Example 3 - Testing, Investigation, Interaction with A&E (5 or 8 criterion audit)

---

Some OOH doctors have access to immediate investigations - particularly bench tests or use of the local laboratory or sometimes imaging services. Depending on the facilities at the treatment centre(s) at which you work it may be helpful to audit your use of testing or investigations as a way to review their effectiveness.

Some ideas:

You might reflect on the use of tests and measurements that you perform in house:

For ten sessions, note your use of in house testing and investigations. You should keep a note of each patient, and at a later date you should

• either review the completed case summary
• or contact the practice to find out the outcome

1. Have you made use of simple equipment or bench tests such as peak flow, sats, visual acuity, glucometer, alcometer, urinalysis or pregnancy test? If so, are you confident that you are familiar with the full range of tests and equipment available to you?
2. Does documentation clearly show the results?
3. Reflecting on the occasions that you have used any of these tests or measurements, can you identify effective use of the results?

Laboratory Investigations

For ten sessions, note your use of laboratory investigations. You should keep a note of each patient, and at a later date you should

• either contact the practice to find out the result
• or contact the laboratory directly to follow-up the result

You can audit against your chosen set of criteria and standards. You could consider setting criteria such as:

1. A request for a laboratory test should have a clear clinical reason. Can you identify one for each of yours? (For example, if checking renal function in hypertension, what is the reason for also requesting LFTs?)
2. Laboratory samples need to be correctly labelled, in the correct container and to arrive timeously
3. A laboratory investigation should be appropriate. On reflection did you ask for a test that was likely to help with managing the patient's problem? (For example, assuming the patient's own GP will receive the results, is it clear what you requested, why, and what you told the patient would happen with the result?
4. Investigations should expect to include a reasonable proportion of abnormal results. (What proportion do you think this should be?)
5. Clear directions should be included on a request form if a telephone report is required. Did you do this?

Working in A&E or near A&E Staff

In some centres you may have access to A&E staff nearby. This may allow you to ask one of these doctors to see the patient on your behalf for further management because they have access to facilities that are not available to you. If you decided that this would be helpful in managing a patient, you should review whether your request was helpful and appropriate in retrospect.

For ten sessions, note your use of A&E referrals investigations, or obtain these data from the OOH computer system. You should review each patient, and you should:

• either contact the practice to find out the result
• or contact the A&E department directly to follow-up the result

You can check the audit against your chosen set of criteria and standards. You could consider setting criteria such as:

1. Did you consider what role you might take in managing the patient, before involving colleagues in the process?
2. Did the referral result in an action that you could not have undertaken yourself?
3. Would it have been appropriate to involve the patient's GP the next day instead?

If the referral was so that the patient could have imaging, you might review your knowledge of this and write a reflective statement:

1. X-rays should only be requested in compliance with the guidelines of the Royal College of Radiologists (to avoid unnecessary exposure to ionising radiation). Do you know what these guidelines state or how to find out?
2. Guidelines now suggest alternatives to X-ray investigations in some cases: did you follow all relevant guidelines? (for example SIGN or local guidelines)

You may find it helpful to contact a local laboratory or X-ray department for some advice on what criteria to choose. Many departments are now able to provide you with feedback on your use of their services if you have made the request with a name or identifier which is unique to you.

This page was last updated on: 27/04/2021