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ESR Audit - Audit across Europe: directive and perspective
Audit Education Professional Issues EuroSafe Imaging Radiographers
Wednesday, February 27, 16:00 - 17:30
Room: X
Type of session: ESR Audit and Standards Session
Topic: Audit, Education, Professional Issues, EuroSafe Imaging, Radiographers
Moderator: D. Howlett (Eastbourne/GB)

Chairperson's introduction
D. Howlett; Eastbourne/GB
Learning Objectives

1. To understand the principles of clinical audit.
2. To update on the Esperanto audit project.
3. To evaluate individual experience on implementation of a clinical audit programme.


This session on clinical audit aims to further promote knowledge and understanding of clinical audit and its application in the departmental radiology setting. Topics include radiographic and industry perspectives, giving insight and guidance on local implementation of clinical audit programmes. An important update on inspection is also provided. The ESR Guide to Clinical Audit, Esperanto, is designed to support radiology departments in developing audit programmes, with an emphasis on compulsory, regulatory, radiation protection type audit and a brief update on the latest version of this guide will be provided.

Clinical audit and inspection: HERCA update
S. Ebdon-Jackson; Didcot/GB
Learning Objectives

1. To understand the differences between inspection and clinical audit.
2. To update on Heads of the European Radiological Protection Competent Authorities (HERCA) and departmental inspection.


Carrying out clinical audits in accordance with national procedures is a requirement of the Basic Safety Standards Directive (BSSD) 2013/59/Euratom Article 58(e). The Heads of the European Radiation protection Competent Authorities (HERCA) intends to publish a position paper on the differences between inspection and audit and the expectations of radiation protection competent authorities regarding the requirements. The contents of this paper will be discussed.

Implementing a clinical audit programme: the Finland experience
T. Autti; Helsinki/FI
Learning Objectives

1. To learn about Finnish clinical audit rounds performed between 2002 and 2016.
2. To introduce the recommendations issued by the Finnish advisory committee for clinical audit and evaluate the effectiveness of these recommendations.
3. To evaluate the future of clinical audits in Finland.


The purpose of clinical audits is to improve the quality and outcome of patient care by reviewing imaging practices against agreed standards for good medical practices and evidence-based medicine. The national advisory committee for the clinical audit (NACA) was founded to support this goal in 2004. The members of the NACA are clinical experts independent of the auditing organisations and public officers from radiation and nuclear safety authority (STUK) in Finland and the ministry of social affairs and health. So far NACA has given 14 recommendations for the clinical implementation of the clinical audit process. These recommendations will be presented and discussed in this presentation. In a clinical audit, the auditors should be independent of the audited organisations. Their role is to produce an independent assessment and report the findings and recommendations to the audited unit. The interval of clinical audits for Finnish medical units using radiation has been five years. Thus, we have experience of three completed audit rounds. Interestingly, the largest number of auditor recommendations were given in the second audit round. Based on our experience, the coordinating and advisory role of the NACA has turned out to be highly important in ensuring good quality of the clinical audit process. In addition, the recommendations of NACA help to harmonise the clinical audit process. Finally, consistent guidelines for auditors given by the recommendations seem to be necessary to produce comparable audit results.

Implementing a clinical audit programme: the radiographic perspective
M.-L. Ryan; Dublin/IE
Learning Objectives

1. To learn how important clinical audit is in day-to-day practice.
2. To appreciate the opportunities and challenges of clinical audit in practice.
3. To understand the impact on quality improvement of clinical audit in a radiographer department, using real life examples.


Clinical audit is arguably the most important part of a quality programme. It allows the radiology team to measure performance against specified standards- local, national and international. This session will help the audience understand something that is often feared in clinical practice and make clinical audit something that is useable, practical and achievable. This session will bring the audience through suggested clinical audits in their department and show real like examples- namely patient identification, workflow optimisation and radiation dose optimisation and justification. The presenter will show examples of where real-life audits have fed into quality improvement in the radiology department around patient and staff safety, financial savings and optimising processes. Different challenges and how to overcome them will be discussed including staff involvement, time management and creating a culture of quality improvement.

Quality improvement and change management: audit in industry
S. Lee; Guildford/GB
Learning Objectives

1. To learn about the genesis of audit.
2. To appreciate the importance of audit in industry.
3. To understand the importance of clinical audit in successful management.


A clinical audit might be likened to the process of ‘continuous improvement’ of quality in the industry. The later focusing on improving competitive performance by raising the quality (for customers) and reducing the cost of products and services. While the former focuses on improving the quality of patient care by ensuring clinical practice is delivered in line with defined standards. Both face the challenges of engaging people, developing supportive cultures and of using systematic methods for sustaining the improvement process. While the industry has been deploying quality improvement approaches for many decades, the practice of clinical audit in many healthcare organisations is by comparison relatively immature. The talk considers the evolution of different industrial management 'paradigms' concerned with quality improvement from the middle of the last century. The growing emphasis on the ‘people dimension’ of quality improvement is highlighted, as is the significance of using an agreed and systematic process (e.g. PDSA: Plan, Do, Study, Act) for effecting quality improvement. The central importance of quality improvement for achieving competitiveness in an industrial setting is described, as are the major ‘trends’ deployed in realising such improvement. Potential areas of symbiosis between clinical audit and management paradigms (e.g. Lean, Six Sigma etc.) are explored, particularly Lean principles, people change management and alignment of structured quality improvement processes. Working to align the intrinsic motivation of staff with the practice of audit and quality improvement, by highlighting the benefits offered to patients (and internal customers) is emphasised as the key to securing staff engagement.

Panel discussion: What are the benefits of good clinical audit?
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