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Ilfita Sahbudin, a clinical lecturer and ST8 in rheumatology based in the West Midlands Deanery, recently joined the National Early Inflammatory Arthritis Audit (NEIAA) project working group as the trainee representative. Here, she explains why trainees are so key to improving patient care through the audit.


Why is clinical audit important?

A clinical audit provides a systematic framework to improve patients’ care. Evidence-based clinical guidelines benefit patients’ when these are implemented in routine practice. Clinical audit is one of the ways to assess if quality of care is in line with the expected standard. It also provides insight to care providers and patients on whether their service is performing well, and, more importantly, whether improvements can be made.


What is the NEIAA?

The purpose of the NEIAA is to improve the quality of care for people living with inflammatory arthritis by measuring care provided to patients against the seven quality statements (QS) set out in NICE quality standard 33. In addition, the NEIAA assesses clinical outcomes and how inflammatory arthritis affects people’s day-to-day function, mobility, sleep, wellbeing, and ability to work.


Why should trainees get involved in NEIAA?

It's easy to see audit as another tickbox exercise that trainees need to complete to jump through hoops during clinical training. Trainees, who are the frontline of clinical care, are among the best workforce to identify issues in clinical practice and find creative solutions to address these issues. Trainee-led clinical audit and quality improvement projects (QIP), if conducted well, have great potential to bring material changes on the shop floor to improve patients’ quality of care.


How can I use the NEIAA data for local clinical audits or QIPs?

The NEIAA's a perfect tool for a trainee to conduct a clinical audit or QIP. The audit lead at your unit can access your department’s real-time data; just click on the dashboard tab and choose the date you would like to view. You can download PDF versions of your NICE Quality Standard 2 and 3 performance alongside national and local performance to discuss with your team.


Any tips on how to conduct a good audit?

Discuss audit or QIP project ideas with your educational supervisor. A high-quality audit includes defined audit criteria, systematic data collection, proposed intervention, and a re-audit to assess the effectiveness of the intervention. The NEIAA's already provided the defined audit criteria and a systematic data collection tool.


You may find useful information during your clinical audit which can then develop into a QIP. As a specialist trainee in rheumatology, this is a good opportunity to design and lead a clinical audit. You may consider inviting other colleagues, e.g. internal medical trainee (IMT) or foundation year trainee, to support audit data collection.


Finally, consider presenting your clinical audit or QIP data beyond the departmental meeting. There are many opportunities to present your audit at regional and national meetings. If you are organising a regional rheumatology training day, consider inviting your colleagues to present their departments’ NEIAA real-time data and discuss potential QIP and audit interventions as a group. It might also be interesting to see post-intervention audit data to note the effectiveness of each unit’s intervention.


Can I request data from the NEIAA for other projects?

Absolutely. We're keen that everyone uses data from the NEIAA. Although the data collection is centralised, meaningful changes in clinical practice are often locally driven. The NEIAA facilitates unit-level data collection for comparison at the national level; please contact the NEIAA team if you require access to the data.


Who can I contact if I have further enquiries?

List of NEIAA local champions

BSR audit team: audit@rheumatology@org.uk.


Any final words?

Remember to create an audit assessment form on your ePortfolio after the audit has been completed and tick the audit box before your next Annual Review of Competence Progression (ARCP) assessment.