Study Guide – Clinical Audit

The COGPED Summative Assessment Audit

The marking schedule for Summative Assessment Audit is given below in italics. My tips follow each point.

AUDIT and SUMMATIVE ASSESSMENT

Marking Schedule

1 Reason for choice of audit

Potential for change
Relevant to the practice

Tips: Try making the audit title a question. For example, if your criterion is "All patients on Viagra should have had a serum rhubarb done in the last year", a good audit title would be: "Have all patients on Viagra had a serum rhubarb in the last year?"

If your audit results from a problem you've noticed in the practice, document it in your write-up; it suggests that there is a potential for change.

Think about whether you will be able to make any changes that are needed as a result of the audit. If you know you won't be able to make any changes, there's not much point in doing the audit.

If you are doing the audit while an SHO, you need to choose a topic that looks at the GP-hospital interface. Referrals or discharge letters are possible areas for audit. Again, you need to demonstrate that you've found a problem that needs to be investigated.

I suggest that you discuss your proposed audit with your GP Scheme Organiser before you go ahead - your hospital colleagues may not know what's needed for Summative Assessment.

2 Criterion/Criteria chosen

Relevant to audit subject and justifiable, e.g. current literature

Tips: Don't make your audit complicated or overambitious! Often the best audits are the simplest; ones with too many/too complex criteria tend to run into trouble. I suggest you limit it to one or two criteria.

Make sure that your criteria are clearly stated and unambiguous - try using the one on the Setting audit criteria page as a model.

You must justify your criteria with references. You will need to do a literature search. I suggest that you quote at least four relevant references, preferably more.

Make sure that your references are properly quoted (authors, year, journal/book, volume, pages etc).

3 Standards set

Targets towards a standard with a suitable timescale

Tips: I'm afraid that the marking statement above doesn't make a lot of sense! I take it to mean that:

You need to set a standard for each criterion.

Make sure that the standard is directly related to the criterion; see the examples on the Setting audit standards page.

Make sure that you can justify your standard. If you can't find any literature evidence to back it up, explain why you chose the percentage that you did.

4 Preparation and planning

Evidence of teamwork and adequate discussion where appropriate

Tips: Audit will only result in change if you involve all the relevant team-members from the start. This may include the GPs and Nurses who will have to implement any changes, as well as office staff who can help you doing a computer search. Again, you will need to document this.

5 Data collection (1)

Results compared against standard

Tips: Count how many patients are in your target (baseline) group, and how many meet the criterion. Divide the first into the second, multiply by 100, and you'll get the standard (as a percentage) that your practice has achieved.

If the practice already meets the standard, tell the practice the good news, but don't submit it for Summative Assessment!

If you didn't meet the standard, you need to explain why you think the practice didn't meet it. See the Looking at your results page for ideas on this.

6 Change(s) to be evaluated

Actual example described

Tips: Just telling people to do things better won't result in change. You need to write up in some detail how the changes will take place. Include short-term and long-term changes. Long-term changes are ones that will continue to operate after you've left the practice.

Example: "The GPs agreed to do a serum rhubarb on any patient that they see who is on Viagra" - fail - this wouldn't be likely to pass, as there is no system to help them remember.

"Short-term changes: (a) I wrote to all the patients on Viagra enclosing an appointment to see the phlebotomist for a serum rhubarb; (b) the GPs were given a prompt card that they could stick on their computer screen as a reminder to do a serum rhubarb on any patient that they see who is on Viagra. Long-term change: the secretary will search every three months for patients who are overdue for their serum rhubarb, and flag it as an active problem on the computer system" - pass - as there are long- and short-term proposals that should actually result in change.

7 Data collection (2)

Comparison with Data collection (1) and standard

Tips: Repeat all the searches - the baseline group and the numbers that now meet the criterion. State that you've done so. The baseline group of patients will probably have changed. For instance, if your criterion is "All patients on Viagra should have had a serum rhubarb done in the last year", after you've made the changes there may be some new patients on Viagra, and some may have stopped taking it. Don't simply say "I've arranged for all the patients from Data 1 to have a serum rhubarb, so I've now reached 100%".

8 Conclusions

Summary of main issues learned

Tips: Comment on any improvements that have resulted.

How well did your proposals for change work?

If you again didn't reach the standard that you set, why not?

If you did, should you be aiming higher next time, or look at something else e.g. whether abnormal serum rhubarbs have actually been acted on?

Where should the practice go from here?

The audit report must satisfactorily cover all eight points to pass.

Drs Ramesh Mehay & Maggie Eisner, VTS Course Organisers in Bradford have developed a superb document to help GP Registrars - and their Trainers - assess their own Summative Assessment audits. Click here to download it.

Back to: "Audit Contents" page

Last update: 16 February 2007