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How to do an Audit

Audits are important for the NHS and you! You will almost certainly be required to do an audit in your F1 year, and throughout your medical training. Getting involved in one while a student will give you some insight and confidence into making sure this is successful. You can also repeat the audit for F1 (completing the cycle) for extra points.


Coming up with a Topic

As a student it can be hard to get to grips with how all the various systems work in a hospital or other health care setting, but with experience you will realise that everything has its own policy or guideline, and some work better than others. Think about what you've seen which doesn't work so well, or where parts of the system are often ignored and you have something to audit.

For example, RISC audits have looked into whether cannulas are dated, whether allergies are recorded on drug charts, and whether the WHO Surgical Safety Checklist is used before operations.

If you can't think of anything, never fear: every audit department has a catalogue of audits which they would like to be carried out, but haven't got the manpower. If you go and talk to them, you can probably get involved in a ready-made audit without the inspiration. Your consultant may also have audits they would like to do but never had the time.

Check the Guidelines

Audits must be based on national or local guidelines for a clinical service or procedure. Find these on the internet or intranet for your chosen topic and base your audit around checking whether the standards are being met.


Think about Methods

Try and work out how you are going to complete the audit, including what data you want to collect, from where, and how you are going to record this. Think about how much data you will need, how many people will be needed for data collection, and when it can be carried out. Will it take place within one specialty or across a number of clinical areas? Do you need to access records, and can you make arrangements for this? Make an audit proforma which you will use to collect data and pilot it with a couple of cases.

Find your Local Audit Department

Every hospital will have an audit department. At UHCW they are on the 5th floor, at GEH they are near the GETEC library, and at Warwick Hospital they are on the top floor of the Medical Education Centre. They are very friendly and you should go and see them in person to make an appointment and discuss your audit.

It will help greatly if you don't need their help for running the actual audit.Tell them at the start that you intend to do all the work yourself or in a small team, and you just want their guidance on getting it started. Most will not be able to recall notes for you retrospectively, but this can sometimes be arranged with individual consultants' secretaries (if you are very very nice to them). The audit departments will also check if a similar audit is currently taking place, or planned to.

Get a Supervisor

You will need at least one supervisor who will be responsible for acting on the results of your audit (otherwise what's the point in doing it?). This should be a consultant working in the area you are studying - most will be happy to help.

Get Going

Make a detailed plan for data collection with targets for what should be achieved. You will be fitting this in around your normal days and it can be easy to lose momentum. It's best to plan and carry out an audit within one block, as things get difficult when you move hospitals or change placements. This requires a lot of organisation but it can be done!


Present your Findings

It is very important to present your audit so you can disseminate your findings and receive feedback on your work. Arrange with your consultant and the audit department where you can present your findings and in what format. Most divisions have meetings where audits are presented and you can usually fit into these. You will also be expected to complete a short written report for the audit department.

If you have an interesting topic or results, consider presenting it at a student conference or even speak to your supervisor about getting it published.

Act on the Results

Audits can be paper exercises with no meaning to the real clinical world. If you find that something is not being done correctly, or can be improved, do something about it. Don't just file the results away and forget about them. Think about how the system can be improved or how people can be persuaded to follow guidelines more closely. This is the key to quality improvement in health care!