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Audit and Quality Improvement Projects (QIPs)

Read Disclaimer

Audits compare current practice in your workplace against a recognised ‘standard’. The person undertaking the audit (the ‘audit lead’) sets the ‘audit standard’ at the beginning; this is often based on national guidance on a topic, such as NICE guidance, but can also be based on local guidance, such as your hospital protocol. A single cycle audit is when you collect data and compare it against this standard. However, if you do an audit, introduce a change to improve practice, and then re-audit against the same standard after the intervention, this is a ‘full cycle audit’, sometimes referred to as a ‘closed cycle audit’. The infamous example is auditing the VTE assessment completion against the local standard, organising a teaching session and posters for juniors to encourage them to complete the VTE assessments appropriately, and then re-auditing to hopefully see an improvement. Of note, although it is preferable, you don’t need to find an improvement for it to still count as a full cycle audit for your portfolio.

Quality improvement projects (QIPs) also involve reviewing current practice and designing ways to improve. Audits can improve quality of care but by definition must compare practice to a ‘standard’. In contrast, QIPs allow creativity by enabling improvements in areas which might not have easily identifiable ‘standards’; for example a QIP may aim to improve patient experience or streamline pathways to minimise waiting times. QIPs are generally conducted over a longer timeframe. Reasons for this include, but are not limited to, funding applications, designing new pathways and engaging with key individuals or stakeholders before implementing the new way of doing things. This shouldn’t put you off undertaking QIPs as they have potential for long-lasting impact and change, but you should make sure there is an appetite for change in your department before investing lots of time on it.

Top five tips:
  1. Stick to quick audits which you can re-audit within your 4 month rotation 
  2. Buddy up with another colleague - invite another F1 to help with a bit of the data collection and do vice versa, so you get your name on two audits with limited extra work 
  3. Register the audit with the audit department so you can get the formal evidence for your portfolio. A letter confirming the audit and your involvement from your Consultant is also very helpful for portfolio evidence. Typically the different aspects to emphasise are whether you initiated/designed the audit, undertook data collection/analysis, and/or presented the audit.
  4. Pick audits where you can collect data electronically if possible - this is infinitely quicker, saving you from the delays of having to request the paper records and trail through them! 
  5. Presenting an audit counts for more than just doing an audit - ask if you can do a ‘local presentation’ at a departmental meeting or M&M. If you want to get a ‘regional/national presentation’ submit an abstract to conferences as soon as possible - abstract deadlines are often well in advance of the conference date, and you will want the presentation certificate before your next round of job applications. 
The classic faux pas!
If you want an audit for your portfolio make sure you clarify what could be used as the ‘standard’ before you start randomly collecting lots of data which might not be useful. Juniors will frequently be asked to collect data for an “audit” - there is a risk you can end up just filling a database (to date there are no points for this on portfolio!)

Further reading
Dr Eleanor Crossley CT2 MRCS (ENT), MBChB,  BMedSci (Hons)
Dr Mitul Patel MBBS BSc (Hons) CT2 Anaesthetics

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