📖Clinical Audits/Quality Improvement Projects outside the UK are acceptable or not?

By Sobnotes

It’s a very good question when it comes to improving the CV for free, whilst you are in your home country and doing your final years or house job.

Clinical Audit or Quality Improvement is defined as a step that you take to enhance the quality of the system or process in place, or you introduce a new process that helps the hospital/ healthcare system.

The above definition is 😎 mine but let’s have a look at more correct definition so you might understand it more :

“Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through a systematic review of care against explicit criteria…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)

As asked by many of my colleagues and juniors back home they are always confused about how to get it sorted and how we can actually perform it. Is it some sort of journal or article that we have to sit back and write? I realise that my knowledge about audits was very scanty when I was taking PLAB.

There is no boundary you can do an audit if you are a medical student or a junior doctor/HO/PG. Now let me tell you a few important fundamental factors without those you can not opt for a clinical audit.

💁1. Description of Change or Topic of your AUDIT.

Example A. Wound Hygiene for inpatients

Example B. Correct Calculation Novorapid Insulin for admitted patients.(you can do this for outpatients)

✏️ 2. Aims and Standards of Best Practice

These include the best medical practices in relation to your topic, for this, you have to consult your hospital consultant or you can look for National Health Guidelines. In Pakistan, you can PMC website for guidelines or you can see the NHS website.

Let’s unfold this in more detail, if you see above we have an example A “Wound Hygiene for inpatients” so to carry out a clinical audit on this you have to gather data on Wound Hygiene you can get from any Book, Medical encyclopedia or Hospital local policy or you can check countries national health policy in the UK its Nice Guidelines which are widely accepted. After that, you have to compile it in a way in order to use it, and it should be easy to understand.

Here it’s important to know that

🧰 CLINICAL AUDIT & RESEARCH: WHAT IS THE DIFFERENCE?

“Research is concerned with discovering the right thing to do; audit with ensuring that it is done right”

Smith R. Audit & Research. BMJ 1992; 305: 905-6

⚠️Be aware of the differences between project categories:

Clinical audit - audit against agreed standards of best practice.

Research - aims to create new knowledge.

Service Evaluation - assesses the effectiveness of a service.

✍️ 3.Engagement of other healthcare staff and Patients in your audit.

It is vital to involve your clinical supervisor or HOD in your audit and make him aware of what you are going to do, In Pakistan, it is hard to convince them because its not something is commonly done, on contrary, in the UK it a common thing so everyone knows and systems are in place.

To engage with patients you can go directly to them or you can give them handouts/leaflets about your audit which must have a questionnaire at the end so you can get the correct data which you are aiming for.

If your audit’s domain is within your department you can easily engage with your colleagues however if it’s beyond your department then you have to try harder and let other departments know about the audit and what you need them to do.

You can relate the example “Wound Hygiene for inpatients” to the General Medicine department and General Surgery Department because both are looking after the patients.

🏇4. Discussing possible changes and Implementing those changes.

This actually the final step in your audit where you are practically doing something to improve something. What you have done in other to help patients with wound hygiene, how to reduce their hospital stay? or whatever your aims are in this audit example.

⌛5.Allowing time for changes to be seen before re-auditing

Always allow some time to settle things down, so you can see the full result, it’s like Plastic surgery which needs time to give you full results. And if there are some stones unturned you can always plan to re-audit.

🙌6. Feedback and Presenting your audit

Discussing whether the practice has improved or not also see the impact of a change initiated by you on wider members of your team. Are they using the agreed hygienic processes in wound care of admitted patients? And if Yes you can present your audit in a seminar and you can also present a poster about your audit.

🤑Do Relevant Aduit according to your taste!

If you are going to be a surgeon do something in the surgery domain, it is not a hard rule but it’s appropriate to do things in your domain.