What, why, how, where?
What is an audit?
Clinical Audit is a quality improvement process that seeks to improve patient care and outcomes by systematically reviewing current practice against defined criteria.
After assessing current practice, if needed, changes are made and further audit is used to confirm improvement. Essentially, you assess what you do against defined standards then make a change and re-assess to show (hopefully) improvement.
Clinical audit is not just a data collection exercise. It involves measuring current patient care and outcomes against explicit audit criteria (also termed standards), but also:
- There is an expectation from the beginning that practice will be improved.
- Further clinical audit may be required to confirm that practice has improved.
Why undertake an audit?
Audit is an integral part of all clinical practice. Participation in audits show that you’re motivated and dedicated; not only to radiology but to the activities expected of a conscientious and desirable radiology trainee. The GMC has said that it is the duty of a doctor to participate in regular medical audit.
An additional benefit is that you will look at a specific aspect of radiological practice to audit and while undertaking this audit you will learn about this area in great detail. This knowledge and experience will be of use in the future, particularly during your radiology interview. Demonstrating this knowledge in your interview will greatly work in your favour.
If you haven’t done anything so far in radiology to boost your CV, then an audit is a good start!
How do I get started?
Firstly, you need a supervisor. Don’t even attempt a radiology audit without involving someone senior in the radiology department, because when it comes to implementing any changes following the audit, you will hit a brick wall.
Ideally your supervisor should be a radiology consultant who can help you set your objectives, keep your project on track, and help you troubleshoot any issues. Having a supervising consultant also has the added advantage that if you don’t have time to complete a re-audit, or if you move jobs before it’s finished, the consultant can help you find someone else to finish your project so all your hard work does not go to waste.
Secondly, you need an audit topic. It may be that your radiology department already has an idea for you in mind, but if you need inspiration then an excellent source of radiological audit materials is RCR AuditLive, where there are 100+ audit recipes with standards, targets, audit data collection tools and guides, recommended sample sizes etc. Utilising this resource cannot be recommended enough for the completion of a radiology-centred audit.
Radiology clinical audit lead
Most radiology departments will have a clinical audit lead who is usually a consultant radiologist. They are responsible for the oversignt and completion of clinical audits within a department. One of their key roles is to encourage and facilitate audit participation including review of proposals for audit and advice and amendments to designs as needed and monitoring of subsequent action plans and re-audits. Audit leads also share outcomes of the audits at audit and governance team meetings and at departmental meetings.
Seeking advice from your department’s radiology audit lead on audit topic and methodology is another good way of getting started.
What makes a good topic?
This does require some thought. Don’t just leap in with the first idea you have. It’s a good idea to consider the following factors when selecting an audit topic:
- Is it a priority for your department/hospital/trust? e.g. Is it in an area with a high volume of work?
- Is the issue topical? If so, consultants are more likely to help and will be keen to strive for change.
- Is there a previous audit or topic that was never re-audited (i.e. the loop was not closed)? If so this is a good audit to get involved with. The method and guidelines will have already been determined as you’ll be expanding on the work of someone else, who incidentally will be very grateful to you for closing the loop.
What is the best sort of audit?
What are the steps to perform a clinical audit?
- Seek advice on the audit topic and methodology from a radiologist.
- Send proposal to the clinical audit lead and register the audit proposal with the hospital’s clinical effectiveness team (or equivalent).
- Complete the audit within scheduled timeframe (i.e. data collection and analysis).
- Complete an action plan with how you intend to improve on the results (as needed). This may involve process changes or education to groups of staff (for example).
- Submit the results and action plan to the departments clinical audit lead.
- Present the results to the wider radiology department and undertake the action plan.
- Repeat the audit (re-audit) after making changes to demonstrate improvement.
Where can I present my audit?
Audit examples
(from RCR Audit Live)
- X-ray confirmation of nasogastric tube placement: documentation in patient notes
- Adequacy of cervical spine x-rays in trauma
- Urgent CT Brain scans for LP
- Compliance with NICE guidelines on head injury and CT brain
