Audit projects measure the extent to which agreed clinical standards are met in each organisation providing cancer care. Unlike key performance indicators audits are usually fixed term data collections. Fixed term audit is often preferable when large or complex datasets are required and a suitable sample size can be found in a relatively short time period.

The network site specific groups consider the audit findings and agree what action, if any, should be taken. The final audit reports are shared with the network governance committee.

Recent audits coordinated across network organisations include:

This audit measured how well chemotherapy units are doing against the recommendation that patients wait no more than one hour for their chemotherapy treatment.

All six chemotherapy units and pharmacies participated in the audit which was developed in collaboration with a chemotherapy nurse, pharmacist and cancer manager.

The audit found that:

• 48% of patients waited one hour or less from the time they were deemed fit for treatment to their first IV medication.
• The median wait ranged from 50 minutes to one hour and 25 minutes at each unit.

The report has been shared with stakeholders and teams are undertaking a root cause analysis of a sample of cases that waited longer than one hour for their treatment. The audit will be repeated in 2011.

This project was led by Alexis Macherianakis, consultant in public health at Sandwell PCT, using a national audit tool to retrospectively audit the timing of events leading up to cancer patients’ first appointment with a cancer specialist.

The audit took place in primary care using GP records and found that:

• The majority of patients with a cancer diagnosis presented initially to their GP and were referred within four weeks of their first or second presentation.
• Just over half of GP referrals were via the two week route.
• A substantial group of patients were referred non-urgently or as emergencies.
• Routine referral usually meant an interval of four weeks or more to see a cancer specialist.
• Emergency referral did not always guarantee rapid access to a cancer specialist.

The findings have been shared with GPs.

The finding that half of patients referred via the two week wait were seen in more than 14 days has been investigated. It was found that data held in the GP notes was incomplete when compared to hospital records and patients were attending their first hospital appointment within 14 days of referral.

This audit was undertaken by the skin network site specific group. Events that took place along the melanoma pathway between referral and treatment were recorded in order to ascertain whether agreed standards were met. The audit found that:

• The expected proportion of cases had clinical margins recorded.
• The initial excision biopsy margins met the required 2mm standard.
• GPs performed 5.6% of the excisions.
• Three quarters of wide local excision took place within one month.

It was concluded that the small number of deviations from the audit standards were within an acceptable tolerance.

Teams have reviewed those cases where the interval between referral, initial excision biopsy and wide local excision was longer than might normally be expected.

Sentinel lymph node biopsy for women undergoing mastectomy or breast conserving surgery is agreed best clinical practice. A three month survey identified those teams who had fully implemented this practice and those which had yet to do so. As a result of the project a network wide protocol has been agreed to be implemented across all sites.

This audit was undertaken by the colorectal network site specific group to determine the rate of referral of cases of liver metastases to the specialist MDT and to review clinical decision making. The audit found that:

• 19% of identified cases of liver metastases were referred to the specialist MDT
• 91% of the unreferred cases were confirmed unresectable
• three cases were potentially resectable

The results of the audit and recommendations were considered at the network site specific group's educational event held in July 2011 and the criteria for referral have been amended as a result.