How to Conduct a Clinical Audit: A Guide for Doctors in the UK

Collected and written by: Mohamed Hassan 

Disclaimer

You have to check the up-to-date information about the topic also, review the local legal regulations 

Clinical audit is a process of improving the quality of care and outcomes for patients by measuring current practice against evidence-based standards and implementing changes to address any gaps or deficiencies. Clinical audit is an essential part of professional development and appraisal for doctors in the UK, as well as a requirement for revalidation.

In this blog post, we will provide a step-by-step guide on how to conduct a clinical audit, as well as 10 ideas for audit topics with links to relevant resources.

Step 1: Choose a topic

The first step is to choose a topic that is relevant, important and feasible for your clinical setting. You should consider the following factors when selecting a topic:

- The potential impact on patient care and safety

- The availability of evidence-based guidelines or standards

- The feasibility of data collection and analysis

- The interest and involvement of your colleagues and stakeholders

Some examples of audit topics are:

- Antibiotic prescribing for urinary tract infections

- Management of acute asthma exacerbations in children

- Compliance with sepsis screening and treatment protocols

- Prevention of venous thromboembolism in surgical patients

- Use of prophylactic antibiotics in dental procedures

You can also find more ideas and inspiration from the following resources:

- National Institute for Health and Care Excellence (NICE) clinical audit tools

- Royal College of Physicians clinical audit resources

- Healthcare Quality Improvement Partnership (HQIP) national clinical audit programme

Step 2: Define the aim, objectives and criteria

The next step is to define the aim, objectives and criteria of your audit. The aim is the overall goal or purpose of your audit, such as "to improve the management of acute asthma exacerbations in children". The objectives are the specific and measurable outcomes that you want to achieve, such as "to increase the percentage of children who receive salbutamol within 10 minutes of arrival". The criteria are the standards or indicators that you will use to measure your performance, such as "the proportion of children who receive salbutamol within 10 minutes of arrival".

You should use SMART criteria, which means they should be:

- Specific: clearly defined and focused

- Measurable: quantifiable and verifiable

- Achievable: realistic and attainable

- Relevant: related to the aim and objectives

- Time-bound: have a clear timeframe or deadline

You can use the PICO framework to help you formulate your criteria, which stands for:

- Population: who are the patients or groups involved?

- Intervention: what is the process or practice being audited?

- Comparison: what is the alternative or current practice?

- Outcome: what is the expected or desired result?

For example, using the PICO framework, a criterion for the audit on acute asthma exacerbations in children could be:

- Population: children aged 1 to 16 years who present with acute asthma exacerbations to the emergency department

- Intervention: administration of salbutamol within 10 minutes of arrival

- Comparison: no administration of salbutamol within 10 minutes of arrival

- Outcome: proportion of children who receive salbutamol within 10 minutes of arrival

Step 3: Plan and conduct data collection

The third step is to plan and conduct data collection for your audit. You should decide on the following aspects of data collection:

- Data sources: where will you get the data from? For example, medical records, patient surveys, observation, etc.

- Data collection methods: how will you collect the data? For example, manual or electronic, retrospective or prospective, etc.

- Data collection tools: what tools will you use to collect the data? For example, forms, checklists, questionnaires, etc.

- Data collection period: when will you collect the data? For example, a specific date range, a random sample, etc.

- Data collection sample size: how many cases will you include in your audit? For example, all cases, a representative sample, etc.

You should ensure that your data collection is accurate, reliable and ethical. You should also obtain any necessary approvals or permissions from your organisation or ethics committee before conducting data collection.

Step 4: Analyse and interpret data

The fourth step is to analyse and interpret data from your audit. You should use appropriate statistical methods and software to analyse your data. You should also compare your results with your criteria and identify any gaps or areas for improvement. You should consider the following questions when interpreting your data:

- What are the main findings or trends from your data?

- How do your results compare with your criteria or standards?

- What are the possible reasons or explanations for your results?

- What are the strengths and limitations of your data collection and analysis?

- What are the implications or recommendations for practice change?

You should present your data in a clear and concise way, using tables, charts, graphs or other visual aids as appropriate. You should also summarise your key points and conclusions in a written report or presentation.

Step 5: Implement and evaluate changes

The final step is to implement and evaluate changes based on your audit findings and recommendations. You should plan and carry out actions to improve your practice and address any gaps or deficiencies. You should also monitor and measure the impact of your changes on patient care and outcomes. You should consider the following factors when implementing and evaluating changes:

- Prioritisation: which changes are most urgent or important?

- Resources: what resources are needed or available to support the changes?

- Stakeholders: who are the people involved or affected by the changes?

- Communication: how will you communicate the changes and their rationale to your colleagues and patients?

- Evaluation: how will you assess the effectiveness and sustainability of the changes?

You should use the Plan-Do-Study-Act (PDSA) cycle to guide your change process, which involves:

- Plan: identify the change, its objectives, methods and measures

- Do: test the change on a small scale, collect data and observe results

- Study: analyse the data, compare with expectations and identify lessons learned

- Act: implement the change on a larger scale, monitor outcomes and make adjustments as needed

You should also repeat the audit cycle after implementing the changes to evaluate their impact and identify further areas for improvement.

Conclusion

Clinical audit is a valuable tool for improving the quality of care and outcomes for patients by measuring current practice against evidence-based standards and implementing changes to address any gaps or deficiencies. Clinical audit is also an essential part of professional development and appraisal for doctors in the UK, as well as a requirement for revalidation.

We hope this blog post has provided you with a useful guide on how to conduct a clinical audit, as well as some ideas for audit topics with links to relevant resources. If you have any questions or feedback, please feel free to contact us or leave a comment below.