PHEM curriculum unit C.5 · Cross-cutting theme C: Clinical Governance
The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit C.5, Support and apply clinical audit.
Below are 2 free practice questions from the DipIMC.Ninja bank, in the Part A single best answer format. Every answer names the textbook page, guideline or statute it was written from, so you can check it rather than take it on trust. The bank holds 6 questions on this unit.
Question 1 · Law, Ethics & Human Factors · Moderate
The clinical governance lead of a BASICS scheme has limited volunteer time and must decide which topics to audit in the coming year. According to the ABC of Prehospital Emergency Medicine, which are arguably the most important criteria for selecting topics for clinical audit?
AThe frequency of the condition, its cost to the scheme and its link to recent complaints
BWide variation in practice, fit with scheme priorities and the associated clinical risk
CA matching national audit, ease of benchmarking and the interest of scheme members
DImpact on patients, potential to influence change and evidence-based guidelines
EEase of data collection, a small sample and the likelihood of good results to report
Show answer
Answer: D
Impact on patients, potential to influence change and evidence-based guidelines
The ABC says appropriate prioritisation is often the greatest challenge, because it simply isn't practical to audit everything across pre-hospital care. It then ranks the criteria: impact on patients, the potential to influence change and the existence of evidence-based guidelines are arguably the most important criteria when selecting topics for audit. The other factors it lists — relationship to organisational priorities, risk, cost, frequency, relation to complaints or incidents, and evidence of wide variation in practice — are relevant but secondary, so the options built from them describe the book's second tier rather than its first. A matching national audit is not among its criteria. Choosing topics because the data are easy or the result will flatter the scheme is the opposite of audit's purpose, which HQIP defines as measuring practice against agreed standards and acting to bring practice into line with them. A well-governed service should articulate an audit strategy and its rationale for including or excluding topics.
Where this comes from
ABC of Prehospital Emergency Medicine
Ch. 36 Clinical Governance · Clinical audit: prioritising topics · p. 198“arguably the most important criteria to consider when selecting topics for audit”
Ch. 36 Clinical Governance · Clinical audit: other factors · p. 198“other factors to consider include the relationship to organizational priorities”
Ch. 36 Clinical Governance · Clinical audit: prioritisation · p. 198“Appropriate prioritization is often the greatest challenge for”
Question 2 · Law, Ethics & Human Factors · Moderate
A critical care network's transfer lead is redesigning the paperwork and incident reporting used for inter-hospital transfers of critically ill adults across the network's hospitals. Which arrangement is recommended by the Intensive Care Society and Faculty of Intensive Care Medicine transfer guidance (2019)?
AEach hospital designs its own transfer form, and the network collates them once a year
BStandard network forms with an audit data set; incidents tagged 'critical care transfer'
CThe escort's contemporaneous notes alone, filed and audited within the receiving hospital
DTransfer incidents reported to the ambulance service alone, through its own system
EAudit only of transfers with a reported critical incident, using each hospital's form
Show answer
Answer: B
Standard network forms with an audit data set; incidents tagged 'critical care transfer'
The ICS/FICM guidance recommends that critical care networks develop standardised documentation for both inter-hospital and intra-hospital transport, including a core data set for audit purposes (its Appendix 6 proposes the minimum data set). It asks all acute provider trusts to report incidents during critical care transfer through their incident system (Datix or equivalent), with 'critical care transfer' as an identifier so that reports can be searched and analysed. Network lead clinicians must ensure that all patient transfers are subject to audit, critical incident reporting and review — not only those where something went wrong — and each network should have a nominated lead for transfer. Hospital-by-hospital forms defeat network-wide audit; an escort's notes alone carry no core data set; and incidents belong in the trust's own reporting system, not only the ambulance service's. NHS England's adult critical care transfer service specification similarly requires the national minimum mandatory data set to be collected and reported.