Audit

Principles of audit participation

The Royal College of Surgeons (RCS) strongly supports surgeon participation in national and local clinical audits as a regular part of day-to-day clinical practice. Audit participation provides a means of measuring performance against agreed standards, supports best practice and demonstrates the profession's commitment to improving patient care.

When participating in clinical audit, surgeons should note the following key points:

• Where national audits are identified which cover your areas of practice, it is essential that you participate. This is an integral part of your revalidation.
• It is your responsibility to gather the relevant information from the audit (e.g. reports and downloads) to present to your appraisal.
• Your employer will need to facilitate the submission of data to national audits.
• Where your area of practice is not appropriately covered by a national audit or where data routinely collected by your employer (e.g. HES data) is not sufficient, you can supplement your data by undertaking a local audit, conducted either by you individually or as part of a wider unit/region-based audit.
• Surgeons should play an active role in quality assuring the data submitted to and reported by an audit, to ensure that the results accurately reflect their practice.
• Alert your organisation and the audit provider If you identify errors in the data attributed to you.
• Analysis of your outcomes will provide one piece of the supporting information required for revalidation, which (along with evidence of continuing professional development, significant events, feedback from colleagues and patients, and review of complaints and compliments) will provide a complete picture of the surgeon’s practice for the appraiser.
• Engage in a constructive conversation with your appraiser about your outcomes data.
• Respond promptly and facilitate any investigation that aims to identify its nature if a concern is identified about your data.

In collaboration with the surgical specialty associations, the College has produced guidance on the use of outcomes for revalidation.

Theory and best practice in audit

There are useful resources available on the theory of audit and what constitutes best practice. 

The Healthcare Quality Improvement Partnership (HQIP) has the following publications:

• The criteria and indicators of best practice in clinical audit
• What is clinical audit?
• Local audit handbook
• Guide to ensuring data quality in clinical audits
• HQIP guide to involving junior doctors in clinical audit
• An introduction to statistics for local clinical audit and quality improvement
• Using root cause analysis techniques in clinical audit

The National Quality Improvement and Clinical Audit Network (NQICAN) brings together the regional clinical audit/effectiveness networks from across England and also has involvement by Wales and Northern Ireland