Standard Report Format for an 8 Criterion Audit Project

A short and succinct title for your audit.

The opening section of the report should clearly explain why the audit topic was chosen and that, as a result of this choice, there is the potential for change to be introduced which is relevant to the practice or you as an individual practitioner.

It is not a requirement for appraisal that you must personally undertake data extraction or analysis; and you may participate in a group audit with other colleagues.  Appraisal is intended to stimulate activity and support learning from audit, but where audit is already under way you do not need to undertake extra audit work.  However, the audit must address some areas of performance which includes your own work, and offer the potential for you to learn and potentially change your clinical practice.

For example, for GP Principals (not just those in training practices) audit is already an established feature of practice activity: the QOF is one example.

Choosing a topic in an area where you know your own clinical practice is strong will not lead to a completed audit cycle being achieved. For example, if the data from your initial audit findings clearly suggest that you do not have to consider the introduction of any change, or carry out a second data collection, then it is evident that this topic was not a problem area.

You should concentrate on prioritising workload and clinical topics in areas where there is a consensus amongst colleagues that practices could most definitely be improved.

You should be able to explain why the particular audit topic was chosen.  There may be a perceived deficiency following feedback; or it is an area in which it is recommended that an audit should be carried out routinely to improve existing practices.  You should also consider what potential benefits there will be to the individual undertaking the audit, the patients and/or the team/practice/clinic in general.

Sessional / OOH doctors

Audit is possible for sessional doctors provided you are undertaking regular clinical activity. Ideally it should be done as part of a larger group or organisation.

Doctors who work in out of hours services can similarly undertake audit and this should be possible with the support of the clinical lead for the service as part of the quality assurance process.

Criteria are simple, logical statements used to describe a definable and measurable item of health care, which describes quality and can be used to assess it.

Examples of audit criteria:

1. Patients with a previous myocardial infarction should be prescribed aspirin, unless contraindicated.
2. Patients with chronic asthma should be assessed at least every 12 months.
3. Patients should wait no longer than 20 minutes in the surgery/clinic before consultation.
4. GPs' medicine bags should contain a supply of in-date adrenaline.
5. Clinics/surgeries should start within 5 minutes of their allotted time.
6. The blood pressure of known hypertensive patients should be <140/85.

It is best to restrict the number of criteria to be measured for any given audit.  Unless otherwise specified, auditing a single criterion is acceptable for appraisal purposes.  Focusing on one or two criteria makes data collection much more manageable and the introduction of small changes to practices much less challenging. Overall it offers a better chance of the audit being completed successfully within a reasonable time span.

It is important that any criteria you choose to audit should be backed up with quoted evidence (e.g. from a clinical guideline or a review of the relevant literature).  Occasionally, because of the type of topic chosen, suitable evidence is not always readily available and therefore cannot be cited.  If this is the case then simply explain that there is a lack of suitable evidence on the subject, but also stress that there is consensual agreement amongst your colleagues on the importance to the team of the particular topic and criteria that have been chosen.

Points to consider:

• The criteria should be very relevant to the actual audit topic chosen.
• Follow the style (short, simple logical statements) used in the above example for each criterion, where possible.
• You must justify why each criterion is chosen, for example with reference to current literature, clinical guidelines or other evidence if available.

An audit standard describes the level of care to be achieved for any particular criterion.

It is unlikely that you will find actual percentage standards quoted in the literature or in clinical guidelines, but you should arrive at the desired level of care (standard) by discussing and agreeing the appropriate figures with colleagues.  There is no hard rule about standard setting - the agreed level is based on both you and your colleagues' professional judgement and this will obviously vary between services for a variety of medical, economic and social reasons.

Examples of audit standards:

1. 90% of patients with a previous myocardial infarction should be prescribed aspirin, unless contraindicated.
2. 80% of patients with chronic asthma should be assessed at least every 12 months.
3. 75% of patients should wait no longer then 20 minutes after their allotted appointment time.
4. 100% of GPs' medicine bags should contain a supply of in-date adrenaline.
5. 95% of clinics should start within their allotted times.
6. 70% of blood pressure measurements of known hypertensive patients should be <140/85.

Agree on a standard which you all believe to be an ideal or desired level of care and briefly explain why each standard was chosen (remember that different standards can be applied to each criterion). The standard(s) set should be outlined together with a timescale as to when you expect it to be achieved (for example, within 3 months if that is how long you envisage it will take to complete the audit project).

In some cases you might require to set realistic targets and a timescale towards the desired standard over a longer period of time.  For example, 50% of asthmatic patients should have a management plan within 4 months, rising to 70% in 12 months, and surpassing 80% within 24 months.

Points to consider:

• Agree on and set a measurable standard for each criterion (as in the above example).
• A timescale towards achieving this standard should be included alongside.
• Briefly explain why each standard was chosen.

This is an important section that is often overlooked when compiling an audit report.

As previously explained, if you work in a team, audit should not be undertaken in isolation - consensus on a topic is necessary, findings should be shared and recommendations for change need to be agreed amongst the team if the audit is to have a successful outcome. Teamwork is therefore essential to practice-based audit, and this must be demonstrated during the audit and evidence of this should be provided in the report.

Put simply: explain in one paragraph who was involved in discussing and planning the audit, how the data were identified, collected, analysed and disseminated and who gave you assistance at any stage of the project (e.g. with a literature review or with collecting or analysing data) if this was required.

If you are working on your own (for example a peripatetic locum) planning and preparation are even more important. You need to identify criteria and standards which can be benchmarked - perhaps by working with a group of other sessional doctors - and which cover an area that you personally can measure and change.

Points to consider:

• Describe the preparation and planning involved in undertaking the audit.
• Demonstrate evidence of teamwork in the preparation and planning of the audit.

The initial data collected should be presented using simple descriptive statistics in table format or using graphs (bar charts, pie charts etc).  Remember to quote actual numbers (n) as well as the percentage (%).  Do not quote irrelevant data (for example, on age, gender, or past medical history) if it bears no relation to your chosen audit criteria.

(Examples of data collection available at bottom of page.)

If the initial audit shows that current practice is below the set standard, it is important to comment on the difference between the first collection of data (current practice in this area) and the standard previously set (the desired level of care).

Points to consider:

• Present initial data in a simple way.  Remember to include actual numbers as well as percentages.
• Do not present irrelevant data that is unrelated to your audit criteria.
• Always comment on how the initial data findings compared with your standard.

The essence of audit is to change practices in order to improve patient care and services. This section should adequately describe any change that was discussed, agreed and introduced by the team.  The role of others involved in this process should also be described.  An explicit example of the change that was introduced should be attached in evidence as an appendix to the report, where this is possible.  Examples could include a new or amended protocol, guideline or flow chart that is introduced to the service, or a letter that is sent to a group of patients inviting them in for a review or check.

Points to consider:

• Adequately describe the change(s) to be implemented, together with the role of staff involved, and when and how it was implemented.
• Attach an explicit example/illustration to provide evidence of the change that was introduced, where this is possible.

After change has been agreed and implemented and a reasonable period of time has elapsed to allow any new practices or systems to take effect, you must then complete the audit cycle.

The failure to undertake a 2nd data collection and therefore complete the audit cycle is arguably the single most common reason why many audit projects are left incomplete.  Time and resources would have been wasted which will lead to frustration for those involved as well as many missed opportunities to improve patient care.

Completion of the audit cycle is achieved by carrying out a second data collection, in order to measure and evaluate what impact the newly introduced change(s) has had on improving the area being audited.  If no change has been introduced, or it has not been given enough time to take effect, then there is no point in undertaking a 2nd data collection - the findings are unlikely to show any improvement in the time that has elapsed because there has been no intervention.

Data from the second data collection should be presented in a similar way to the first round of data. Include the results from data collection (1) alongside your desired standard as well so that comparisons can be easily made.

Remember to comment on the comparison between data collections (1) and (2), and the desired standard to be achieved.  If the standard is not attained or surpassed, reflect and explain why you think this is the case and how you would propose to reach it in future.

Points to consider:

• Present the findings from data collection (1) and (2), briefly compare them with each other and the standard (s) set and discuss the outcome.
• If the standard is not reached, speculate as to why this was the case and how you might reach it in future.

The final section of the audit report should conclude by briefly and simply summarising what the audit achieved, and what are the main learning points gained from this exercise.

In doing this, the benefits achieved through the audit should be discussed along with any problems encountered with the process or findings.  Some thought should also be given as to whether the audit will be repeated in future and if so, when.