The development, implementation and documentation of robust processes of clinical audit are both a high clinical priority and a legal requirement for all European radiology departments. A key component in effective clinical audit is a functional infrastructure at both departmental and national level, allowing external direction (and guidance) of departmental internal audit, with the potential for wider collaborations with hub organisations such as the ESR.
A reasonable response rate (41%) was obtained for the EuroSafe Imaging Star component of the survey and allows some observations of wider European clinical audit practice and associated challenges. Only 43 departments from 16/48 National Radiological Societies responded – although these responses are valuable in themselves, the actual number of responders is small and cannot be considered representative of European practice. These latter results do lend credence however to the findings of the 2019 published National Radiological Societies survey [7] – in particular the previous survey findings show that only 22% of National Radiological Societies had an administrative facility dedicated to clinical audit, 72% had a functional means of communication with their national radiology departments and only 36% of National Radiological Societies were in regular communication with these departments.
As previously alluded to, the promotion and dissemination of good clinical audit practice is seen as a high priority by the ESR. The publication in 2019 of an updated version of Esperanto – the ESR clinical audit guide and the accompanying toolkit of 30 audit templates (with a focus on radiation protection) – was a key component of the ESR audit promotion initiative [4]. Esperanto (version 2) was launched at ECR 2019 and the clinical audit guide and toolkit were widely publicised using existing ESR networks and communications with individual, department and National Radiological Society members.
In this context, positive response rates around awareness of Esperanto and its contents of only 38% respondents (EuroSafe Imaging Stars) and 58% respondents (National Radiological Society contacted departments) are disappointing and will need further consideration and review. ESR promotional activities (email, twitter, publications and ECR-related) were the most common mechanism for alerting EuroSafe Imaging Star departments to Esperanto 2019 (21 positive responses), with 7 EuroSafe Imaging Star departments having been informed by their National Radiological Society. Departmental feedback in both surveys on both the Esperanto ESR Guide to Clinical Audit in Radiology and the ESR Clinical Audit Tool can be seen to be graded as positive/very positive by the majority of responders (see Tables 1 and 2) in terms of clinical utility, range of topics and accessibility.
The survey also evaluated whether key requirements for establishing a local clinical audit infrastructure were in place (administrative, IT, clinical leadership and engagement and managerial support). Overall departmental responses in both surveys to these questions were generally positive (the majority >70-75%).
In the EuroSafe Imaging Star department survey 36 departments (77%) and 22 departments (51%) in the National Radiological Societies departmental survey) have a clinical audit programme in place. However, interestingly, this positive response rate drops to only 21 departments (44.7%) in the EuroSafe Imaging Star department survey and 11 departments (25.6%) in the National Radiological Societies departmental survey when asked if the existing departmental clinical audit structure will allow BSSD compliance (noting work in progress in this area in 17/47 EuroSafe Imaging Star departments). The recorded positive response rate of 44.7% is significantly lower than that obtained for a similar question in the previous ESR survey examining EuroSafe Imaging Star department BSSD compliance [6], where 82% of departments responded positively (54/66). Acknowledging a smaller return rate for the current survey, it is feasible that in the previous survey some departments may have overestimated the capacity of their audit systems to allow BSSD compliance. As the challenges and complexities of BSSD implementation have subsequently become more apparent this may have served to highlight existing limitations in supporting audit infrastructure.
The final survey questions related to national clinical audit programmes. In the EuroSafe Imaging Star survey 21/47 departments have access to a national radiology audit programme organised via the relevant National Radiological Society (two departments do have access but do not participate). Levels of participation in a national audit programme were higher in the National Radiological Societies departmental survey (27/43, 62.8% departmental participation) although, as discussed, these results may not be representative of wider practice.
All departments in the EuroSafe Imaging Stars survey (and the majority in the National Radiological Societies departmental survey) expressed willingness to participate in larger-scale, pan-European surveys potentially co-ordinated by ESR/National Societies. It is important to note that the majority of EuroSafe Imaging Star responders (57.4%) felt that additional resources would be required to facilitate this participation.