10 ideas for audit projects in acute medicine

Collected and written by: Mohamed Hassan 

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If you are a doctor in the UK who is doing an acute medicine rotation, you might be wondering what kind of audit projects you can do to improve your skills and knowledge. Audit is a systematic process of measuring and improving the quality of care and outcomes for patients. It can also help you to demonstrate your competencies and achievements for your portfolio and career progression.

Here are 10 ideas for audit projects in acute medicine that you can consider, along with some links for resources and guidance.

1. Sepsis screening and management. Sepsis is a life-threatening condition that occurs when the body's response to infection causes organ dysfunction. Early recognition and treatment of sepsis can reduce mortality and morbidity. You can audit how well your team follows the sepsis six bundle, which consists of three tests and three treatments that should be done within one hour of suspecting sepsis. You can use the National Early Warning Score (NEWS) to identify patients at risk of sepsis and the Sepsis Trust's audit tools to measure your performance.

https://www.sepsistrust.org/healthcare-professionals/audit-tools/

https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2

2. Acute kidney injury (AKI) detection and management. AKI is a sudden decline in kidney function that can lead to complications such as fluid overload, electrolyte imbalance, and increased risk of infection. AKI is common in acute medicine and can be caused by various factors such as dehydration, drugs, sepsis, and obstruction. You can audit how well your team follows the NICE guidelines on AKI, which include assessing the risk of AKI, measuring serum creatinine and urine output, and managing the underlying cause and complications of AKI.

https://www.nice.org.uk/guidance/ng148

https://www.thinkkidneys.nhs.uk/aki/resources/audit-and-quality-improvement/

3. Venous thromboembolism (VTE) prophylaxis. VTE is a condition where a blood clot forms in a vein, usually in the leg or lung. It can cause pain, swelling, breathlessness, and even death if not treated promptly. VTE is preventable by using pharmacological or mechanical methods to prevent blood clots from forming in patients who are at risk. You can audit how well your team follows the NICE guidelines on VTE prophylaxis, which include assessing the risk of VTE, prescribing appropriate prophylaxis, and reviewing the need for prophylaxis regularly.

https://www.nice.org.uk/guidance/ng89

https://www.rcplondon.ac.uk/projects/outputs/vte-prevention-quality-improvement-audit-toolkit

4. Chest pain assessment and management. Chest pain is a common presenting complaint in acute medicine and can have various causes such as angina, myocardial infarction, pulmonary embolism, aortic dissection, and musculoskeletal pain. It is important to assess the severity, location, radiation, duration, frequency, triggers, relieving factors, and associated symptoms of chest pain to determine the most likely diagnosis and management plan. You can audit how well your team follows the NICE guidelines on chest pain, which include using clinical assessment, electrocardiogram (ECG), troponin testing, and imaging to diagnose the cause of chest pain and using pharmacological or invasive interventions to treat it.

https://www.nice.org.uk/guidance/cg95

https://www.nice.org.uk/guidance/cg167

5. Acute asthma exacerbation management. Asthma is a chronic inflammatory condition of the airways that causes wheezing, coughing, breathlessness, and chest tightness. An acute asthma exacerbation is a sudden worsening of asthma symptoms that can be triggered by various factors such as allergens, infections, stress, or drugs. It can be life-threatening if not treated promptly and effectively. You can audit how well your team follows the British Thoracic Society (BTS) guidelines on acute asthma management, which include using objective measures such as peak expiratory flow rate (PEFR) or forced expiratory volume in one second (FEV1) to assess the severity of asthma exacerbation, using oxygen, bronchodilators, steroids, and other drugs to treat it, and arranging follow-up care and education for patients.

https://www.brit-thoracic.org.uk/quality-improvement/guidelines/asthma/

https://www.brit-thoracic.org.uk/quality-improvement/quality-improvement-tools-and-resources/asthma-audit-tools/

6. Acute heart failure management. Heart failure is a condition where the heart is unable to pump enough blood to meet the body's needs. It can cause symptoms such as breathlessness,

fatigue,

edema,

and reduced exercise tolerance. Acute heart failure is a rapid onset or worsening of heart failure symptoms that requires urgent medical attention. You can audit how well your team follows the NICE guidelines on acute heart failure management, which include using clinical assessment, biomarkers, imaging, and hemodynamic monitoring to diagnose the cause and severity of acute heart failure, using oxygen, diuretics, vasodilators, inotropes, and other drugs to treat it, and arranging follow-up care and education for patients.

https://www.nice.org.uk/guidance/ng106

https://www.rcplondon.ac.uk/projects/outputs/heart-failure-audit

7. Acute stroke management. Stroke is a condition where the blood supply to a part of the brain is interrupted, causing brain cells to die. It can cause symptoms such as weakness, numbness, speech problems, vision problems, and confusion. Stroke is a medical emergency that requires immediate treatment to prevent further brain damage and disability. You can audit how well your team follows the Royal College of Physicians (RCP) guidelines on acute stroke management, which include using clinical assessment, FAST test, ECG, blood tests, and imaging to diagnose the type and location of stroke, using thrombolysis, thrombectomy, anticoagulation, antiplatelet, and other drugs to treat it, and providing stroke unit care and rehabilitation for patients.

https://www.strokeaudit.org/Guideline/Guideline-Home.aspx

https://www.strokeaudit.org/SupportFiles/Documents/Guidelines/2016-National-Clinical-Guideline-for-Stroke-5th-ed.aspx

8. Acute gastrointestinal bleeding management. Gastrointestinal bleeding is a condition where bleeding occurs from any part of the digestive tract, such as the esophagus, stomach, intestines, or rectum. It can cause symptoms such as vomiting blood, black or bloody stools, abdominal pain, and shock. Gastrointestinal bleeding can be caused by various factors such as ulcers, varices, polyps, diverticula, tumors, or medications. It can be life-threatening if not treated promptly and effectively. You can audit how well your team follows the NICE guidelines on acute gastrointestinal bleeding management, which include using clinical assessment, blood tests, endoscopy, and imaging to diagnose the source and severity of bleeding, using fluid resuscitation,

blood transfusion,

endoscopic therapy,

and other drugs to treat it,

and arranging follow-up care and education for patients.

https://www.nice.org.uk/guidance/ng141

https://www.nice.org.uk/guidance/cg141

9. Acute delirium management. Delirium is a condition where there is a sudden change in mental state that causes confusion,

disorientation,

hallucinations,

and agitation.

It can affect anyone,

but it is more common in older people and those with dementia or other cognitive impairments.

Delirium can be caused by various factors such as infections,

medications,

dehydration,

pain,

or stress.

It can increase the risk of falls,

injuries,

complications,

and mortality.

You can audit how well your team follows the NICE guidelines on acute delirium management,

which include using clinical assessment,

cognitive screening tools,

and blood tests to diagnose the cause and type of delirium,

using non-pharmacological interventions such as reorientation,

hydration,

and pain relief to prevent and treat it,

and using antipsychotic drugs only when necessary and with caution.

https://www.nice.org.uk/guidance/cg103

https://www.rcpsych.ac.uk/improving-care/ccqi/national-clinical-audits/national-audit-of-dementia/nad-resources/delirium-audit-toolkit

10. Acute alcohol withdrawal management. Alcohol withdrawal is a condition where there is a physical and psychological reaction to stopping or reducing alcohol intake after a period of heavy or regular drinking.

It can cause symptoms such as tremors,

sweating,

anxiety,

insomnia,

nausea,

vomiting,

seizures,

and hallucinations.

It can be life-threatening if not treated promptly and effectively.

You can audit how well your team follows the NICE guidelines on acute alcohol withdrawal management,

which include using clinical assessment,

alcohol screening tools,

and blood tests to diagnose the severity and complications of alcohol withdrawal,

using benzodiazepines or other drugs to treat it,

and providing psychosocial support and referral for patients.

https://www.nice.org.uk/guidance/cg100

https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/national-clinical-audits/alcohol-related-liver-disease/arlqip-audit-toolkit.pdf?sfvrsn=2