Audits & QIPs are a way to identify issues, drive changes and assess the effects they have. It is your way of making improvements in your workplace, where you can assess the impact they have to see if they were worthwhile. It is easy to make a poster, provide education or tell people to do something – but if you don’t assess it, how will you know if it has had any impact?

You can always contact us to collaborate on educational QIPs such as making resources for junior doctors. It’s a win-win: you boost your portfolio & junior doctors across the UK benefit from the resources you develop. Examples of QIPs we’ve supported include our careers section, improving referrals, our upcoming international medical graduate content and others. Make sure you include your grade, skills & at least one idea for a QIP you’d like to carry out & why.

What is an Audit?

Audits compare current practices in your workplace against a recognised ‘standard’. These standards could be issued by any official authority on a subject e.g. NICE, the NHS, a leading society (e.g. British Thoracic Society for Asthma) or your local hospital protocols. Examples include:

• Inhaler technique should be checked in 100% of patients admitted with an asthma exacerbation
• VTE assessment should be done on 100% of patients during their hospital stay
• Following a STEMI, 100% of patients should be given a follow-up appointment with cardiology

The person undertaking the audit (the ‘audit lead’) sets the ‘audit standard’ at the beginning. 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, your intervention doesn’t need to be successful at making an improvement for it to still count as a full cycle audit for your portfolio.

What is a Quality Improvement Project?

Quality improvement projects (QIPs) also involve reviewing current practices and designing ways to improve. Audits can improve the quality of care but by definition must compare current practice to a ‘standard’. In contrast, QIPs allow creativity by enabling improvements in areas that might not have easily identifiable ‘standards’. Examples include projects aiming to:

• Improve patient experience
• Streamline pathways for patients to minimise waiting times
• Improve wellbeing of staff
• Improve the confidence of staff in dealing with a situation
• Making information leaflets

QIPs are often 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 the 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 in it.

How do I come up with an idea for a project?

Ask the consultants or registrars in your team if they have any ideas for projects you can get involved with. If they haven’t got any ideas, ask them, your colleagues (and yourself) if there is any part of the department or hospital that frustrates you or could be working more efficiently.

For example, during my FY1 year, the following things I noticed became QIPs:

• A patient went into Type 2 respiratory failure. This resulted in reviewing BTS standards, auditing our prescription rates and staff knowledge on T2RF & providing teaching and leaflets accordingly
• A patient was given too much amikacin. This resulted in an audit looking at whether doctors knew how to calculate the dose & developing a calculator to simplify the process
• An FY1 complained that they didn’t know how to refer to x department. This resulted in a referrals booklet that explained how to refer to each department generated by registrars from each specialty

Top Five Tips

1. Make sure you can complete it: Often you have only a single 4-month rotation to complete a full cycle audit. Select something that takes a shorter time (e.g. 2-3 months) in case there are delays.
2. Have an active role: You will need to evidence that you had a large role in every cycle of the audit e.g. look at the QI section for IMT applicants. You can buddy up with colleagues to share the workload. By inviting another F1 to help you and vice versa, you can have your name on two audits without extra work.
3. Register the audit with the audit department: This provides you with formal evidence for your portfolio. Also, request a letter from your consultant confirming how you were involved. Typically the different aspects to emphasise are whether you initiated/designed the audit, undertook data collection/analysis, and/or presented the audit.
4. Electronic data collection: Pick audits where you can collect data electronically if possible as this is infinitely quicker. Not only will your information or coding department provide you with streamlined data, but you’re also saved from the delay of requesting paper records and trailing through them!
5. Present the audit: It counts for more than simply doing the audit. You can present it locally at departmental meetings or morbidity & mortality meetings. You can also get points for a regional or national presentation by submitting your project to a conference. Check for deadlines fo upcoming conferences so you know how to pace yourself.

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 your portfolio!)

Further Reading

• Setting objectives, aims & standards
• Audit Template Report

Dr Eleanor Crossley CT2 MRCS (ENT), MBChB,  BMedSci (Hons)
Dr Mitul Patel MBBS BSc (Hons) CT2 Anaesthetics
Edits by Dr Akash Doshi (ST3)