Not just an academic exercise

LOVE it or hate it, audit is here to stay. Since 2001 dentists in Scotland with an NHS list have been required to carry out audit as part of their terms of service.

Many of us have asked what is the purpose of audit? Is it really worth doing? Or is it something we do reluctantly because we are obliged to?

The Royal College of Surgeons of England tells us that: “The aim of clinical audit is to improve patient treatment by improving professional practice and the quality of services delivered.” This is indeed a grand aspiration. To carry out a project that improves patient treatment, professional practice and services to patients really could not be faulted.

But what if the audit project also or (dare I say it) instead was designed primarily to make our busy lives easier: a project that made cash flow better within the practice, a project that ensured patients turned up for their appointments when they were supposed to, or one that organised staffing better within the practice. Well, why not? All of the above would ultimately do all the things the Royal College says are the main aims of an audit project and it seems sensible to me that if you are going to carry out an audit project then one of the best places to start is with something that annoys you about clinical practice.

Topics relevant to you

There are a few critical steps to audit. The first rather obviously is to select what you want to audit. Pick something that you would like to improve about your working day. No, a Claire Renton suggests how dental audit can be more than just a box-ticking exercise longer lie-in and extended lunch break don’t count! But what about those “failed to attend” appointments that drive you mad?

We’ve all been there, set up for that crown prep, impression trays ready, retraction cord found, X-rays checked and... maybe she’s held up in traffic or maybe she just can’t get parked. But no, she’s either forgotten or found something better to do but she’s not turned up. What a hassle it is then, packing up all the kit, contacting the patient to rearrange another appointment not to mention that if you are an associate in this position you’ve not earned anything for the last hour. If you own the practice, then not only have you not earned anything but you’ve had the staff to pay as well as all the other overheads too.

Other concerns in this situation might include the impact this has on other patients who might have been seen had the patient phoned to cancel the appointment a few days before. So perhaps a project about patients failing to attend might just be the answer.

What about other topics? Sometimes significant event analyses (SEAs) in your practice can provide good topics for audit. NHS Education for Scotland (NES) suggests also selecting an audit topic with:

• Clear national standards and guidelines available, e.g. SDCEP guidance on problems encountered in practice

• Clear potential for improving patient care

• Areas of high volume, high risk or high cost, where improvements can be made for the benefit of the practice.

Setting standards

The next step is to define the criteria and standard. This is relatively easy to do if you chose a clinical audit. for example, we are all familiar with the idea that 70 per cent of your X-rays should ideally be grade 1, 20 per cent grade 2 and only 10 per cent grade 3. With regards to evidence of current medical history in the records you might want to aim high and say that your standard is to be 100 per cent. Set the standard for your audit project at an early stage, keeping in mind that the quality of patient care should be high for all patients but also that these high standards must be achievable. The website Scottish Dental (www.scottishdental.org) provides links to a large number of standards documents, such as SDCEP and SIGN guidance.

Data collection

Next you must decide what data you are going to collect. The simplest way is to produce a spreadsheet and fill in the data as you go. If your data is being collected from dental records then staff at the practice may be willing to help here and any assistance should always be gratefully received. The data should be verifiable, so while you might wish to exclude personal data such as the patient’s name, it is sensible to develop a code so that if the data needs to be checked at a later date this can be done easily. You can then submit your audit for approval (and funding).

Making the change

Next you must establish a baseline in your audit and this is achieved by collecting the initial round of data. You can then compare the baseline data to the standard you set and want to achieve. Now you are in a position to make the change.

This is the step that needs the most thought. Making the right change in the right way will make all the difference. If the change involves other staff in the practice then get them on board with your idea. Encourage them to see how practice life or patient care or preferably both will be enhanced by making the change. Then do it.

Obviously it is important to check that the change you have made has been effective and so you need to collect another round of data to prove that things have improved. It is usual to let the change you have made be in place for three months or so before you carry out this second round of data collection but this time can be varied depending on your project.

To finish…

The next process is to analyse the second round of data, pat yourself on the back for the improvements you have made to patient care, bask in the adulation of your practice colleagues for making their life that little bit easier, and don’t forget you then have the unglamorous job of writing up your report.

And after all that hard work you deserve your long lie. Enjoy!

Claire Renton is a dental adviser at MDDUS

Audit steps

Step 1: Select what to audit

Step 2: Define the criteria and standard

Step 3: Define data to be collected

Step 4: Submit your audit for approval

Step 5: Establish the baseline (collect initial data)

Step 6: Compare performance with criteria and standards

Step 7: Implement change

Step 8: Carry out a second round of data collection

Step 9: Analyse the data

Step 10: Produce and submit your audit report

Find out more on the NES website