Requirements for Clincial Audit in Radiology in Ireland, 2011
Clinical Audit in Radiological practices is a legal requirement set out under Statutory Instrument 478 (2002), of the European Communities Regulations and in the Medical Practitioners’ Act 2007. Therefore there is a professional and organisational responsibility to implement clinical audit in all locations. In addition, clinical audit represents one of the most powerful tools at our disposal to improve the quality of the service we provide to patients.
The National Radiation Safety Committee and the Faculty of Radiologists undertook broad consultation on Clincial Audit requirements and have come together to produce the above guideline document, outlining the requirements in Ireland for Clinical Audit in Radiological practice. It can be used as a step by step guide to the implementation of structures and processes for an effective audit cycle.
The National Radiation Safety Committee (NRSC) has made specific recommendations to facilitate organisations and professionals in implementing their legal requirement to conduct clinical audit, as follows:
- Each location should review the recommendations of this document to produce a map of Clinical Audit Structures and individual responsibilities for the location (example given in appendix 5). Smaller locations should make links with other facilities where possible.
- The CEO/Hospital Manager has responsibility to ensure a clinical audit structure and process is put in place that is integrated in to local accountability and clinical governance structures.
- The Lead Radiologist has responsibility to ensure that multidisciplinary clinical audit takes place and that changes are implemented as a result.
- The NRSC intends to work with the Faculty of Radiologists and other stakeholders to produce some sample templates for audit which will be available in the near future.
The signatories of the document would urge all those who provide radiological health services to implement the recommendations within.
Clinical audit can apply to the structure, process or outcome. Relevant topics for audit in patient radiation protection include justification, optimisation, clinical responsibility, clinical standards and assurance, protocols for procedures and equipment, training and special practices. Justification that the medical benefits outweigh the risks of a procedure, optimisation of radiation dose and the effectiveness of a procedure, are key elements in implementing radiation protection in medicine. The Health Service Executive (HSE) is required to monitor the implementation of clinical audit and is required to conduct external audit every five years.
The definition of clinical audit under SI 478 is: “a systematic examination or review of medical radiological procedures which seeks to improve the quality and outcome of patient care through structured review, whereby radiological practices, procedures and results are examined against agreed standards for good medical radiological procedures, with modification of practices where indicated and the application of new standards if necessary”.
Guidelines for Audit
A clinical audit should look at the work of all healthcare professionals involved with ionising radiation and all elements of their work that affect the radiation doses received by patients. Currently the Medical and Dental Councils are responsible for providing written protocols on radiology practice.
Other Guideline Documents
The EU has issued guidelines to assist countries in meeting their clinical audit requirements - The European Commission Guidelines on Clinical Audit for Medical Radiological Practices, 2009
In addition, the International Atomic Energy Agency, of which Ireland is a member, has issued a toolkit for clinical audit in diagnostic radiology; Comprehensive Clinical Audits of Diagnostic Radiology Practices: A Tool for Quality Improvement, 2010. A similar toolkit has been produced for Radiotherapy; Comprehensive Clinical Audits of Radiotherapy Practices: A Tool for Quality Improvement, 2007.
Medical Council has issued criteria for clinical audit as required in the Irish legislation, these guidelines are available here.
Guideline Documents for Audit of Dental Practice
The Dental Council has produced criteria for clinical audit.
The Audit Subcommittee of the Dental Radiation Safety Committee of the HSE (Dublin North East and Dublin Mid Leinster) produced the document "An Introduction to Audit Compliance With SI 478 (2002)" in Dentistry for use by dentists in the HSE and it is available here.
The Irish Dental Association has a Clinical Audit manual available to members of that association as a download from their website, http://dentist.ie/
A National Dental Review which included questions on Clincial Audit took place in 2010;
Audit of the Dosimetry Calibration of Prostate Intensity modulated Radiation Therapy.pdf (size 52.5 KB)
Review of Dental Compliance 2010.
National Baseline Audit Radiology and Nuclear Medicine 2008
National Baseline Audit for Radiotherapy 2008
National Audit of Medical Radiological and Radiotherapy Practices (2012)