If you are working towards or have successfully met the Quality Standards for Imaging (QSI) you will be aware that one valuable way to evidence your quality outcomes is through audit. Clinical audit is now a well-established improvement tool for measuring and increasing patient care within healthcare settings.

In its basic form, auditing has been around for most of human civilisation. The word audit is derived from the Latin word “audire” meaning “to hear”, and there were people who double-checked public spending in Ancient Egypt and the Roman Empire.

Audit was formally introduced into the NHS in 1989 via the Working for Patients White Paper, and initially called medical audit because only doctors were encouraged to participate. The early aim of medical audit was to allow doctors time to reflect on their practice to improve the quality of patient care.

In the early 1990s, audit in healthcare settings rapidly evolved and within some five years of that White Paper, the term ‘clinical audit’ started to gain momentum as nursing staff and other healthcare professionals began participating in audit. 

The focus on quality improvement progressed, resulting in the publication of the historic White Paper entitled The New NHS: modern and dependable. This 1997 paper introduced the concept of clinical governance, with clinical audit as a key mechanism to measure the quality of care.

QSI support for audit 

When reviewing compliance against a QSI standard we can look at auditing the procedures of our services to ensure the systems we have in place are safe and effective. Audit can highlight where services might introduce an improvement change. The QI Partners have support available to help direct services, engaged in QSI, in audit, and our forums enable services to share audit tools, ideas and talk through any challenges.

The RCR’s Audit Live resources is a collection of audit templates providing a framework identifying best practice. More recently, the library of audit templates has been reviewed to include the associated reference of the relevant QSI standard. The QSI reference number can be found in the title of the template using the search function. 

The RCR also has plans to refresh the design of Audit Live, and hopes that the links to the standards will be improved in the new system. The Audit Live team is always looking for new material and services are encouraged to submit audit templates in order to further build this resource.

Within our Future NHS QSI page we have a folder of audit resources. This maintains a comprehensive list of the audits that are desirable to achieve QSI assurance, together with any relevant links to relevant Audit Live templates, for example:

XR-501 Referral Management Guidelines

• Outcome measure: The referral management protocol is available to all staff and entitled referring clinicians. Audit shows that this protocol is being followed and reviewed.
• Audit Live tool: Accuracy of scanning the entire request information onto the Radiology information system

The QSI standard XR-703 Audit asks that services maintain a rolling programme of audit of compliance with guidelines, protocols and clinical best practice is in place. The QI Partners hold regular support meetings and gap analysis sessions for services to access where they can advise or direct QSI leads to additional audit resources.

Department audit engagement is essential to meet the indicative inputs of XR-703. Holding a regular audit meeting is a beneficial way to share audits in your service, however big or small. Virtual meetings have made it possible to improve attendance and share audit presentations more easily.

It is useful to have a designated audit lead and to coordinate the audit programme and track the audits that need to be reviewed regularly. The meeting can be useful for agreeing proposed audit changes and keeping a record to ensure these are kept on track and hopefully achieved. 

Audit meeting registers

Audit meeting registers help demonstrate attendance, examples of audit presentations, minutes of meetings and follow-up action plans are all great evidence to show that your service is meeting standard XR-703. Tracking your audits through a dedicated quality management system also helps to establish which audits are due and who is the lead auditor for that task.

An additional way to engage staff is to encourage audit to fulfil the need for CPD. This ensures that improvement is a shared responsibility within the service and as many staff as possible are engaged in evidence-based practice. All members of the imaging team should be invited to contribute and attend departmental audit meetings to establish a healthy change culture.

Taking part in an audit awareness week can also help staff to access resources such as audit tools and can help demystify some of the anxieties of those who are less familiar with undertaking audit. It can also be utilised to celebrate any team or individual that has contributed significantly to audit and celebrate the success of the service, helping to encourage ongoing audit and feeling valued at work.

Many of the skills learned by supporting audit can be transferred to other areas of service improvement such as research and quality improvement projects. The Healthcare Quality Improvement Partnership holds an annual campaign to promote and celebrate the benefits of audit and the website is a great resource for helping audit and QSI leads to support their teams.

Maintaining your audit programme

When workforce pressures make it difficult to find time for audit, a challenge you could consider is a buddy system to ensure audit programmes are maintained and new staff are supported in undertaking audit. Diarising audits and using quality management systems can make it much easier to see which audits are outstanding and where to focus any resources. 

Being sensible about what needs to be re-audited, and the frequency of repeats, is also critical to ensure that services direct change to where there are most concerns and where improvements will most benefit staff and patients. Being realistic with compliance targets around what is acceptable to achieve a high quality service, and any impact that undertaking an audit will have on service delivery, should also be carefully considered to avoid auditing for the sake of auditing. 

A successful audit with a noticeable impact on the service can have really positive impacts on service delivery and morale.