Enhancing healthcare with Xyla: Our auditing processes, tools, and training

Published 18 June, 2024

Auditing is a critical component in healthcare, particularly within specialised fields like echocardiography. In the UK, the importance of auditing in echocardiography departments cannot be overstated. Auditing ensures compliance with legislation, enhances quality of care, manages risks, and improves operational efficiency. 

Clinical audit

A clinical audit involves reviewing the performance of clinical services against agreed standards. In echocardiography, clinical audits can focus on various aspects, such as the accuracy of diagnoses, the timeliness of procedures, and patient outcomes. By comparing current practices against established benchmarks, audits can highlight areas for improvement and drive initiatives to enhance the quality of care.

Ensuring compliance

In the UK, echocardiography departments must adhere to several regulations and guidelines to maintain high standards of care and patient safety. Key legislative frameworks include the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the Care Quality Commission (CQC) regulations, and guidelines from professional bodies such as the British Society of Echocardiography (BSE).

The Health and Social Care Act 2008, particularly the Regulated Activities Regulations 2014, sets out essential standards for care, including the provision of safe and effective care. Regulation 12 of the Act mandates that healthcare providers must provide care and treatment in a safe way for patients. In echocardiography, this means ensuring that all procedures are performed by qualified professionals using well-maintained equipment. Regular audits help ensure that these standards are met consistently.

The CQC is the independent regulator of health and social care in England. It monitors, inspects, and regulates services to ensure they meet fundamental standards of quality and safety. Echocardiography departments are subject to CQC inspections, and failure to comply with CQC standards can lead to severe consequences, including the closure of services. Xyla is a CQC-registered provider, ensuring its services meet these standards. Audits help echocardiography departments prepare for CQC inspections by identifying and addressing potential areas of non-compliance.

The BSE provides guidelines and accreditation standards for echocardiography. These guidelines cover various aspects, including the qualifications of practitioners, the quality of echocardiographic studies, and the maintenance of equipment. Regular audits ensure adherence to these guidelines, which not only enhances the quality of care but also bolsters the department’s reputation.

Our echocardiography team has been awarded departmental echo quality accreditation by the British Society Of Echocardiography, recognising that we are providing a high-quality and safe service to both our clients and clinical staff is a testament to everyone’s commitment to excellence. Departmental accreditation underpins our commitment to providing a first-class service and a culture that supports the quality and safety of both patients and echocardiographers.

Quality improvement

Audits play a crucial role in identifying gaps and opportunities for quality improvement in echocardiography services. Through systematic review and analysis, audits can uncover deficiencies in processes, training, and equipment that might compromise patient care.

Ensuring that echocardiographers engage in CPD is essential for maintaining high standards of care. Audits can monitor CPD activities to ensure that staff are up to date with the latest advancements in echocardiography. This not only improves the skill set of the practitioners but also ensures that patients receive the most current and effective care possible.

Risk management

 Proactively managing risks is another significant benefit of auditing in echocardiography settings. Identifying and mitigating potential risks helps prevent adverse events and ensures patient safety.

Audits can evaluate the effectiveness of incident reporting systems. By ensuring that all incidents are reported, analysed, and addressed, echocardiography departments can learn from past mistakes and prevent future occurrences. This fosters a culture of transparency and continuous improvement.

Operational efficiency

 Improving operational efficiency is another key advantage of auditing in echocardiography. Efficient operations not only enhance patient care but also reduce costs and improve the overall functioning of the department.


Our clinical audit is centred on competence and accuracy ensuring that our staff meet the highest industry standards.  As recommended by the BSE Echocardiography Quality Framework, we look to incorporate blind over-reading of a random selection of studies as well as all scans with significant clinical findings.

  • 5% of scans are randomly chosen within the time range of the review plus all red cases logged for that site.
  • All new operators are audited at 10% for the first month of their contract.
  • The quality audit spreadsheet is used to log findings.
  • Findings are written up in the quality control report. This document is reviewed and then signed off by the head of clinical operations and returned to the client.
  • Feedback is given to the echocardiographer.

Inter-operator variability in an echocardiogram evaluation is a well-known problem in echocardiography. Having clear and direct protocols helps reduce the level of disparity within the reports and more importantly in the conclusions.

Audit toolkit

When auditing and reviewing echocardiograms, there is a focus on the degree of cardiac pathology or the pathology which is looked for in more than 95% of clinical requests, including valves (stenosis or regurgitation), RV function, LV size and systolic function and LV diastolic function.

Our audit tool aligns with the British Society of Echocardiography (BSE) Echo Quality Framework (EQF) 1 Echo Quality.

The audit form is divided into 13 sections, representing the main areas of an echocardiogram, and to each a relative importance is attributed: 40% weighting to the interpretation and report, 40% to the measurements and the remainder to image optimisation and demographics.

The completed quality spreadsheet produces an audit score averaged from all staff working at the site.  This is included in the customer report and each staff member is provided with feedback based on their individual scores.

When a disagreement is found about a pathology, the scan is reviewed by a 3rd person to assess and evaluate the findings. If the original staff member who performed the scan is found to be incorrect in their assessment of the findings, further assessment of the technician’s work, quality, processes, and actions may be considered.

This comprehensive clinical monitoring of our work forms a key part of our quarterly clinical quality reporting to our customers, as we are continuously monitoring the quality of our staff and services. This ensures we provide clinical services of the highest quality and have open communication channels for any required actions and feedback.

Training and development

Clinical audits help in identifying gaps in practice, guiding targeted training, and enhancing overall performance.

Audits help in standardizing echocardiographic practices by promoting adherence to guidelines and protocols. By reviewing how closely practitioners follow established procedures, training can emphasize the importance of these standards. This not only improves the consistency and reliability of echocardiographic exams but also enhances the comparability of results across different operators and institutions.

An audit might highlight a recurring issue with image quality or measurement accuracy in certain types of cardiac abnormalities. By pinpointing these deficiencies, training programs can be tailored to address specific weaknesses, ensuring that all practitioners meet the required standards.

Fostering a culture of continuous improvement

 Integrating clinical audits into the training regimen promotes a culture of continuous improvement. Practitioners become accustomed to regular performance evaluations and constructive feedback, which encourages a proactive approach to professional development. This mindset not only improves individual performance but also elevates the overall quality of care provided by the echocardiography department.

The implementation of clinical audits within echocardiography departments in the UK is crucial for maintaining high standards of care and ensuring patient safety. These audits serve as a powerful tool for compliance, quality improvement, risk management, and operational efficiency. By systematically reviewing clinical practices against established benchmarks, audits highlight areas for improvement and drive initiatives that enhance the overall quality of care.

In conclusion, clinical audits are indispensable for the sustained improvement of echocardiography services. They not only ensure compliance with regulatory standards but also foster a culture of excellence, continuous learning, and professional development. By embracing clinical audits, Xyla consistently provides high-quality, patient-centred care, ultimately enhancing patient outcomes and the overall effectiveness of cardiovascular diagnostics.

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Xyla is a trading name of ICS Operations Ltd (Registered No 4793945), Pulse Healthcare Limited (Registered No 3156103), Carehome Selection Limited (Registered No 3091598), Independent Clinical Services Limited (Registered No 4768329) and CHS Healthcare Software Limited (Registered No 11582111)