Hi I'm Prateek, a dentist and specialty doctor, and in this video we're going to be looking at the
audit cycle which is a crucial part of the seven pillars of clinical governance. If you are wanting
to see more educational videos and wanting general hints and tips for applications and interviews
then please make sure to subscribe to this channel. So audits are an extremely important part
of clinical governance and they often come up in exams and interviews so this video should help you
provide a well-structured answer if you are asked about audits and how they work. If we look at what
an audit is according to the National Institute for Health and Clinical Excellence, an audit
is defined as a quality improvement process that seeks to improve patient care and outcomes through
a systematic review against explicit criteria and the implementation of change. Essentially an audit
is a systematic process by which we're examining, reflecting and then implementing change, ultimately
to improve patient outcomes and patient care. We then have the audit cycle - now the audit
cycle refers to the six parts of an audit and the six steps involved. If we look at these very,
very briefly. We first have identifying the problem so what do we actually want to audit. We then have
setting the standard so identifying the criteria that we want to compare to. We then want to gather
information and collect the data. Following this we want to compare the data to the standard that
we've set. From the information we gain from this, we then want to implement change to ideally meet
the standard that we want. And finally the most important sixth step of an audit is to re-audit and
this closes the loop or closes the cycle. Let's now look at each of these steps in a bit more detail.
The first step is identifying the problem. So you may come across something in your day-to-day work
that you think actually we can improve this for our patients. It may be anything from complications
of certain aspects of care for example, if you're taking teeth out the complication rates following
this. It could be record-keeping audits so there may be lots of information missing from
notes and so you may want to audit this. So that's how we identify a problem and ultimately we want
the solution to improve patient care. We then move on to step two which is setting the standard. Now
the standard may be something that is already available to us so these may be from existing
research or guidelines that are set. For example, a set complication rate from a paper that you've
read or alternatively it may be a standard that we are aspiring towards and that we set ourselves.
So you may have a vision that you want to achieve. Additionally in a lot of hospitals you also then
have to register your audit with the central department or the auditing department. You then
want to gather the data. Now often the best way to do this is to create a data capture form or
data collection form and this will have all the information that you want to collect. So you can
gather it very, very easily and very effectively it also makes analysing the data a lot easier
when it comes to it. Generally you will set time periods for when you want to collect
data for example it may be over a month long period. So often you could do it at the time or
you could do it retrospectively looking at back at data that was previously collected. So next
you want to analyse your data and you want to compare it to the set standard. This will then
allow us to identify whether we're doing well in comparison to the set standard or whether
we're falling short of the standard. We're then moving to step five which is implementing change
so based on our analysis we'll identify if we're falling short of what we want to achieve and if
we are doing, we need to identify why this is happening so is it a potential problem in terms
of how our clinics run, is it potential problems with software, is it a variation how procedures are
carried out between clinicians. So we want to try and identify this and implement change in order
to meet our standard and then finally following this we then want to reorder the same information.
So you may wait for six months or a year and allow this change that you've implemented to take effect
and once this has taken effect you then want to re-audit the data so you want to look and
see whether your changes have actually worked. So you could then compare your new audit data back to
when you first collected and see whether there's an improvement. If there still is an improvement or
there's not a sufficient improvement then you may go through the entire cycle again and implement
further change. So that summarises the audit loop now it's really important when it comes to
interview questions and exam answers that you have an example of an audit and also discuss how you
went about collecting the data, how you went about discovering that you wanted to do this audit and
what the final conclusions were. So an example of an audit that I have done. I have looked at consent
processes for patients ensuring that consent forms were properly collected, that they were signed, they
were done in advance of the procedure - all of these factors I then went through the audit loop and the
audit cycle. I then re-audited it to make sure that my changes had actually made a difference.
Now let's think about things that we can audit. There are lots of topics and in your day-to-day
life I'm sure when you're working you'll think 'oh this should be easier' or these problems shouldn't
occur and those can often give you hints as to what you can audit. A couple of quick examples are
patient wait times for clinics, complication rates following procedures. The really basic ones you can
do in practice are radiograph quality audits or comparing to endodontic guidelines and auditing
the criteria for endodontic guidelines against what you're doing within your practice. We can also
compare to NICE guidelines for example extraction of wisdom teeth and making sure extractions that
are done are in line with the guidelines that are set. Ideally when you're answering this interview
question you want it to be a worthwhile audit not just an easy audit that you've done for
ticking the box. And finally why do we actually audit? Auditing is important although auditing
can sometimes be a long, drawn-out process, it's a really important part of clinical governance to
improve our patient outcomes and our patient care because if we didn't audit we may not necessarily
identify issues that are going on and therefore we would never implement change to try and improve on
these. Audits are also required for training and development as a trainee if you're going through
a training process auditing is crucial for this. So this video should have provided you with a good
overview of what an audit is and what the audit cycle involves as well as a couple of hints and
tips in order to gain the most from your exam and interview questions. I hope that you can now
create a well-structured answer if you are asked about this topic. As always if you found this video
useful please like, comment and subscribe and do share it with others. If you do want other videos
doing please make sure to let me know either through a comment or on one of the social media
handles. My recommendation in this video is Dr G's Toothpix which is an excellent website if
you're wanting to improve your knowledge regarding radiographs and interpretation of them there are
a huge number of examples of various pathology and also tutorials on how to understand these
radiographs - so please make sure to check the website out. Until the next video, take care