What is a Clinical Audit?
An audit is a clinical quality improvement process that seeks to improve patient care and outcomes through a systematic review of care against explicit criteria set out at the beginning of the project, subsequent measuring of the initial findings and review of any changes as a result of the quality initiative. Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery. (Reference from the National Institute for Health and Clinical Excellence UK, 2002.)
Typical Audit Cycle
- Identify a problem or area of improvement
- Set the audit target
- Collect the data (retrospective or prospective “misses” in your department)
- Compare results to the set standard and target
- Implement change / Interventions
Audit Projects Presentation Guidelines
For the purpose of the Clinical Departmental Audit Project competition at the CAR, the principal lead of this audit project must be a resident, a fellow or a medical student and must be mentored by a staff radiologist. All stakeholders involved in or affected by a quality initiative must be part of the planning and implementation of the project. Depending on the quality initiative scope, this could include staff radiologists, clerical staff, technologists and others (e.g. medical student, residents and fellows). This is important since interventions or changes resulting from a quality initiatives require acceptance and support from all departmental personnel.
Writing the Abstract
The abstract will outline the Departmental Clinical Audit Project performed and the results from the first cycle of data collection, without identifying the name of the institution. It is to be a maximum of 250 words, excluding subtitles and authors.
Submitted abstracts must go through a full Departmental Clinical Audit. An abstract submitted as an “idea of a Departmental Clinical Audit" will not be accepted. Audits must be completed in time to present interventions and second cycle data at the CAR 2019 Annual Scientific Meeting.
The required sections to submit an abstract for the CAR Departmental Clinical Audit Project contest follow. Failure to include all the required sections in your submission will result in the rejection of your abstract.
- Audit Title (clear title which indicates what the audit is about)
- Presenter’s level of training (medical student, resident or fellow)
- Principal Location of Audit (e.g., type of department, university-based practice, community hospital, community clinic, etc.) Note: do not indicate the name of the institution.
- Background and Aim of the Audit (reason why an audit was initiated)
- Methods (describing what data is collected and how it is collected)
- Results (first cycle is mandatory in the abstract)
- Interventions / Action Plan /Discussion (this section is expected to be expanded in the final oral presentation)
Preference will be given to original projects.
Please review the sample abstract and the presentation guide below for further guidance on how to write and present the abstract.
Examples of Audit Projects
- CT Dose Studies
- Improving Success Rates for Image-Guided Biopsies
- Patient Safety Issues (Hand-Washing Rates, Correct Patient ID, Correct Exam Issues)
- Technical Items (Improving Quality of Lateral or Portable Chest Radiographs)
Presentation Guide for Accepted Abstracts
Authors of accepted abstracts are to prepare a PowerPoint presentation (including the disclosure on the second slide) and the lead authors of each of the nine most highly-rated abstracts will have the opportunity to give an oral presentation at the CAR 2018 Annual Scientific Meeting.
Abstracts of projects not ranked in the top nine may still be asked to provide an electronic display of the audit and template for meeting attendees to view. These will not be judged as part of the contest.
Authors will be judged on the format, the content of the presentation and the collected data.
The presentation must be in the following format:
- Audit Title
- Level of training (medical student, resident or fellow)
- Principle Location of Audit (e.g. type of department, university-based practice, community hospital, community clinic, etc.) Note: Authors are not to indicate the name of the institution
- Background and Aim of the Audit (reason why an audit was initiated)
- Methods (what data is collected and how it is collected)
- First Cycle Results / Data
- Interventions / Action Plan
- Second Cycle Results / Data (if applicable)
- Discussion / Conclusions
- References and Acknowledgements
Background and Aim of the Audit
Presentations are to focus on the trigger for the audits. For example: was there an adverse event, a patient satisfaction issue, concern about adherence to guidelines or concern about the validity of a national or local guideline?
Comment on the clinical relevance of the audit and mention any previous known or published audits with relevant population differences from your study.
Background details are to be brief. The project should be within the author’s department with the aim of improving quality of patient care locally or improving a specific process within the department.
'The Standard' is the explicit statement which says what the best practice should be.
The number of times you should achieve the standard. Explain how you arrived at the percentage of events/cases/data that should meet the standard.
E.g.: Target could be that 100% of health care workers working with ionising radiation should wear TLD badges.
Describe how you collected your data. Who was involved? What was the time period?
State how many hours were involved in completing the audit.
First Cycle Results / Data
Present the data as a comparison of performance against the identified standard and target. Histograms, bar charts and pie charts can be useful. Statistical analysis is not necessarily required as the data is expected to be simple numerical or percentage compliance against a target.
Interventions / Action Plan
Describe how any changes were implemented and managed, as well as share realistic recommendations for other departments, should they wish to replicate this audit. Identify any barriers to implementing changes.
Second Cycle Results / Data (if applicable)
Ensure the second cycle results are clear. Compare them with the first cycle and the set target.
Discussion / Conclusions
Discuss the progress of the audit. What changes were effected?
Discuss the reasons this audit was successful, or not, in making a change.
If a good practice was identified in the first cycle and was helpful in achieving the target, discuss the factors. Could other radiology departments learn from this audit’s success?
What are the derived recommendations?
References and Acknowledgements
References, to a maximum of 10, must be included in the presentation.
As a separate document, provide an audit template including up to five relevant references. The template should be a “how to guide” that will provide practical guidance to another institution who may wish to perform the audit in their department. Suitable templates may be selected by the CAR to be posted on the CAR website as a resource. Authors will be credited as the template authors.
The audit template is to follow the following format:
- Audit Title
- Descriptor (that clarifies the title)
- Method (what data is collected and how it is collected)
- Intervention / Action Plan / Suggestions for Change
- Resources Required
- Time Required to Perform the Audit
References and Resources for Audit Template
Audit template examples can be found on the Royal College of Radiologists website. Review the templates available to customize your own.
Based on merit, the three top projects will be presented with awards during the CAR 2019 Awards Ceremony on Saturday April 13, 2018.
References and Resources
- The Canadian Association of Radiologists Maximizing the Effectiveness of Clinical Audits: A Step-by-Step Guide.
- Richenberg, Jonathan. Audit of Scrotal Ultrasound and its Relevance to Detection of Testicular Cancer.(Example of clinical audit.)
- The Royal College of Radiologists. Audit Projects.
- The Royal College of Radiologists. AuditLive.
- Fowkes, Gerry and Mark Charny. Mastering Clinical Audit. The University of Edinburg (multimedia course).
- Swonnell, Chris. Clinical Audit Policy. University Hospitals Bristol, September 2010.