Introduction to Medical Auditing
Welcome to the world of medical auditing! As a junior doctor, you may be wondering what exactly this entails. Simply put, a medical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. It's a tool used to confirm that current practice meets the expected level of performance and to improve aspects of care across a wide variety of topics. It's also a fantastic opportunity for learning, improving patient safety, and enhancing your CV for college applications.
Audit versus survey
There is a subtle but important difference between clinical audit and a survey. In a survey, you are trying to gather information in order to explore hypotheses. For example, you might gather information on the process of putting in a cannula - the site, the size, the role of the operator, what dressing was used etc. This information is then used to try to find links to outcomes, such as infection.
In an audit, you are trying to establish whether specific actions or interventions were implemented, or not. The outcome is binary, and should be clear, measurable, evidence based and agreed upon. An example might be “was thromboprophylaxis given in a patient who had indications and no contraindications” - the answer is yes or no.
The Role of Junior Doctors in Medical Auditing
As a junior doctor, you play a crucial role in the auditing process. Not only does participating in an audit provide a valuable learning experience (you will learn not only about audit, but a lot about the subject of your audit), but it also offers a chance to influence change within your healthcare organisation.
Audit and your CPD Home program
Importantly, an audit can often be claimed as part of your Continuing Professional Development (CPD). In Australia, for example, this is a key way to achieve credits in categories like "Reviewing Performance" and "Measuring Outcomes". Furthermore, an audit may satisfy the research requirement for many college programs, making it a worthwhile endeavor for your professional growth.
Audits can also be useful in your career - many college programs accept audit as an acceptable research project, while completing audits also looks good on your resumè.
Understanding the Audit Cycle
The audit cycle consists of five stages : preparation, selecting criteria, measuring performance, implementing changes, and re-auditing. Each stage is vital to the process, and understanding these stages is the first step towards conducting a successful audit.
Identify the Audit Subject: This is the first step where the auditor identifies what is to be audited. It could be a process, a department, a project, etc.
Planning: In this step, the auditor plans the audit. This includes identifying the scope, objectives, and criteria for the audit. It also involves determining the resources and time required for the audit.
Conducting the Audit: The auditor conducts the audit according to the plan. This involves gathering evidence through interviews, observations, and document reviews.
Reporting: The auditor prepares a report summarising the findings of the audit. The report includes any non-compliances or areas for improvement identified during the audit.
Follow-up: The auditor follows up on the actions taken to address the findings of the audit. This ensures that the issues identified during the audit have been resolved.
Review and Improvement: The auditor reviews the audit process and identifies areas for improvement. This could include changes to the audit plan, methods, or criteria.
Choosing the Right Audit Topic
Choosing an appropriate and relevant topic for an audit is the most important part of the process. The best audit is one where there is a clear, measurable, and evidence-based outcome. This outcome should be agreed upon by local staff to ensure buy-in and reduce resistance to change. Remember, the participation of staff in selecting topics enables concerns about care to be reported and addressed.
Data Collection and Analysis
Once you've chosen your audit topic, the next step is data collection. Creating a standardised data collection form can help ensure that the data you gather is consistent and reliable. This data will then be analyzed to identify areas for improvement. Remember, the clear benchmarking in an audit allows for tracking progress over time, also known as compliance.
Ethical Considerations in Medical Auditing
Throughout the auditing process, it's crucial to maintain patient confidentiality and adhere to ethical guidelines. This includes obtaining ethical approval for certain types of audits and respecting patient rights and autonomy.
Presenting and Reporting Audit Results
Once the data is collected and analysed, it's important to effectively communicate these findings to various stakeholders. This may include colleagues, management, and regulatory bodies. Clear and effective communication is key to ensuring that the implications of the audit are understood and appreciated by all.
Implementing Changes Based on Audit Findings
After analysing the data, the next step is to use these findings to implement changes (if required). This is where the real magic happens - the improvements in care resulting from clinical audit can increase patient safety dramatically. However, it's important to note that improvements in care can also increase costs, so organisations must be prepared for this.
Overcoming Challenges in Medical Auditing
While auditing can be a rewarding process, it's not without its challenges. These can include time constraints, lack of resources, the Hawthorn effect (where behaviour changes because it is being observed) and resistance to change. However, with effective leadership, participation by all staff, and an emphasis on team working and support, these challenges can be overcome.
The Value of Auditing Skills for Junior Doctors
Learning the skills of clinical audit is an invaluable part of your journey as a junior doctor. Not only does it provide a structured approach to improving patient care, but it also offers a unique opportunity for professional development. The most frequently cited barrier to successful clinical audit is the failure of organisations to provide sufficient protected time for healthcare teams. Therefore, it's essential to advocate for the time and resources needed to conduct an audit effectively.
Remember, audits are not just about ticking boxes or meeting regulatory requirements. They're about continuously striving for excellence in patient care. They're about learning, growing, and making a real difference in the lives of patients. So, as you embark on your first audit, remember that you're not just improving your skills and enhancing your CV - you're also contributing to the betterment of healthcare.
We hope this introduction has been helpful and wish you the best of luck on your auditing journey. Remember, the world of healthcare is always evolving, and as a junior doctor, you're at the forefront of this evolution. Happy auditing!
Useful tools
The NHS provides a great resource for auditing :