Occupational Health | Bulletin | No.OH0003 V 1 | 24 May 2022

Audit findings: Spirometry practices

Audit overview

Resources Safety and Health Queensland (RSHQ) undertakes audits of spirometry as part of ongoing compliance and quality improvement processes for the Coal Mine Workers’ Health Scheme (the Scheme). The audits target problem areas identified in the 2016 Monash Review including spirometry training, equipment and maintenance, and test quality. Over 3,000 spirometry reports from 80 practices have been reviewed against test quality and reporting requirements set out in the Thoracic Society of Australia and New Zealand Standards for the Delivery of Spirometry for Resource Sector Workers (the Standards). In addition, 94 spirometry practices have been audited on-site against the Standards and other administrative requirements for registration with RSHQ.

General feedback from practices indicated that the accreditation program delivered by Quality Innovation Performance Limited (QIP) for RSHQ, along with compulsory training has contributed to improved spirometry quality.

Opportunities for improvement

While RSHQ has followed-up non-compliances with audited practices, the results provide specific opportunities for shared learnings and improvement, which should be reviewed and implemented by all providers to improve their practice, compliance and ultimately health outcomes for workers.

• Thirteen percent of spirometry tests were identified as non-compliant with the requirements in the Standards, particularly for acceptability and repeatability.
• Issues with reporting on the spirometry test were common across all practices. Comprehensive reporting assists doctors reviewing the spirometry to assess test quality and interpret the results. The most common issues included: lack of operator comments on test quality; no comments on the use of bronchodilator prior to the test; use of reference values other than the Global Lung Initiative (GLI 2012); not including all required trial values and curves to assist in determining the overall quality of the test.
• Almost 40 per cent of spirometry practices audited were missing one or more elements of the required equipment described in the Standards. Components missing included a certified and calibrated 3L calibration syringe, single-use mouthpieces, and daily access to local atmospheric conditions. Consequently, practices were not performing the associated calibration or verification activities that ensure quality spirometry. Additionally, one out of every five audited spirometry practices were not adhering to requirements for cleaning and maintenance described in the Standard.
• Several spirometry practices were found to have operators who were either not maintaining a logbook or adequately logging tests to demonstrate progress towards the minimum 100 tests per annum required under the Standards. This requirement ensures spirometry is completed frequently to maintain operator competency and promotes improved quality. Logged spirometry tests do not necessarily need to be conducted on coal mine workers and can include other patients, staff members, family, or friends.
• Operators from five practices had not completed the required initial training and operators from six practices had not completed the required refresher training. The Standard requires spirometry operators to complete an initial training course through a RSHQ registered training provider prior to undertaking spirometry for the Scheme and continue to complete periodic refresher training. This ensures operators are aware of the requirements in the Standards and have the practical skills and knowledge to perform quality spirometry tests.
• Many practices had little awareness or understanding of RSHQ’s registration Conditions of Approval (the Conditions).  Adherence to the Conditions is a requirement for all registered providers that perform functions for the Scheme. Failure to comply may result in suspension or cancellation of a practice’s approval with RSHQ.

Detailed insights 

The following video provides a more detailed overview of the findings and recommendations from the spirometry clinical audit.

References and further information 

Always refer to the Standards and resources for health assessments webpage for access to the most up to date requirements for performing health assessments.