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Clinical Audit
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How to conduct a Clinical Audit

Clinical audit is the collection of data in a clinical environment in order to improve patient care. Audit is a key way of showing how keen you are to a potential employer. A good time to do an audit is within a "self-directed" learning period (as long as the medical school agrees). Here is a short guide to getting one done.

About Audits

NICE defines clinical audit as:

A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change.

The key idea is to take a published standard and see whether this is being followed in practice. Standards are often NICE guidance (available on their website.) If a topic is investigated and not compared to a standard it is considered research. This is an important distinction because unlike audits, research must be approved before an ethics council and participants have to agree to participate in the study. An example of an audit would be to take the NICE guidelines on the management of renal disease and go through patient notes recording whether each had had the correct investigation and treatment. In contrast, an example of a research topic would be to investigate the mortality of patients with renal failure if they are given a specific drug, as compared to the mortality of those who had not been given that drug.

Auditing is considered a "cycle", as when as audit has been completed and the changes implemented the idea is to re-audit to discover if the changes are working. The stages of audit include:

  1. Identify the problem/topic
  2. Define criteria and standards
  3. Data collection
  4. Compare performance with the criteria and standards
  5. Implement change

Indentifying a topic to audit

Some topics are more appropriate to audit than others. The hospital may have standard topics that they have audited before and you can find out about these by talking to the hospital's "audit facilitator". The facilitator's job is to log all audits and provide advice and assistance if needed. It is also recommended that topics are important: areas of high volume or risk, and in which problems have encountered before. It is worth asking consultants and other doctors if they have any ideas for audits or if you can assist them with any that they are undertaking.

Define criteria and standards

You must have a standard to follow and these are often NICE guidelines, royal college guidelines, or local protocalls. Once you have the idea it is a good idea to approach the audit facilitator again. They can decide on the appropriateness and suggest changes. You need to also select the specific pieces of information that you want to collect. For example if you were auditing the management of acute myocardial infarction you would might want to know the percentage of patients that were given aspirin on admission.

Data Collection

Sources of information for audits are often:

The quickest audits are those where all the information can be obtained from a computer database. If patient notes are audited these must be requested and then you must go through them collecting and recording the information. It is common to audit a period of time: for example a month, and select a certain number of records from this period.

It is a good idea to create a data collection page with all these pieces of information with tick-boxes for the various options. Recording the information can become confusing quite easily and it is depressing having to go through again to ensure that no mistakes have been made.

Comparing performance with criteria

The data collected is compared to the standard. The target is 100% compliance but obviously this is rarely achieved.

Implementing Change

The first step is to present the results at a local audit meeting. This is usually in the form of a powerpoint presentation. A written document may need to be submitted also. Presenting the findings is important in making people aware of where the weaknesses lie so that change can be made. It is also useful to provide an assessment of why targets weren't achieved and some recommendations on how to improve performance in your presentation. Additionally, proposing a future time for the re-audit can be valuable. If the audit is important and large enough it may also be presented at a national audit level, which looks even better on your CV.

Links

  1. A Practical Handbook for Clinical Audit: NHS Governance Support Team 2005
  2. Wikipedia: Clinical Audit
  3. UBHT Clinical Audit
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