Hannah Morison graduated from Cardiff Dental School in 2012. Hannah currently works as an SHO in Oral and Maxillofacial Surgery in Northern Ireland. She has also undertaken a year of training as an SHO in Orthodontics and Paediatric Dentistry at the Royal Victoria Hospital, Belfast.
"I wrote this article to help trainees understand the importance of clinical audit. It is something that I believe is increasingly important and yet new trainees have very little experience in this respect. I hope that this article will provide trainees with useful tips during their busy first year of work."
This article provides a brief introduction to the topic of clinical audit. It explains what clinical audit is, it shows and explains the seven stages of an audit cycle, provides help on choosing your audit topic and concludes by explaining the impact audit can have on a trainee's career pathway.
When you graduate from dental school and embrace the world of day-to-day dental practice, worrying about your audit skills may not be your first concern. However, clinical audit will be very much a part of your working life and you need to ensure you hone your audit skills as well as your operative skills. Whether you are working in a general dental practice, hospital or community, audit is a regular feature of clinical practice for all registrants. Therefore, and not surprisingly, an essential component of all trainee programmes is that you will undertake and present audits.
Once you are clear about why clinical audit is done and how to do it, it will become a routine element of your clinical practice and will benefit your patients, your practice and your colleagues alike.
What is clinical audit?
Clinical audit is the process of systematic critical analysis of the quality of dental care delivered to patients. The aim of clinical audit is to identify service deficiencies so that they may be remedied. Its purpose is also to encourage dentists to assess all aspects of patient care and consider it routine to aim to improve any aspects of service that are below standard.
Clinical audit is also an essential tool within the clinical governance regime and it is therefore important to get to grips with the ins and outs of how it works.
The audit cycle
The diagram below shows the way in which a typical audit cycle works(1).
Step 1: The first task is to select a topic for audit. As a trainee, as well as identifying an area that requires auditing, it will be important to select a topic that interests you. As you are learning how to conduct an audit, alongside developing many other skills, you will find that you spend a fair amount of your time carrying out your first few audits.
Step 2: Next you need to define the criteria and standards for your audit. As the purpose of audit is to monitor different aspects of patient care against agreed standards, defining these carefully is a crucial step. The criteria for the audit will be defined by means of a specific statement of what should be happening in practice. The standard will be defined in terms of the minimum level of acceptable performance. For example: the criteria could be to take quality standard Grade 1 radiographs for all patients. The standard (minimum acceptable level) would be 70%.
Step 3: The next stage is to set rules for data collection. Data can be collected in a variety of ways. For example it can be collected prospectively (as it is happening) or retrospectively (looking back over existing data). The sample size should also be large enough to ensure it is representative of the area or topic being studied(3). Ideally, data collection should be randomised, that is a random sample taken, to avoid any bias.
For example: using the same scenario as for Step 2 above, concerning taking standard Grade 1 radiographs, the data collection rule could be to use the next 50 radiographs taken over 1 week (prospective). Alternatively the data collection rule could be to use a random sample of 50 radiographs taken from patient charts (retrospective).
Step 4: Once the data collection rules have been determined the data must then be collected. This can be done from the appropriate sources and may include reviewing medical records or developing and administering questionnaires or data collection sheets.
Step 5: The data now has to be analysed and compared to the standard set. This will allow you to reflect on the results. You will be able to see if you are achieving the set standard or if your attainments are higher or lower. You will also be able to identify and reflect on any departure from best practice.
Step 6: Once the data analysis and reflection is completed you will then need to agree what changes need to be made and to implement these. The findings of your audit will allow you to identify a problem but you also have to decide what needs to be done to put it right. You need to determine how you are going to solve the problem, who is going to do it and when this is going to be done in order to maximise success. Change will then need to be implemented and put into practice.
Step 7: Finally, the implementation of change as a result of audit must be monitored. The audit should be repeated, a suitable length of time after (often six months) to allow for further reflection on the results of the change that has been made. It may then be necessary to make further changes. This repeat cycle will ensure the changes have been implemented, monitored and that standards have improved, to meet or beat the required standard set.
A note on choosing your audit topic
As suggested earlier, choose a topic that interests you. It is helpful if your topic is clinically important, involves patient complaints and opinions or relates to clinical guidelines as ultimately audit is there to improve patient care, enhance staff professionalism and improve efficient use of resources.
A well-chosen topic should also help trainees with continuing education demands that meet the General Dental Council's (GDC) Continuing Professional Development (CPD) requirements(2).
Audit can be your chance to make a change to your everyday working environment and help make the dental experience better for your patients. In addition, a well-designed audit can be extremely valuable to your career. Writing up the results of your audit may provide a great opportunity to disseminate your work and share good practice with a larger dental audience. You could, for example submit an abstract to give a paper or present a poster at a regional, national or even international conference. This can be a significant boost to your CV and is becoming vitally important in the highly competitive dental market if you are interested in undertaking specialist training.
1. Chestnutt and J.Gibson (2007). Clinical Dentistry . 3rd ed. Edinburgh: Churchill Livingstone. 26-28.
2. General Dental Council. (2013). Continuing Professional Development for Dental Professionals. Available: http://www.gdc-uk.org/Dentalprofessionals/CPD/Documents/GDC%20CPD%20booklet.pdf. Last accessed 01 December 2014.
3. Guidelines and Audit Implementation Network. (2014). All about audit data. Available: http://www.gain-ni.org/index.php/resources/clinical-audit/all-about-audit-data. Last accessed 01 December 2014.
Image 1 is a collage of words associated with clinical audit (source google)
Image 2 is the audit cycle (source Chestnutt and Gibson)
Image 3 illustrates the seven steps of the audit cycle (source google)
Image 4 illustrated making a choice (source google)
Image 5 illustrates success (source google)