Page 42 - IDF Journal 2023

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Audit – A Beginner’s Guide
Dr Alexandra Harkins
Carrying out an audit is an interesting and useful way to demonstrate and improve quality and performance. There are CQC requirements for audits and also GMC appraisal and revalidation requirements for audits which doctors should be conversant with.
The Royal College of General Practitioners defines audit as “a way
to measure and improve the quality of clinical care by assessing performance against one or more criteria. Results are then analysed and change implemented; finally a re-audit is conducted.”
It is important to distinguish audit from a survey as many doctors confuse them.
A survey is a measurement of current practice with no criteria or standards. Change may or may not be implemented as a result.
The RCGP has a useful guide to audit called “RCGP Quick Guide to Clinical Audit”.1
CQC generally require two full audit cycles per year to be carried out.
The GMC’s guidance on supporting information for appraisal and revalidation states, “you should participate in any national audit or outcome review if one is being conducted in your area of practice. You should also reflect on the outcomes of these audits or reviews, even if you are unable to participate directly” and gives examples of audit as supporting information for quality improvement.2
Many doctors worry about the workload associated with carrying out an audit. It is important to note that doctors do not need to do all the background work and data collection or analysis for audit. It
is reasonable and proportionate use of time for someone else to be delegated to assist with the data collection. Many clinical audits are team-based involving colleagues in the practice or hospital and may also be regional or national projects.
Identify topic
Re-audit
Allow time for changes to take place
Select the standards
Data collection
Data analysis
When writing up an audit the following areas should be included and the IDF has a structured reflective template – audit which can be used by members.3
• title
• reason for the audit
• criteria or criterion to be measured
• standard(s) set and time period defined
• preparation and planning
• results and data collection
• description of change implemented
• results and data collection repeated
• conclusions and reflections
It is important that the results of the audit are shared with the team so that whole practice/team changes can be implemented to more patients benefit.
REFERENCES
1. RCGP Quick Guide to Clinical Audit
2. GMC Guidance on supporting information for appraisal and revalidation
3. IDF Structured Reflective Template - Audit (on Appraisal tab of IDF website under Further Guidance section)
Dr Alexandra Harkins
MA MBBS MRCGP DRCOG DCH DFSRH PGCE
Responsible Officer IDF E: revalidation@idf.co.uk
Implement change
When considering what to audit, it is helpful to consider areas of potential concern or interest and areas where it is suspected that improvement might be needed.
When planning an audit, it is important to consider the practice population and to be realistic about the numbers needed for a meaningful audit. In some cases, it may be necessary to have a representative sample e.g. within a defined time period. Consideration should be given to how
to access the data. Many electronic records systems now allow the coding of diagnoses to allow patients with certain conditions to be identified. Where this is not possible, prescribing data or laboratory data may also be used to identify cases.
For doctors who are not patient facing e.g. medicolegal doctors, meaningful audit is still possible and may include record keeping audits or audits looking at the turnaround time for reports.
The standards selected should be evidence based where possible e.g. using NICE guidelines or local guidelines, although some selected standards in independent practice may not always be so easy to define.
Retrospective audits are generally better than prospective ones to ensure behaviour is not changed in light of the audit taking place.
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