An Introduction to Clinical Audit for Radiographers

8. Defining an Audit Standard

The standard describes the level of care to be achieved for any particular criterion. In some cases, there should be an ideal standard which we aim for at all times. For example, a radiographer should always aim for an imaging exposure to be 'correct first time'; our ideal standard would be 100% (all exposures should be diagnostically acceptable). However we know that an ideal standard may only be deliverable under ideal conditions with minimal constraints. We might therefore set an optimum standard which is agreed by the team to be achievable under normal working conditions (for example, 90%). In some cases it is essential to also have a minimum standard which might help to distinguish between acceptable and unacceptable practice which requires urgent attention.

The indicators are measurable variables (percentages, numbers, averages) that should be identified during the planning stage; if it is a re-audit, then the same indicators should be used 3. A successful audit also needs careful consideration about sample sizes and confidence levels, which determine how many pieces of data you need to collect and over what timeframe. The Clinical Audit department will advise on this; normally larger sample sizes give you greater confidence that the results of your audit are valid and have not occurred by chance, however, smaller audits may also provide radiographers with very useful information that can assist them to recommend improvements.

Covid-19 Example:

Issue: You want to be sure that chest radiographs have the maximum potential to influence patient management during the Covid-19 pandemic. This might include ensuring that there is a written report by an imaging expert, and that this is received in a timely manner.

Criterion: ALL chest x-rays should receive a definitive report by a radiologist or reporting radiographer within [1 hour] of upload to PACS.

Standards: 100% chest radiographs have a definitive report (Ideal standard). 80% receive the report within 1 hour (optimum standard), 100% receive the report within 4 hours (minimum standard). Not achieving the latter target may require further review of available resources.