20 potentially highest-risk decisions practitioners can make.

  1. Analytics query

We work with our analytics team to generate specialised queries for the specific risks identified. This would also cross-audit 100% of the consults performed under this specific event. Decisions with high-risk potential are audited every 24 -72 hours.

  1. Manual audit

If there are any consults that have been identified through the analytics queries, our team performs a manual audit. The consult is reviewed to assess the clinical decision that was made.

  1. Actions and feedback

These steps allow us to provide robust feedback immediately to the prescribers and give us the opportunity to minimise any potential risks as a result of that clinical decision. All of these steps take place before a patient’s prescription gets to the pharmacy.

What is our safety criteria?

Our safety criteria rely on a combination of contraindications and precautions outlined in our internal prescribing protocols, as well as external clinical guidelines. These protocols include identifying critical flags in patients’ medical history that, when missed or not clarified by the practitioner, can result in an undesirable health outcome for the patient. Notably, the clinical protocols used at Eucalyptus may be more conservative than those used in traditional face-to-face practice, due to the remote nature of our consultations. Our commitment to patient safety means we encourage our practitioners to refer to external healthcare providers (e.g. GPs, specialists) where in-person treatment would be more beneficial.

To capture trends in the prescriber errors surfaced by our audit function, we track two key factors: “severity” and “harm score”.

Severity outlines the potential harm a prescribing event can inflict upon the patient and dictates the priority of the initial response from the clinical team. Severity ratings fall into four distinct categories, ranging from the most severe and highest priority “never events” where a prescribing decision has the potential to cause death or likely permanent harm, which is not reasonably expected as an outcome of healthcare, to the least severe “low risk” events where no harm will occur.

Harm score, on the other hand, is based on the actual incident outcome and additional care and resources that the patient may need as a result of the prescribing event. Harm scores are categorised on a scale of 1 to 4, with 1 representing the most significant harm such as the actualisation of a "never event," and 4 indicating minor harm that can be self-managed or a near miss where no harm has occurred. Since our clinical audit function is proactively identifying prescriber errors before medications are dispatched from the pharmacy, the actual harm risk is significantly minimised, even if the potential for harm is high. It is worth noting that this harm score classification is also utilised by public-sector healthcare institutions, both in Australia and internationally.

In short, we use severity to internally prioritise the errors that need to be addressed first and use harm score to capture the outcome of the prescribing event. This systematic approach to identifying potential harm has significantly helped us in capturing opportunities for overall safety and quality improvements.

Through effective clinical risk mitigation strategies, we are dedicated to continuously improving patient safety and playing a pivotal role in shaping the healthcare landscape worldwide. Our confidence in the efficacy of our safety systems has been reaffirmed during periods of onboarding new practitioners and fluctuations in consultation volumes. We are committed to continually improving our safety and quality standards, consistently raising the bar for the standard of digital healthcare in Australia.

Authors

Sarah Fuller
Clinical Operations Lead
Daisy Lu
Clinical Operations Associate
Tiffany Cheng
Clinical Operations Associate