Audit Service
As a Care Quality Commission registered practice we provide both primary imaging for NHS purchasers and audit service for NHS and other healthcare systems.
We are registered under the Data Protection Act with the Information Commissioners Office and comply with confidentially and data security standards. We carry practice and personal medical indemnity insurance.
It is our view that the audit of a radiology practice is fundamental to good quality service. We employ consultant radiologists and sonographer practitioners who have specialist experience in their field. Our senior partner reviews the audit practice of the others to maintain an equitable standard. The curriculum vitae of all the auditors will be provided to any purchaser of our service. The auditor identifies themselves in their report and expects that a number of the radiologists, reporting radiographers, and sonographers who are subject to audit will make personal contact by email or phone to discuss cases.
Cases referred to us for audit are at first triaged to the appropriate specialty auditor. They are reviewed electronically and then compared to the written report. We review conventional radiographs on high-resolution DICOM monitors with a minimum of 3Megapixels. These monitors are calibrated and reviewed by our radiation physics team. Cross-sectional images are review on a minimum of 2Megapixel monitors.
We are aware that the process of audit is potentially threatening to practitioners. Our reports and comments are made in this light and are intended to be factual and non- judgmental. All the audit team as also the subject of audit themselves and therefore appreciate that every one of us makes errors and miss abnormalities. We firmly believe that the audit process is part of lifelong learning that is fundamental to medical practice and we expect that the comments we receive from those audited will in turn improve our own knowledge.
Scoring Systems
The team provides an audit of cases categorizing discrepancies using the system selected by the purchaser. Typically we use either the “ERadPeer“ system developed in North America or our preferred St Luke’s Radiology system which expands this review and offers an A* category for exceptional reports.
We prefer the expanded scoring system as it offers encouragement to exceptional reporters.
ERadPeer Scoring System
1 Concur with interpretation
2 Discrepancy in interpretation – Diagnosis not ordinarily expected to be made (understandable miss)
3 Discrepancy in interpretation -Diagnosis should be made most of the time
4 Discrepancy in interpretation -Diagnosis should be made almost every time
a Unlikely to be clinically significant
b Likely to be clinically significant
St Luke’s Radiology Scoring System
A* Excellent report
A Concur with interpretation
B Discrepancy in interpretation or communication issue or -Diagnosis not ordinarily expected to be made (understandable miss)
C Discrepancy in interpretation -Diagnosis should be made most of the time
D Discrepancy in interpretation -Diagnosis should be made almost every time
1 No risk
2 Risk of low or minor morbidity
3 Risk of moderate morbidity
4 Risk of serious morbidity or threat to life
ULTRASOUND
There are problems in providing a comprehensive audit of ultrasound examinations. At present we aim to review the following questions for an ultrasound examination:
• Was the indication for the examination appropriate?
• Where the examination will not provide all the information that a clinician may require has this been recorded?
• Are there images of all the structures that should have been examined?
• Are there images demonstrating all the abnormalities reported?
• Does the report cover all the regions that should have been examined reporting normality when this is important?
• Has Doppler and dynamic examination been used appropriately and have the findings been recorded?
We note that those ultrasonographers being audited may be asked to provide some additional review of their practice by repeat or duplicate examination, clinical or operative outcome measures. We run Ultrasound Skills Courses in Oxford and Bath and are pleased to arrange this type of one to one audit when requested.
