The QuADRANT study: Current status and recommendations for improving uptake and implementation of clinical audit of medical radiological procedures in Europe. The radiotherapy perspective

Background:QuADRANT was a research project funded by the European Commission to evaluate clinical audit uptake and implementation across Europe, with an emphasis on clinical audit as mandated within the BSSD (Basic Safety Standards Directive). Aim:Focusing on the QuADRANT objectives - to obtain an overview of European clinical audit activity; identify good practices, resources, barriers and challenges; provide guidance and recommendations going forwards; identify the potential for European Union action on quality and safety focusing on the field of radiotherapy. Results:A pan-European survey, expert interviews and a literature review conducted within the frame-work of the QuADRANT project indicated that developments in national clinical audit infrastructure are required. While in radiotherapy, there is a strong tradition and high level of experience of dosimetry audits and well-established practice through the IAEA's QUATRO audits, few countries have a well -established comprehensive clinical audit programme or international/national initiatives on tumour specific clinical audits. Even if sparse, the experience from countries with established system of quality audits can be used as role-models for national professional societies to promote clinical audit implemen-tation. However, resource allocation and national prioritisation of clinical audit are needed in many coun-tries. National and international societies should take the initiative to promote and facilitate training and resources (guidelines, experts, courses) for clinical audits. Enablers used to enhance clinical audit partic-ipation are not widely employed. Development of hospital accreditation programmes can facilitate clin-ical audit uptake. An active and formalised role for patients in clinical audit practice and policy development is recommended. Because there is a persisting variation in European awareness of BSSD clinical audit requirements, work is needed to improve dissemination of information on the legislative requirements relating to clinical audit in the BSSD and in relation to inspection processes. The aim is to ensure these include clinical audit and that they encompass all clinics and specialties involved in med-ical applications using ionising radiation. Conclusion:QuADRANT provided an overarching view of clinical audit practice in Europe, with all its related aspects. Unfortunately, it showed that the awareness of the BSSD requirements for clinical audit are highly variable. Therefore, there is an urgent need to dedicate efforts towards ensuring that regula-tory inspections also incorporate an assessment of clinical audit program(s), affecting all aspects of clin-ical work and specialties involved in patient exposure to ionising radiation. & COPY; 2023 Elsevier B.V. All rights reserved. Radiotherapy and Oncology 186 (2023) 1-7

Automated summary

The QuADRANT project funded by the European Commission evaluated clinical audit uptake and implementation in Europe, emphasizing the BSSD mandate. The results showed the need for developing national clinical audit infrastructure, promoting patient involvement, and improving awareness of BSSD requirements.