What is clinical audit?

Clinical 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…Where indicated, changes are implemented…and further monitoring is used to confirm improvement in healthcare delivery.

Principles for Best Practice in Clinical Audit (2002, NICE/CHI)

In short, clinical audit is a way of assessing what clinicians are doing against what we should be doing.

Stages of the audit cycle

  1. Select a topic
  2. Define standards of best practice (audit criteria)
  3. Collect data
  4. Analyse data against standards
  5. Present results and recommend possible changes
  6. Implement changes
  7. Re-audit after allowing a period for changes to take place
  8. Collect, analyse and present second set of results
  9. Determine whether practice has improved (completing the audit cycle)

Students can get involved at any stages of the audit but ideally, to have a full appreciation of an audit, students are recommended to be involved right from the first stage.

Choosing a coloprotology topic to audit or re-audit

Audit projects are best focussed on the processes, e.g. investigations, treatments, procedures and follow-up regimes, which can be compared against national or local guidelines to ensure best practice. Possible sources for your clinical audit projects include the National Institute of Clinical Excellence (NICE), the four Royal Colleges of Surgeons and the Association of Coloproctology of GB and Ireland (ASGBI). You can also speak to your colorectal consultants for some suggestions. Examples of some common audit projects are frequently re-audited:

  1. Is your local hospital meeting the 31-day and/or 62-day targets for colorectal cancer referral, diagnosis and treatment?
  2. Current waiting times for investigations for benign disease and/or suspected colorectal cancer.
  3. Are all patients receiving antibiotic prophylaxis at time of anaesthetic induction just prior to surgery?
  4. Are all patients appropriately assessed for DVT risks and received appropriate prophylaxis during their hospital stay?
  5. Assessment on the quality of colorectal cancer surgical techniques.
  6. Are colorectal cancer follow up regimes at your local hospital in line with national guidelines?

In each hospital, there is usually a Clinical Audit Team who can provide help with planning, data collection and presentation. Get in contact with them from the start.