Clinical Audits and Continual Improvement Cycle
4 Ways Clinical Governance Programme
We are a clinically led organisation with clinical governance at the helm of our decision making. We have a proven track record of structural clinical audits and our clinical governance is underpinned by ISAS accreditation.
4 Ways' audit software randomly selects a predefined percentage of each individual radiologist's work according to modality and sub-specialty. This ensures comprehensive selection and identification of the competencies and capabilities of each individual radiologist.
It is our normal current practice to perform 10% clinical audit (double reporting) for cross sectional reporting and 2% for plain film reporting.
Audit Process
Audits are performed by independent audit groups comprised of sub-specialist radiologists from within the NHS.
The current auditing group comprises of:
- Nottingham Neuroradiology Group
- Barts Neuroradiology Group
- Royal Orthopaedic Hospital and Stoke Mandeville Musculoskeletal Group
- Whittington General Radiology Group
We have followed the Department of Health approved 5 point discrepancy scale for over 5 years. Auditors use the following framework for audits:
Regular audits not only highlight the strengths and weaknesses of the individual but also ensure that the organisational processes are followed to produce quality activity output. A continuous improvement process is in place to ensure that this is followed at all times. 4 Ways has dedicated staff members for the collation and distribution of the images to be audited and for the formulation of final reports.
We are accustomed to providing information that enables service improvement. For example, we have created a very large body of audit experience which was presented at UKRC 2010. This shows two important features. Firstly, it provides a comprehensive estimate of error rates in certain types of radiological work when there is limited data available on this in the UK. Secondly, and most importantly, it shows the improvement in precision that follows when the work of individual radiologists is audited and they receive regular feedback to improve performance.
We have published an extremely large audit case series. This series of almost ten thousand reports (9,359) is probably the largest audit case series published in the UK. The series was a 10% random audit of more than one hundred thousand referrals. We published this series to help establish some benchmarks for precision in radiology.