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 practices and protocol against explicit criteria. These criteria are established at the beginning of the project, subsequently measured, then re-measured following an intervention or quality improvement initiative. Where indicated, changes are implemented at the 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
- Establish a standard
- Set the audit target
- Collect the data (retrospective or prospective in your department)
- Compare results to the set standard and target
- Implement change / Interventions
- Re-audit
DCAP Abstract and Presentation Guidelines
For the purpose of the Departmental Clinical Audit Project competition at the CAR, the principal leader of this audit project must be a resident, fellow or medical student and must be mentored by a staff radiologist. All stakeholders involved 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, nurses, technologists, non-radiology clinicians, laboratory staff, and others. This is important because interventions or changes resulting from quality initiatives require acceptance and support from all affected personnel. A multidisciplinary approach to clinical audit is central to finding solutions and making change.
Guidelines for Writing the DCAP Abstract
The abstract outlines the Departmental Clinical Audit Project performed and the results from the first cycle of data collection, without identifying the name of the institution. The abstract must be a maximum of 250 words, excluding the title, subtitles, authors and audit team details.
Submitted abstracts must have conducted at least the first cycle of a 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 (if applicable) at the CAR Annual Scientific Meeting.
The required sections to submit an abstract for the CAR Departmental Clinical Audit Project are detailed below. Each section is graded as part of the abstract judging. Failure to include all the required sections in your submission will result in the rejection or poor grading of your abstract.
The abstract document must be written in the following format:
- Audit Title (clear title which indicates what the audit is about)
- Presenting Author's Level of Training (fellow, resident, medical student)
- Principal Location of Audit Note: To preserve a blinded review process, do not indicate the name of the institution.
- Background and Aim of the Audit (reason why an audit was initiated)
- Standard
- Target
- Methods (describing what data is collected and how it is collected)
- Audit Team (job titles of the individuals/co-authors) Note: This section is not included in the word limit.
- Results (first cycle is mandatory in the abstract)
- Interventions / Action Plan (this section is expected to be expanded in the final oral presentation)
- Discussion / Conclusion
Preference will be given to original projects.
Please review the sample abstract and the CAR 2022 ASM DCAP Abstract Winner Examples.
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)
Guidance Notes for the Written Abstract
Audit Title
Clear title which indicates what the audit is about.
Presenter’s level of training
Tell us who will be presenting if accepted: medical student, resident or fellow.
Principal Location of Audit
Where was the audit performed (type of department, university-based practice, community hospital, community clinic, etc.)? Do not indicate the name of the institution.
Background and Aim of the Audit
Briefly indicate why this audit was performed. State the most important factors that led to the audit. State any important relevant background information to support the audit.
Standard
What is the reference standard of practice against which local performance can be measured against? The standard may be obtained from a variety of sources including: local, regional, national or international guidelines; seminal studies and peer-reviewed research and recommendations or consensus statements from societies and organizations.
Target
This refers to how many times the standard should be achieved. The target that is set depends on the audit that is being conducted. It should be set at a level that is considered good practice and good care/service for patients. This may not be 100% as some targets are not achievable especially if requiring patient compliance. Most targets are usually between 70 and 95%.
Methods
Describing what data is collected and how it is collected. Indicate who collected the data.
Audit team (This section is not included in the 250 word limit)
State the job titles of the individuals/co-authors in the audit team
Example
Staff radiologist
Head CT technologist
Staff orthopedic surgeon
Head of radiology film loan/processing services
Results
The first cycle results are mandatory in the abstract.
If second cycle results are available, these should also be included.
Interventions / Action Plan
Briefly describe what you actually did and who in the team was involved in the change process. (A generic “we had an educational event” comment is not enough detail).
Discussion / Conclusion
Tell us if the intervention was successful or not. What are your conclusions?
This section is expected to be expanded in the final oral presentation
Guidelines for DCAP On-site Presentations
Authors of accepted abstracts are to prepare a PowerPoint presentation. Lead authors of the highest rated abstracts will have the opportunity to deliver an oral presentation at the CAR Annual Scientific Meeting. Oral presentations will be judged on the delivery format, the content of the presentation and the collected data.
Presentations must include a disclosure on the second slide.
Abstracts not selected for oral presentation will be asked to provide an electronic display of the audit and template for participant viewing. These will not be judged as part of the contest.
The presentation should follow the format below:
- Audit Title
- Disclosure Slide
- Authors
- Presenting Author's 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.)
- Background and Aim of the Audit (reason why an audit was initiated)
- Standard
- Target
- Methods (what data is collected and how it is collected)
- Audit Team
- First Cycle Results / Data
- Interventions / Action Plan
- Second Cycle Results / Data
- Discussion / Conclusion
- References and Acknowledgements
Guidance Notes for On-site Presentations
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.
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.
Standard
'The Standard' is the explicit statement which says what the best practice should be. This may have been based on international or national standards or locally established standards.
Target
The number of times you should achieve the standard. Explain how you decided what the target should be.
Example:
Standard: Healthcare workers working in areas where there is possible exposure to ionising radiation should wear TLD badges.
Target: 100% of these healthcare workers should be wearing a TLD badge
Methods
Describe how you collected your data.
Also include: Who was involved? What were their roles in the audit? What was the time period over which data was collected?
State how many hours were involved in completing the audit.
Audit team
Provide information about the project team and their roles.
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. Who carried out the intervention /changes? Share practical recommendations for other departments, should they wish to replicate this audit. Identify any barriers to implementing changes.
Second Cycle Results / Data
Ensure the second cycle results are clearly stated. Compare them with the first cycle and the set target.
Discussion / Conclusions
Please consider some of the following:
Discuss the outcome of the audit.
Discuss the reasons this audit was successful, or not, in making a change in your practice.
If the target was achieved in the first cycle discuss the factors that you think contributed to the success. Could other radiology departments learn from this audit? Is there still room for improvement?
Did the audit change or confirm your local practice?
Did the audit provide recommendations you could share with others?
References and Acknowledgements
References, to a maximum of 10, must be included in the presentation.
Audit Template
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)
- Background
- Standard
- Target
- 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
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.
Abstract Awards
Based on merit, the top-ranked projects will be presented with awards during the CAR 2023 Awards Ceremony.
Past Departmental Clinical Audit Project contest winners
Past Departmental Clinical Audit Project presentations
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.