Background to the project

In 1996, The Royal College of Radiologists (RCR) published Clinical Audit in Radiology: 100+ Recipes, edited by Gerald de Lacey, Ray Godwin and Adrian Manhire. This was an invaluable resource to many of us as we struggled with the concept of undertaking audit in a systematic and logical way, repeating the cycle and above all choosing audits which were relevant and not too challenging to busy radiologists.

In 2000, the authors followed with Clinical Governance and Revalidation: A Practical Guide, to meet the challenges of producing evidence on quality of care in a department of clinical radiology.

Both these publications were much used by members and Fellows as seen by the posters submitted to the Annual Scientific Meeting Poster Competition, but both were in need of updating. The Clinical Radiology Audit Sub-Committee of The Royal College of Radiologists (CRASC) set themselves this task.

Several drivers emerged while the project was under way. The first was the realisation that revalidation was unlikely to take the form of an examination, but would probably include assembling a portfolio of good practice of which personal audit would be a component.

One of the original objectives of Clinical Governance and Revalidation: A Practical Guide was:

This aim remains just as relevant today as revalidation approaches for us all.

In 2006, the Chief Medical Officer's report Good Doctors, Safer Patients¹ called for the reinvigoration of clinical audit to enable it to reach its potential as a rich source of information to support service improvement, better information for patients and other activities such as revalidation of clinicians.

In September 2007, the Department of Health announced the National Clinical Audit Advisory Group (NCAAG) would be established, to drive the reinvigoration programme and provide a national focus for discussion and advice on matters relating to clinical audit. The programme is being led by the Quality Strategy Team of the Department of Health, and will include support to clinical audit with new responsibilities to develop materials and resources to support practitioners carrying out both local and national audit. These might include training materials and guidance, and a library of validated audits that practitioners can download for use locally.

In updating the two publications, CRASC has endeavoured to remain true to the principles laid out originally with regard to standards and targets. Where the Standards Sub-committee of the RCR has produced a standard, we have incorporated the matching audit 'recipe'. Where a defined evidence-based standard exists, this has been used. However, in many of the recipes, there is a suggested standard and target for guidance which will be best set locally.

Using the best available evidence, common sense and adhering to the requirements of clinical governance should still remain the underlying principles when defining a local standard and when setting a target.

Several opportunities result from the way this collection of audits has been created in the web-based format. It provides a fully searchable menu of topics which can be used by a department when planning the annual forward programme in clinical audit. This is likely to be an important aspect of accreditation of departments.

It will assist individuals who wish to evaluate a particular area of local practice for their revalidation portfolio but are uncertain how best to set about it, to seek a suitable methodology from among these projects.

All the recipes and templates for data collection can be downloaded in Word format and adapted for local or individual use.

Users can submit their own recipes, hence spreading good practice, and it creates the opening for identical regional or national audits to be carried out by different centres.

None of the recipes is fully comprehensive. The limitations of the format, even with the use of appendices, does not allow every detail of the audit cycle to be spelt out. For example, all recipes move swiftly from stage 2 of the cycle (assessment of local practice) to stage 3 (comparison of findings with the standard) to stage 4 (listing the changes which might be indicated) without mentioning data analysis which will need to occur between each of these stages. This requirement for data analysis needs to be assumed within all the recipes.

However, the live web-based format will allow the editors to amend and expand following user feedback. If you have ideas for improvement, please let us know!

We hope you will enjoy using AuditLive and will find it useful for the challenges of audit, revalidation, and accreditation.

Sue Barter and Karen Duncan
Chair of CRASC and Editor

Note: For those wishing to read the introductions to the original publications which give more background on audit and clinical governance please follow the links below:

Original Introduction from Clinical Governance and Revalidation A practical guide for radiologists

Acknowledgements

We are indebted to Gerald de Lacey, Ray Godwin and Adrian Manhire who were our inspiration and to Chris Ryall and Peter Lumb for turning our aspirations into reality with their technical expertise.

Thanks go to all the original recipe authors who kindly updated their contributions.
The Healthcare Quality Directorate of the Department of Health provide funding for this project.

Project team

Sue Barter, Hazel Beckett,

Richard Coulden, Karl Drinkwater,

Karen Duncan, Peter Lumb,

Denis Remedios, Nan Parkinson,

Chris Ryall, Rowena Warwick.

Note: Current CRASC members act as advisors

References