Audit is an integral part of everyday life. A familiar example unfolds at your local coffee shop most mornings, where MAMILs (middle-aged men in Lycra) review the details of their latest bike ride using apps like Strava, receiving immediate and detailed feedback. Similarly, school and university students undergo regular testing, and many of us rely on smartwatches that provide intricate data on our health and even our sleep patterns. These are all forms of audit – seamlessly collecting real-time data on our daily activities to enhance well-being.
However, audit is less embedded in our professional lives. Unlike cyclists, students, or smartwatch users, clinicians and surgeons do not receive immediate and seamless feedback on their work. Why, for instance, don’t we have real-time feedback for cataract surgery outcomes? Surely, these are at least as important as cycling performance, academic progress, or sleep quality.
Clinical audit is defined as a focused review aimed at assessing and improving a clinician’s practice by comparing performance against established standards or guidelines, identifying areas for improvement, and implementing changes to enhance patient care and outcomes. It should be a routine part of our practice, seamlessly integrated into daily operations.
In cataract surgery, an ophthalmologist who avoids clinical audit risks a false sense of security. Outcomes in our field are generally excellent, with complications being rare. As one senior academic ophthalmologist once told me, “I don’t need to know my cataract surgery results; I already know they’re good!” However, low complication rates do not mean there’s no room for improvement. Clinical audit challenges us to make excellent results even better.
Our professional body’s continuing professional development (CPD) requirements include a clinical audit component. Yet, barriers to widespread adoption of high-quality audits persist. Audit can be onerous and time-consuming, and the process may feel confronting. A colleague once expressed concerns, asking, “What if my results are bad? Will knowing them increase my stress and negatively impact my performance? What if I’m not as good as I think I am?”
To overcome these challenges, audit in our professional lives should be engaging and approachable, not burdensome. It should go beyond the minimum required for CPD compliance. We must also avoid the pitfalls seen in the US where individual surgeons’ results are publicly available online, effectively creating a league table. In such systems, surgeons may avoid difficult cases to protect their statistics. In some Australian specialties, surgeons are obligated to report their results and face actions against outliers. While these measures aim to improve accountability, they may compromise reporting accuracy and influence case mix. Audit should not be a tool to penalise poorly performing surgeons – that is the role of the Australian Health Practitioner Regulation Agency (Ahpra). Instead, it should be driven by motivation, not fear.
To ensure clinical audit is seamless, it must integrate naturally with routine patient care. Data, such as visual acuity measurements, should be entered into an intuitive electronic medical record (EMR) system with fields designed to maintain data integrity. An automated query can then aggregate the clinician’s data, allowing performance comparisons against established standards or guidelines. Crucially, clinicians must have confidence in the privacy and security of their data. Audit should never devolve into a competition among peers.
We all take great pride in our work. Clinical audit should reflect this, be an embraced part of patient care and facilitated by modern EMRs. Are we up to the challenge?
Conflict of interest: I’m a Strava-using MAMIL, frequently spotted at a cafe in Melbourne’s inner north on Sunday mornings.
ABOUT THE AUTHOR:
Name: Dr Ben Connell
Qualifications: FRANZCO MPH
Affiliations: Cataract, refractive, and corneal surgery at Eye Surgery Associates, Melbourne; consultant on the Corneal Unit at the Royal Victorian Eye and Ear Hospital.
Location: Melbourne
Years in industry: 25
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