An Introduction to Clinical Audit for Radiographers

9. Where do you find the standards?

Where possible, refer to evidence based guidelines and professional body guidance to see if standards exist in your audit area. Remember that these standards may be available wider than your own professional area, for example in guidance documents for radiographers, radiologists, respiratory and intensive care physicians, and the wider multi-disciplinary community. A useful hierarchy of resources is found here and is summarised below 10:

1. International - worldwide best practice e.g. World Health Organisation; ISRRT guidance11

2. National - distils evidence into national standards e.g. National Institute of Clinical Excellence (England) 12 Professional body guidance 13

3. Local - regional or local hospital guidelines and radiology department protocols or procedures

4. Literature - outlines current thinking where best practice has not yet been agreed

5. Consensus - where there is no agreement on best practice, experts can come together to develop new (often local) guidance

Covid-19 Example:

While most Covid-19 radiology professional documents focus on the role of CT, some give guidance that may be useful to the delivery of chest radiography services.

The following are excerpts related to justification for chest x-rays during the Covid-19 pandemic:

  1. There is no indication for daily chest radiographs for ICU patients who are stable on ventilators (no improvement in outcome, increased risk to staff and use of limited PPE). This is relevant to chest x-ray justification and monitoring previous requests. [Radiology Fleischner consensus statement 14]
  2. Chest radiographs are not valuable in asymptomatic population / for screening / early Covid-19 symptoms - CT would be more sensitive. However it will show signs for moderate to severe symptoms." This is relevant to chest x-ray justification [Radiology Fleischner consensus statement 14]
  3. Departments should work with local clinicians to ensure relevant clinical information on all imaging requests. The following information should be documented in the imaging request:
    • Suspicion of COVID-19
    • Infection risk - impacts on how, where and when patients are imaged
    • Raised WCC / lymphopaenia - usually present in COVID-19
    • CRP - unusual to be COVID-19 +ve if CRP is normal
    • Relevant respiratory history
    • Smoking history
    [British Society of Thoracic Imaging, 15]