Audit/ Quality improvement : Not an uncharted territory for you from today

“Clinical audit is a way to find out if healthcare is being provided in line with standards and lets care providers and patients know where their service is doing well, and where there could be improvements.”

Now ignore the definition and lets make it simple-

The concept of ‘Audit’:

1. You will need to find a problem in your hospitals service ( it can be clinical problem/ managerial problem/ documentation problem – any thing relevant to the trust that needs improvement.)

2. You find a standard to compare your data with – example – NICE has set a goal for sepsis – every patient needs to be assessed and treated for sepsis within 1 hour ( 100% cases ). Now, if your hospital breaches this target, you can do an audit on this topic. Gather the baseline data at what extent the target is breached. Example – you collect data for 100 people who comes to acute medicine with sepsis – only 70 people had their sepsis protocol started in 1 hour. That’s your base line data. ( you can do audit with as minimum as 25-30 patient, the bigger number the better impact though)

3. Now, you know that you trust is not meeting the standard of national guideline for sepsis. You need to suggest an intervention that can effectively improve the sepsis care.

Example – you can suggest a sepsis 6 sticker , every patient comes with a suspicion of sepsis, must have all the boxes ticked in the sticker ( take 3 , give 3) . In this way you can bring about a change in trust’s sepsis practice . Now to complete the loop of the audit, you need to collect another set of data after intervention with same questionnaire to show the change.

4. To complete an audit, you need to present your work. It can be your departmental meeting or poster presentation in a conference, anywhere you presented your work will count.

Audit is not daunting. It is just we don’t know how to do it. This is the list of tasks you will need fir an audit.

Step by step to get an audit done:

1. Find a topic that is most relevant to do an audit on and make sure it is not audited in last few years in your trust.

2. Speak with a consultant or educational supervisor. Please make sure you know what you are planning to do for the project. The aim, objective, method and outcome – make a rough note on these points when you talk to them. ( I had no idea even what an audit is when I went to speak, but my supervisor was an angel who actually taught me everything about audit, Almighty bless her ! )

3. Once you sketched out the plan, contact your audit registration officer in the trust. Get it registered to start it.

4. Prepare your questionnaire form carefully. Dont put the question in narratives ( like – why sepsis bundle criteria is not met) , you will find it difficult to extract data at the end. Questions should include simple data set ( do you think your last septic patient received antibiotic in 1 hour – yes/ no, if no , how long did it take ( > 1 hour/ 1-2 hours / > 2hours ). In this way, you can put every data in your graph and this will make a good audit.

5. Choose easy intervention – poster/ magnet/ sticker etc these are easier to implement. Remember with every audit you are increasing work load for another person, so make it simple.

6. Till you present it in a meeting/ seminar – it is not finished.

7. Get a certificate from your audit department.

8.Done and dusted – put this certificate in your portfolio.

☆ Another example : you work in acute medicine, you see AKI patients everyday. You find out whether your hospital follows the standard dictated by NICE/ follows its own guideline. If there is a deviation, you will collect data in what parameters the service is deviated. You compare it with the national/ RCP AKI tool kit/ local standard in numbers and finally you suggest a plan to improve it. You continue the intervention for some days to months and finally, you run the same data collection cycle again to show there is an improvement following your intervention. Voila your audit/ Quality improvement is finished!

Few important cents, you must know:

1. I did three quality improvement projects prior to applying for ST3(specialty training) in that year. You should do at least one audit in your specialty of your choice, that is counted as commitment.

2. Anything innovative in audit is always well appreciated and you can write up for publication. That adds extra points. BMJ quality is a journal for these publications.

3. I am happy to share my template on my INSPECT audit on neurology examination in acute setting. This is published in Journal of Neurology , Neurosurgery and Psychiatry (JNNP) by BMJ. So you can easily cite the reference from the article and can do an easy but effective audit. Please let me know if you need it.
https://jnnp.bmj.com/content/90/3/e8.1

4. You don’t have to do audits on clinical practice. You can pick any managerial issues- how many doctors and nurses signs at the end of the notes, delay in medication administration, if junior doctors leave late than contracted hour, you can do an audit on this.

I am honest with you guys, the word audit haunted me till I got it done. Its not very difficult. Find a person in your trust who knows about audit and plan for it from today! You will be fine. Please do share your knowledge and experience with all of us.

Happy to answer any practical question related to audit ,best wishes.


DR. MAHJABIN ISLAM
ST3 Trainee( south yorkshire Deanery) 

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