Audit of medical practice

Purpose

A doctor's active involvement in continuing professional development (CPD) helps to ensure ongoing competence. CPD covers three broad areas – audit, peer review and continuing medical education (CME). Research tells us that, of these areas, audit activity is most strongly associated with a positive effect.

Having clear criteria and definition of a medical practice audit is intended to make it as easy as possible for doctors to ensure that an audit forms a part of their annual CPD programme.

Council recognises that not all doctors are in clinical practice, and uses the term ‘audit of medical practice’ to cover both clinical and non-clinical practice. Council's definition, and the criteria that should underpin your audit activities, are as follows.

Definition

An audit of medical practice is a systematic, critical analysis of the quality of a doctor’s own practice, the results of which are used to improve clinical care and/or health outcomes, or to confirm that current management is consistent with the current available evidence or accepted consensus guidelines.

Criteria

The criteria for conducting an audit of medical practice are:

1. The topic for the audit relates to an area of your practice that may be improved.
2. There are sufficient resources to undertake the process without unduly jeopardising other aspects of health service delivery.
3. Current performance is measured against an identified or generated standard.
4. A written plan is documented.
5. Outcomes of the audit are documented and discussed.
6. Where appropriate an action plan is developed that will identify and maximise the benefit of the process to patient outcomes. The plan should outline how the actions will be implemented and a process of monitoring.
7. Subsequent audit cycles are planned, where required, so that the audit is part of a process of continuous quality improvement.

Audit examples

Council requires that doctors undertake audit activity as part of their CPD every year. It may be, however, that some audit activities span several years. In essence many audits can be described as continuous quality improvement (CQI) activities. Many doctors will already be involved in CQI activities in their practice or workplace.

An audit of medical practice may take many forms. The specifics will often be determined by the nature of the doctor’s employment.

Some examples are:

• Audits of clinical procedures are an obvious choice for clinicians.
• Comparing the processes, or outcomes of health delivery or patient care with recognised benchmarks or standards.
• Patient satisfaction surveys are often used as the basis for a CQI activity. Doctors who do not see patients usually produce outputs for someone – their customers – and satisfaction surveys of customers rather than patients can also be the basis of a CQI activity.
• CQI can be applied to audits of written outputs e.g. patient records, policy, board or research papers. Many existing standards and guidelines are accessible via the web to help.
• Annual performance agreements may be another source for audit of medical practice.
• Personal development plans often include an audit activity.