An Introduction to Clinical Audit for Radiographers

5. Types of audit

There are several different types of audit, with variations around the scope, timeline and methodology:

1. Scope: National clinical audits are large multi-centre studies which are often responding to current country-wide concerns in healthcare. They audit against published national or international standards of care or in some cases gather evidence to set national standards. One recent example is the Care Quality Commission review of radiology reporting in NHS organisations within England7 . In contrast, local clinical audit often involves a single centre, and may be uni-professional or span a whole patient pathway. While local studies will always audit against national standards where they are available, often an audit standard needs to be developed by local stakeholders.

2. Timeline: Retrospective audits involve auditing existing information sources such as patient records and reports stored on radiology information systems, and while they are less intrusive on staff and patients they are often compromised by incomplete data. Prospective audits may be more intrusive over a longer period of time but are likely to yield more accurate data sets. This may require a data collection template to be produced; subsequently, these may be adopted as a useful clinical tool. Some templates are already available such as the Society of Radiographers Chest x-ray (CXR) report template for ICU settings 8
Prospective audits should be designed so that they do not impinge on normal radiography clinical activity and this is of great importance when dealing with high workloads and/or significant change, as recognised within the current Covid-19 pandemic.

3. Methodology: Compliance Audits (ensuring compliance with a set standard taken from professional guidelines or national / local policies)3 are often used within radiography settings to review radiation doses, image quality or appropriate justification of procedures. Process Audits (assessing the efficiency or effectiveness of a process such as a patient pathway) 3, may be used to review timelines such as referral to imaging examination, or examination to radiological report. Either of these methods can be used within a wider Improvement audit, used mainly 'where an issue has already been identified and a systematic approach is required to implement change'3. The final audit methodology is a Documentation audit where a document (such as an imaging protocol) is reviewed to ensure content is current and relevant to current practice.